therapeutic topics
The Top 10 Medications and Contact Lens Practice, Part 1
BY JULIE A. SCHORNACK, OD, MED

When learning more on the effects of systemic medications and their impact on contact lens practice, a reasonable question is, "What am I most likely to see in everyday practice?" We may be able to establish those patterns by examining the most frequently prescribed drugs in the United States. It can be argued that the profile of the contact lens wearing population and the profile of patients being prescribed the most frequently used drugs are not coincident, but these drugs will show up in your contact lens-wearing population with significant frequency.

Many lists present the most frequently prescribed medications. The information presented here represents the most frequently prescribed medications in United States Community Pharmacies based on both new and refill prescriptions. Although the players in the top 10 list move little in rank from year to year, the top 10 drugs consistently remain widely prescribed over the past several years. We will march through the top 10 medications and examine if any of their ocular side effects may cause contact lens compromises. The side effects discussed here will not be exhaustive lists of ocular side effects, but only those that may be an issue in contact lens practice.

1. Hydrocodone w/APAP (hydrocodone bitartrate with acetaminophen) is a narcotic analgesic medication. The only side effect associated with this medication that may serve as a complication in contact lens practice is dizziness and lightheadedness. These symptoms may seem like a stretch to be associated with contact lens practice, but some patients who receive a new prescription (especially astigmatic correction) or a dramatic change in a prescription may elicit this type of complaint.

2. Lipitor (atorvastatin) ­ this lipid-lowering agent is more aggressively prescribed in younger populations. Side effects in contact lens practice include refraction variability and amblyopia. It would be easy to attribute a decrease in visual acuity or refractive change to a contact lens- related problem rather than consider the medication. Additional side effects include dry eye and dizziness.

Eye hemorrhages in both anterior and posterior segment have been noted with Lipitor. Although we do not routinely expect hemorrhages associated with contact lens wear, the appearance of a subconjunctival hemorrhage or an intracorneal bleed in your contact lens-wearing population will drive patients into your office asking for an explanation.

3. Premarin (conjugated estrogen) is a hormone supplement to level off the effects of menopause and decrease the loss of bone mass in osteoporosis. The side effects associated with Premarin are very similar to those associated with many oral contraceptives. Headache is the primary side effect that may be misinterpreted as contact lens or refraction related. Other side effects of Premarin which should be considered in contact lens practice are minor steepening of corneal curvature and a generalized contact lens intolerance. The contact lens intolerance typically manifests as reduced wearing times and complaints of generalized discomfort.

4. Atenolol (atenolol) ­ this most widely prescribed anti-hypertensive medication is a beta 1- selective adrenoreceptor blocking agent. It may cause dry eyes in your contact lens-wearing population. This dry eye side effect is common among many of the anti-hypertensive medications.

5. Synthyroid (levothyroxine) ­ Synthyroid is prescribed for patients who have been diagnosed with hypothyroidism. This medication has no known ocular side effects that may impact contact lens practice.

Dr. Schornack is the Assistant Dean of Clinical Education and serves in the Cornea and Contact Lens Service at the Southern California College of Optometry.