therapeutic topics
Asthma Medications and Their Effects on Lens Wear
BY JULIE A. SCHORNACK, OD, MED, FAAO

Current estimates indicate that the prevalence of asthma is on the rise in the United States. Rates of asthma run higher among women and among the African American and Hispanic populations. (However, the rate of childhood asthma [zero to 17 years of age] is higher in boys than in girls.)

Because of this high level of prevalence, you can expect many of your patients to present with various ongoing therapeutic measures of treatment.

Two Treatment Choices

Because of the chronic nature of asthma, most patients use drugs from two major categories in their therapeutic strategy. Medications taken for long-term, routine management of asthma are called controller medications, which diminish inflammation of the airway passages and lower
patients' sensitivity to asthma triggers.

The second category of asthma medications are quick-relief or rescue medications. They're typically bronchodilators that open air passages and ease breathing in the midst of an asthma attack.

Under these two categories of drugs for controlling asthma, many choices of specific medications with various actions exist.

Keeping Asthma Under Control

Long-term use of inhaled corticosteroids (AeroBid, Azmacort, Flovent, Pulmicort and Vanceril) as controller medications for asthma is common. In the same way that cromolyn (Crolom, Bausch & Lomb) serves as a mast cell stabilizer in treating ocular allergies, it also controls asthma under the brand name Intal. Nedrocromicil (Tilade), another controller medication, shares a chemical background with Alocril (Allergan), which also treats ocular allergies.

Another category of controller medication contains anti-leukotrienes (Singulair, Zyflo, Accolate) that inhibit the action of leukotrienes implicated in the pathophysiology of asthma. Theophylline (Theo-Dur, Slo-bid, Uni-Dur, Theo-24) is a dual-action medication that helps relax airway muscles and suppresses a patient's tendency to react to asthma triggers. Finally, long-duration beta2 agonists (Serevent) are asthma control medications.

Most of the drugs in this category have few side effects that impact contact lens wear, with perhaps two cautions. Serevent has shown some instances of keratitis and conjunctivitis associated with its use. You could mistakenly attribute these findings to a contact lens-related etiology when in fact a chronically administered medication was the cause. And, of course, you need to diligently monitor intraocular pressure in patients who take corticosteroids for chronic management of disease. In addition, cataract development is also associated with corticosteroid use.

Stopping Asthma Attacks

Medications for acute asthma treatment include short-acting beta2 agonists, anticholinergics and oral steroids. Short-acting beta2 agonists (Albuterol, Bitolterol, Levalbuterol, Pirbuterol) often cause mydriasis shortly after administration. A mydriatic pupil may exceed the diameter of an optic zone in a GP lens, and patients may complain of flare and glare symptoms under these circumstances. A larger-than-normal pupil may also negatively affect patients who wear contact lens designs that are pupil-size dependent (such as many multifocal designs in both soft and GP lens materials).

Anticholinergics are likely to initiate complaints of blurred vision from patients. A careful patient history that details medication use and pinpoints the times when blurred vision occurs may eliminate confusion over its etiologic cause.

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.