November 04, 2021

The human eye—an organ that is exposed to the ambient environment—theoretically should allow for easy access to administer medications. Actually, the eye’s structure resists administration of topical ophthalmic medications.

Compounders, pharmacists, and pharmacy technicians need to be familiar with eye anatomy and ophthalmic preparations’ components to choose and/or develop the best dosage form to treat various ocular disease states.

Compounded ophthalmic products can be helpful for a small number of patients who cannot use a commercially available product or for whom no commercially available product exists.

Extemporaneous preparation of medicines for the eye is considered complex compounding and is best undertaken by pharmacists with the appropriate facilities and equipment to ensure a sterile product.

When dispensing, the pharmacist evaluates medication appropriateness, effectiveness and safety for each individual patient. For a compounded medicine, the pharmacist will also pay close attention to the formulation, physical, chemical and microbiological stability and utility of the preparation.

Optometrists who are considering writing a prescription for any medicine will find that the pharmacist is a useful source of information regarding the availability of alternatives, stock outages and the availability or feasibility of a compounded product.

Compounding can be a useful adjunct to the care of some patients and patient safety should always be paramount.

Compounded drugs are made-to-order combinations of two or more drugs that have already been individually approved for use by the FDA.

Compounded drugs serve as an important alternative to branded and generic products — they offer good value for patients, compliance benefits and more choices for physicians.

As surgeons, we pay close attention to tiny details that can affect my surgical outcomes, such as hand position, the amount of fluid used, the exact axis of astigmatism based on multiple preoperative measurements.

So it is frustrating how dependent we are on factors outside of our control when it comes to preventing endophthalmitis and postoperative inflammation.

We need patients to use the correct antibiotics and antiinflammatory drops on an appropriate schedule — and there are a lot of barriers to achieving that goal with commercially available, single-agent drugs.

By giving our cataract patients a compounded sub-Tenon’s triamcinolone/moxifloxacin injection at the end of surgery and a compounded oncedaily drop of prednisolone/moxifloxacin/nepafenac for 4 weeks, we are able to regain a measure of control over this essential aspect of surgical success.

We ensure that patients actually get what we prescribe, with no pharmacy call-backs, pre-authorization requirements or substitutions. Additionally, because we are either delivering the drugs intracamerally or dispensing a single bottle, we are much less concerned about patient compliance with a confusing drop regimen.

Compounding also provides the opportunity to give patients preservativefree drops to minimize their exposure to preservatives, help them control the cost of postoperative or chronic medications, customize a drop to their unique needs or provide access to medications that are otherwise in short supply.

It is important to know how your compounded drugs are made. State-regulated 503A facilities are permitted to formulate compounded medications for limited use in individual patient cases.

503B FDA-registered outsourcing facilities like ImprimisRx and Leiters are regulated under the Drug Quality and Security Act.

Medications from these 503B facilities are made in U.S. facilities with the same oversight and inspections as major pharmaceutical companies, so doctors can be confident in the drugs they are ordering.