Q: Optometrists in my state have the authority to prescribe glaucoma medications. Does that mean we also have the authority to prescribe Latisse, the version of bimatoprost specifically indicated for growing lashes?

A: It depends on the state, says optometrist Daryl Mann, chair of the AOA Medical Eyecare Committee. It can be a very gray area.

In late December 2008, the Food and Drug Administration approved Latisse (bimatoprost 0.03%, Allergan) with the specific indication to treat hypotrichosis of the eyelashes by increasing their growth including length, thickness and darkness. Latisse is the same formulation as the glaucoma medication Lumigan (bimatoprost 0.03%, Allergan).

Should O.D.s get involved in cosmetic medication? Do patients even need it?

But even though O.D.s in a certain state may have prescribing authority for glaucoma medications, that doesnt necessarily mean they can prescribe Latisse, which has a cosmetic indication for thickening eyelashes.

Dr. Mann categorizes the prescribing authority of states into four general categories:

In some states, optometrists have the authority to both prescribe and dispense Latisse.

In other states, optometrists can prescribe it, but they cant dispense/retail it to their patients.

In states with a formulary, the state board of optometry may need to approve adding Latisse to the formulary before O.D.s can prescribe it.

Lastly, optometrists in some states may not be permitted to prescribe it whatsoever.

If you dont know if you are permitted to prescribe it, contact your state board of optometry to find out if this indication is within your scope of practice, Dr. Mann says. Your state board can then coordinate with Allergan to release it to optometrists in your state.

No master list of Latisse-approved states is currently available, he says. Such a list would be constantly changing because state boards are now meeting to review their prescribing authority to determine approval for Latisse.

The company initially launched the drug to dermatologists and cosmetic surgeons, and is now expanding it to optometrists and ophthalmologists. A full-scale direct-to-consumer marketing campaign is also expected. Dr. Mann says Latisse is already in high demand through the medi-spa division of his secondary eye-care center in Chattanooga, Tenn.

The interest level is very high, agrees optometrist Milton Hom, who has a handful of patients on Latisse in his Azusa, Calif., practice. I took a quick poll of female patients; the overwhelming majority wants thicker, longer, darker lashes. This is a no-brainer to me.

Dr. Hom, who is also a consultant for Allergan, says technology is moving us into a new area of opportunity: cosmetic optometry. We are already the experts in cosmetic contact lenses, or more specifically, colored contact lenses. In some states, O.D.s can use Botox. Now, we have Latisse.

 

Aside from the question of whether O.D.s can prescribe Latisse, another question is whether O.D.s should prescribe such a drug? Do patients even need it?

Our profession does not need to be part of an agenda of elevating hypotrichosis to the level of serious disease, says optometrist Brian Chou, of San Diego. Does our society really need increased awareness about how our eyelashes are insufficient or inadequate?

Also, its not cheap, and the drugs effect isnt permanent. Patients apply one drop nightly to each upper eyelid margin using a disposable applicator. It usually takes two months for the first changes to appear, and nearly four months to achieve the full effect. Lashes eventually return to normal after the drug is discontinued, so continuous application is required. The expected retail price for patients is $120 for a months supply, which adds up to $1,440 a year. Medical insurance is unlikely to cover the cost of this elective medication.

Nevertheless, Allergan estimates that worldwide sales of Latisse could be more than $500 million per year. So, Dr. Chou says, the writing is on the wall. He has two patients who already requested the drug, which he obligingly prescribed.

If the patient is determined to receive the drug, wouldnt you rather be the one prescribing it ahead of the primary-care physician? he asks.

It is a very safe drug, Dr. Mann says. That said, if any side effects do occur, theyre going to be ocular side effectssuch as redness or irritationand whos better prepared to address those issues than an optometrist or ophthalmologist?

Indeed, the most common adverse events found in the clinical trial were hyperemia (3.6%), ocular itching (3.6%) and skin hyperpigmentation (2.9%). Permanent iris darkening is another side effect. In addition, glaucoma patients who are already on Lumigan or another prostaglandin analog could have a decreased IOP-lowering effect of the glaucoma medication if used concurrently with Latisse. Use caution in prescribing Latisse for patients with uveitis and patients at risk for macular edema, such as aphakes or pseudophakes with a torn posterior capsule.

Instruct patients not to use more than one drop per eyelash per day, Dr. Chou says. Additional applications wont increase the growth of eyelashes, and may even raise the risk for side effects of ocular redness and itching.

Although most of the clinical work has been done by dermatologists and plastic surgeons, I am certain no other health-care profess- ionals have more clinical expertise and experience looking at lashes than optometrists or our ophthalmology colleagues, Dr. Hom says. O.D.s are more than qualified to prescribe and manage Latisse patients.