Affiliation:
1. PharmaLogic Development, Inc. San Rafael CA USA
2. Department of Ophthalmology and Vision Science School of Medicine University of California Davis CA USA
3. Department of Ophthalmology University of Michigan Ann Arbor MI USA
4. Department of Ophthalmology School of Medicine Johns Hopkins University Baltimore MD USA
5. Department of International Health Bloomberg School of International Health Johns Hopkins University Baltimore MD USA
Abstract
AbstractTreatment of ocular diseases presents unique challenges and opportunities for the clinician and for the clinical pharmacologist. Ophthalmic pharmaceuticals, typically given as liquids, require consideration of solubility, physiological pH, and osmolarity, as well as sterility and stability, which in turn requires optimal pharmaceutics. Ocular tissue levels are challenging to obtain in humans, and the clinical pharmacokinetics is typically blood levels, which are primarily related to safety, rather than efficacy. The eye is a closed compartment with multiple physiological barriers with esterases and transporters, but relatively little cytochrome oxidases. Delivery routes include topical, intravitreal, and systemic. Patient dosing involves not only adherence issues common to all chronic diseases, but also performance requirements on eye drop instillation. Therapeutically, ocular diseases and their pharmacological treatments include both those analogous to systemic diseases (e.g., inflammation, infection, and neuronal degeneration) and those unique to the eye (e.g., cataract and myopia).