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ALLAN
J. FLACH, MD, PharmD
Professor of Ophthalmology
Director, Evening Ophthalmology Outpatient Unit, UCSF
Director, Ophthalmic Clinical Pharmacology, Department of Veterans Affairs,
San Francisco
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Research
Summary
Clinical
Pharmacology
My research is focused on external ocular disease, cataract surgery,
retinal disease, glaucoma, pharmacology and toxicology - specifically,
ophthalmic clinical pharmacology, exploring drugs' relationship to
the pathophysiology of ocular disease. The goal of these activities
is to treat ocular disease with maximum efficacy and minimum toxicity. |
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Glaucoma
Research. During the past 20 years I have taken a special interest
in treatments for the glaucomas. My focus has been on the pharmacodynamics
of drugs that affect the autonomic nervous system, particularly the
sympathomimetics, including epinephrine. I have demonstrated autonomic
nerve terminal damage in epinephrine-treated eyes using histofluorometric
techniques, variations in endogenous catecholamine levels, and electron
microscopy.
These investigative efforts provided, for the first time, that topical
application instead of oral administration of a CAI (carbonic anhydrase
inhibitor) can influence intraocular pressure. There is now a topically
effective CAI available for glaucoma treatment; prior to this discovery,
patients were subjected to potentially severe systemic toxicity on
the orally administered CAIs available.
Prostaglandin Analogs for Glaucoma Therapy.
In collaboration with Joseph Eliason, MD, we reported potentially
useful changes in the intraocular pressure in normal human eyes with
topically applied prostaglandin E 2 derivative. Although this specific
prostaglandin analog proved unsuitable for clinical use, subsequent
investigative efforts by others have led to a commercially-available
prostaglandin analog for patient use.
Topically Applied NSAIDs.
In collaboration with investigators worldwide and the drug industry,
we have
demonstrated that nonsteroidal anti-inflammatory drugs (NSAIDs) in
eye drop form can modify postoperative inflammation following cataract
surgery. As a result, there are now two topically effective NSAIDs
to prevent excessive postoperative inflammation after cataract surgery.
Cystoid Macular Edema (CME).
The most common vision-threatening post-operative complication after
cataract surgery, chronic CME is a potentially blinding retinal syndrome.
With co-investigators, two separate clinical studies of NSAID treatments
were completed that demonstrate a beneficial effect for vision in
patients with CME for 6 months or longer. I have also collaborated
with doctors in Africa to report the first controlled clinical study
of the prophylactic treatment of CME with a topically applied NSAID,
without concurrent corticosteroid therapy. This study suggests that
NSAIDs can be used alone, without the need to expose patients to toxic
effects of topically applied corticosteroids.
These research efforts diagnosed several clinical entities for the
first time, including conjunctival scarring in sarcoidosis; episcleritis
in Lyme disease; and anterior subcapsular cataracts in patients treated
with amiodarone (a drug used in other parts of the world for 20 years
without recognition of this toxicity). A simple, nontoxic treatment
for Adie's Syndrome has also been identified. |
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