ABSTRACT
It is possible that many patients avoid complete ophthalmic exams because pupil dilation is slow, reversal sluggish, and vision blurred. Others experience incomplete dilation during exams or prior to surgery when good dilation is essential to successful outcome. Iontophoresis, the application of low-level electrical current to promote traversal of desired molecules across a boundary, has been used for many years and has recently become common in transdermal drug delivery. We now investigate iontophoresis as a method of accelerating drug absorption into the ocular anterior segment. In vivo rabbit studies assessed iontophoresis effects on the performance of dilators and constrictors. 1-mA and 4-mA direct current levels applied for 2-minute durations yielded dilation time-history measurements. Subsequent in vitro tests at a wide range of current densities showed minimal chemical modifications in ocular pharmaceuticals. Drug samples processed through high-performance liquid chromatography (HPLC) pinpointed minimal structural changes. Detailed in vivo rabbit testing is under way. Using 2 dilators and constrictors in crossed testing with 0.5-mA to 1.25-mA current levels and 20-sec to 60-sec durations, we recorded dilation progress by digital photography. Initial studies showed faster, larger dilations and quicker reversal using iontophoresis. Drug testing showed chemical structures remaining constant for clinically useful current levels, < or = 1 mA (< or = 1.25 mA/cm2 current density). Drug pH and HPLC retention times were constant within this range, and resistivity varied linearly as expected for increasing current. Rabbit testing will quantify improved drug speed and efficacy, validate the charge delivery electrode design, and indicate iontophoretic current and duration for further use. Tested ocular drugs showed no degradation when exposed to clinically useful iontophoretic currents. Preliminary results indicate significant time reductions for dilation and reversal, plus increases in maximum dilation. This procedure may aid clinicians by allowing more rapid complete examinations and surgical preparations for patients. Making dilation more convenient will also improve patient acceptance of exams, aiding earlier detection and treatment of ocular disease.
