A fluttering of hope: Bimatoprost solution lengthens, darkens eyelashes

Ophthalmologists looking for a new avenue for growth might want to consider adding bimatoprost ophthalmic solution 0.03% (Latisse, Allergan) to their repertoire.

The newly approved novel topical treatment for hypotrichosis of the eyelashes has been wowing patients and physicians alike with its ability to increase the number, length, and darkness of eyelashes. Long used to lower IOP in patients with glaucoma, bimatoprost has the added benefit of causing noticeably longer, darker, and fuller eyelashes. After years of observing this side effect, Allergan launched a phase III, multi-center, double-masked, placebo-controlled study. All endpoints-improved eyelash prominence, length, thickness, and darkness-were met, and the FDA approved its use Dec. 26. Physicians said they are pleased to have a drug they can prescribe to help patients with insufficient or inadequate eyelashes.

"Patients who were interested in improving the appearance of their eyelashes were (formerly) recommended traditional treatments such as commercially available mascara, eyelash extensions, and, in severe cases, eyelash transplants," said Steven Fagien, MD, FACS, in private practice at Aesthetic Eyelid Plastic Surgery in Boca Raton, FL, and a Latisse clinical investigator. "Now that [bimatoprost] is FDA-approved, there is a safe and effective alternative that is easy to use."

The product contains the same active ingredient and formulation as the company’s bimatoprost ophthalmic solution 0.03% (Lumigan), which was approved by the FDA in 2001 to lower IOP in patients with open-angle glaucoma or ocular hypertension. Although the glaucoma treatment involves a traditional eye drop, the company developed a single-use applicator that delivers a much smaller dose to the base of the upper eyelid. Dr. Fagien said the dose is about 5% of the dose that is delivered by a 1-drop dose of the agent indicated for patients with open-angle glaucoma or ocular hypertension.

A monthly supply of the drug comes in 60 sterile, single-use applicators, one for each eye for 30 days. The drug is applied like an eyeliner, where the applicator is pulled gently along the lash line, and any excess solution is blotted with a tissue to avoid darkening the surrounding skin. Although 4% of patients in clinical trials reported ocular irritation-itching or redness-Dr. Fagien said the dose in this case is so small that most patients do not complain.

"In my experience with the clinical trials, this was generally not seen, and this is presumably since the amount of drug applied is so dramatically reduced in the topical application that, when used correctly, a negligible amount comes in contact with the ocular surface," Dr. Fagien said.

Those patients who experienced ocular redness during initial weeks of treatment found the redness disappeared after a few weeks of treatment. The redness is due to vasodilatation and is not an allergic reaction, Dr. Fagien said in a recent press conference.

To measure the drug’s effectiveness, physicians in the clinical trials used specially developed scales for evaluating the intensity of lash darkness. A computer measured the number of pixels in digital photos of patient eyes to determine changes in length and thickness.

"What was so impressive was that, after 16 weeks, patients experienced a 106% increase in thickness," Dr. Fagien said. "What was equally compelling was the patient satisfaction."

Patients experience results after eight weeks, and see the full benefit by 16 weeks. They must continue the drug or lashes will gradually return to their usual length and darkness. Doris Day, MD, a dermatologist who participated in the clinical trial, said in the conference call that 90% of patients said they would likely continue to use mascara in addition to using the bimatoprost application.

"Think of [the product] as helping women grow longer, thicker, more natural lashes," said Dr. Day, a clinical assistant professor of dermatology at the New York University Medical Center. "Mascara is the paint."

While the drug can be used by anyone, it holds particular hope for those patients who have suffered hair loss. Steven G. Yoelin, MD, an ophthalmologist in private practice in Newport Beach, CA, said that one of his happiest patients had lost her eyelashes as a result of a medical condition.

"The eyelashes that she grew as a result of the treatment protocol allowed her to leave home and go out in public without having to worry routinely about gluing fake eyelashes," he said.

"As ophthalmologists, we are extremely familiar with this particular molecule given its long and very successful history in the treatment of glaucoma," Dr. Yoelin continued. "It is gratifying to see this same molecule grow eyelashes in healthy individuals in a matter of weeks with limited side effects."

The drug has helped to drive new patients into his practice, Dr. Yoelin said. Allergan spokeswoman Christy Curran said the company’s suggested retail price for the solution, dispensed by either a pharmacy or physician, is $120 for a 3 mL bottle, which includes 60 single-use-per-eye disposable sterile applicators. The treatment is used once daily, and one prescription used as directed should last 30 days.

"These patients, as well as their friends and family, have all become very important to my ophthalmology office," he added. "Latisse is extremely important to my practice in general, and to my aesthetics portion of my practice in particular."

Similarly, Dr. Fagien said that patients treated in his aesthetic eyelid plastic surgery practice often complain of having inadequate lashes.

"I will find it useful both for patients at any age who would like more prominent eyelashes and particularly useful in patients who might experience a paucity of lashes after eyelid surgery/blepharoplasty," Dr. Fagien said. "Even those individuals with seemingly normal eyelash prominence oftentimes desire an enhancement in appearance. The transition of good eyelashes to great eyelashes is typically what they experience, and they are thrilled with this outcome."