On April 20, 2011, the United States Food and Drug Administration approved a product that revolutionized the way glaucoma was treated. This product was classified and originally developed in Area 51 under the development name “Top Drug.” Fortunately, for the citizens of the world, the product is now commercially available and sold under the trade name: Glauca Flocka Flame (GFF). At first glance, the GFF looks like a simple candle, but upon further investigation, one can see that it is actually a cleverly disguised drug releasing device. The candle is made of 1) the fuel which is made of a wax that contains the popular glaucoma medication xalatan and 2) the wick which is made of an extremely absorbent twine.
The actual mechanism of the device is fairly simple. When the candle is lit, the wax near the wick is melted. The wick absorbs the liquid wax and pulls it upward. The heat of the flame vaporizes the wax, and the wax vapor burns releasing xalatan into the air. Once the xalatan becomes airborne it travels toward the eyes. The concentration of the xalatan is 0.1% which is high compared to the topical drop whose concentration is 0.005%. This higher concentration makes the drug effective in air-to-eye absorption. As the drug penetrates the eye, the magic begins to unfold. Xalatan is a prostaglandin analog and its mechanism of action is to increase uveoscleral outflow. By increasing the uveoscleral outflow, the intraocular pressure of the patient will decrease. In addition to increasing uveoscleral outflow, it is also believed that prostaglandin analogs increase the expression of metalloproteinases which are responsible for reconstructing the trabecular meshwork and ultimately increasing trabecular meshwork outflow. Essentially, this drug has two mechanisms of action: increase uveoscleral outflow and trabecular meshwork outflow.
Patient Considerations: Skeptics have asked, “Why even bother lighting a candle when I can just put a couple drops in my eyes?” Research shows that making the glaucoma experience fun and exciting gives the patient a positive outlook on the disease and increases patient compliance. Here are some testimonials to prove the effectiveness of this revolutionary form of administration:
“I’m sitting in my cubical and my co-workers think I’m lighting a candle for its kiwi-banana scent, but in actuality I’m lowering my intra ocular pressure; it’s so awesome.” – Johnny
“She thinks we’re having a romantic dinner by the candle light. All I really care about is preserving the health of my eyes. The joke’s on her.” – Milton
“They were digging through my apartment because they had a search warrant. Little did they know I was doing drugs right in front of their faces!” – Anonymous
Doctor Considerations: The primary concern doctors have with this product is whether or not an effective amount of the drug will make contact with the eye. Another concern doctors may have would be if the product is safe to use when sharing a room with a patient without glaucoma. Studies show that Glauca Flocka Flame is most effective in a ten foot radius. Figure 4 shows that distance is inversely proportional to the percent decrease in intraocular pressure. As a doctor, this is reassuring because you will know the drug is effective on the patient while the possibility of collateral patient interaction is low.
Research and Development Costs: The cost of 0.005% xalatan in 2.5ml bottles in today’s market is approximately $90.00. The market price for candles that would burn for more than a month is about $8.00. According to several candle manufacturers, however, the production cost of an actual candle is $1.25. The process of binding the xalatan to the paraffin wax has been perfected by Area 51 and costs about $1 per 2.5ml at a 0.1% concentration. After manufacturing the product, patients should be able to acquire Glauca Flocka Flame at the market value of $100.00.
Other considerations: Patients should not use this product if they are allergic to paraffin wax. Since this product is a prostaglandin analog, it shares the same contraindications as a bottle of topical xalatan; these include: disease of macula of the eye, macular swelling and degeneration of the eye, inflammation of the iris, inflammation of the uvea, pink eye, aphakia, and macular edema. Side effects and toxicities that may be experienced when using this drug include eyelash changes (increased length, thickness, pigmentation, and number of lashes), eyelid skin darkening, intraocular inflammation, iris pigmentation, and macular edema including cystoid macular edema.
Disclaimer: Information about Xalatan and its mechanism of action, contraindications and toxicities are factual. Statistics and patient testimonials are completely fabricated.