Taking a prescription drug for a cosmetic side effect -- at the risk of other side effects -- may seem risky. But it's a risk that many Americans, mostly women, have shown themselves happy to take.
Latisse, originally a glaucoma drug marketed under the name Lumigan, was approved separately at the end of last year for its eyelash-enhancing purposes, and its maker, Allergan, has reported sales of $47.7 million thus far. The company says 2009 sales could reach $70 million, exceeding projections of $30 million to $50 million. The national advertising campaign featuring model and actress Brooke Shields hasn't hurt.
The success of Latisse, however, concerns some ophthalmologists -- albeit medically conservative ones, who say it's important to see an eye doctor before taking any eye medication, especially if you've never had a full eye exam. As increasing numbers of dermatologists, plastic surgeons and medical-spa physicians prescribe the drug, the desire for pretty eyelashes seems to be taking precedence over eye health, they say.
Besides stimulating lash growth, the drug can cause eye redness, itchiness, irritation, infection, darkening of the skin around the application area. It may even cause a change in eye color, especially in people who have any amount of brown pigment in their eyes.
"As it is, most Americans don't get basic routine eye exams, and it's really important that people get a baseline eye exam before they consider using a drug like Latisse," says Andrew Iwach, the executive director of the Glaucoma Center in San Francisco and a spokesman for the American Academy of Ophthalmology. "The eyes are a delicate tissue. And if someone is thinking about Latisse, they need to see if there are any contraindications or underlying problems they aren't aware of."
Such contraindications, or conditions precluding the use of the drug, include pregnancy, breast feeding, cataract surgery and ocular inflammation. "Use Latisse as an opportunity to look good but to see well too," Iwach said.
There simply is no long-term data on Latisse, he points out. The original version, Lumigan, wasn't even approved for glaucoma until 2001. "We have data for using this type of medication as an eye drop," he said. "But we don't know if this will have a cumulative risk with topical application over time."
To many, the gamble is a small one -- and well worth taking.
Ready and willing
Lacey Gattis, an assistant editor at the blog Bella Sugar, said women face a cultural imperative to want longer and darker lashes. Her posts about trying Latisse were some of the most widely read on the blog, which attracts about 350,000 readers a month:
"People are very curious, especially when Latisse ads have been on television and in every magazine. It's hard not to want to know more. . . . Because it's a drug that has 10 years of study behind it, there's also a perception that it's safe and it's worth the money because it actually does what it claims."
Newport Beach ophthalmologist Steve Yoelin, among the first to test Lumigan for its eyelash effect, prescribes Latisse with confidence. He says the drug works -- and it makes his patients happy.
He dismisses safety concerns, saying he has more than 1,500 patients using Latisse and, in his experience, side effects are minimal. The most common ones, itchy lids and irritation, seem to subside after a couple of weeks. And some patients welcome one of the rarer side effects, skin pigment changes along the eye lid, because the change mimics eyeliner. He writes 12 to 16 Latisse prescriptions a week, he says.
A one-month supply of Latisse costs $120 and requires nightly application with a disposable brush that dispenses the recommended dose amount. Patients begin seeing results in about four to six weeks.
"The good news is that Latisse got approval fairly quickly because there was already a lot of safety data out there from Lumigan," Yoelin says. "And I've continued to prescribe it because I feel it is extremely safe."
In a randomized, placebo-controlled clinical trial of Latisse involving 278 people, those who used the drug experienced 25% longer and 106% fuller lashes. Adverse effects included eye redness and itchy eyes in 3.6% of Latisse users, plus eyelid pigment changes in 2.9%. (Those side effects subside when use is discontinued.) Less common side effects included eye dryness and hair growth in areas that Latisse touched.
No eye-color changes were reported in the Latisse trial.
Yoelin points out that the drug isn't applied directly into the eye as it is when used to treat glaucoma and that cosmetic use requires just 5% of the Lumigan dose. "In the four years I've been using this drug [for eyelash growth], I have not seen any iris eye color change," he says.
But the potential exists. In September, the FDA sent a warning letter to Allergan stating that side-effect information in the Frequently Asked Questions and About Safety sections of the Latisse website minimized or failed to mention possible problems such as bacterial eye infection, excess hair growth outside the intended treatment area and eyelid pigmentation and eye-color changes.
The FDA also stated that when these side effects were mentioned, they were hard to find because they are less emphasized than Latisse's positive results. Allergan subsequently amended the safety information on the website, listing the potential side effects in a more prominent way. Devotees are undeterred by such descriptions.
Christine Smith, 55, of Irvine started using Latisse because her eyelashes had thinned due to menopause and an underactive thyroid gland.
"I couldn't believe the change," Smith said. "It does what it says it's going to do and my lashes look nice and healthy. It gives me a more youthful appearance. Younger gals have gorgeous lashes, and now I don't have to wear false lashes. I can curl them and put on mascara and get a great effect."
Smith has seen a few fine hairs sprout on her upper cheek (she just plucks them) and said her eyes itch sometimes. ("I'm used to it. I've adapted.") Even so, she's begun using the drug on her eyebrows to compensate for hypothyroidism's effects there. As for the $120 a bottle cost, Smith said she now uses the drug only a few times a week for maintenance.
Nancy Pimental, a 36-year-old screenwriter, wasn't so lucky. After coveting the lashes of a friend who was using Latisse, she went to her dermatologist because, she said, "I suffer from lack of lash. I was so excited by the stuff."
She tried Latisse for about two weeks. Every night, Pimental says, she woke up in pain, and in the morning her eyes were crusted over and itchy. "I got nervous," she said. "I didn't think something should burn your eyes. I'm usually pretty tenacious, but it just seemed like I shouldn't mess with my eyes. I also thought it was weird that this is a glaucoma medication that's now a beauty product."
Pimental admits she's jealous of the people who can tolerate Latisse, but she said, "I'm pretty vain but I'm not so vain [as] to risk my eyes. But I will say, if it had worked for me, I'd probably be telling you it was the greatest thing on the planet."