An eye specialist told my sister that she has the herpes virus on her left eye. He says she needs to be on two different medications -- viroptic, which she's been on for years, and acyclovir. He says she needs to take acyclovir for the rest of her life, and that if she doesn't do this she may lose her eyesight. Needless to say she is very concerned. She's not sure she can afford the drug. She doesn't have insurance. She is self-employed and has not yet found an insurance company that will cover this pre-existing problem. Can you give us some information on acyclovir? How important is it really? Is there anything else she can do?

Carmen

Herpes virus infection of the eye is a very serious condition and a major cause of blindness in the United States. The initial infection usually causes inflammation of the cornea. The infection is treated with anti-herpes medications that come in oral (acyclovir) or eye drop (viroptic) form. The initial infection can usually be controlled without vision loss. However, recurrence of the herpes infection in the cornea is the major cause of blindness from this infection.

A recent study in the New England Journal of Medicine found continued use of low-dose, oral acyclovir in patients with herpes eye infections reduced the risk of recurrence by 50 percent. But is it really necessary for people with ocular herpes to take this medicine for the rest of their lives?

Speaking strictly from a medical standpoint, I would tell my own patients that it's in their best interest to take the drug, because it reduces the risk of herpes recurring. However, medical benefit is not the only consideration for patients like your sister, who has financial concerns as well. As you've discovered, acyclovir is costly. In fact, some people might say the cost is not worth the small benefit. In the study I mentioned, although acyclovir reduced the overall risk of recurrence of ocular herpes, it had only a very small impact on lowering the chance that someone would go blind. And this study ended after just one year; there are no studies yet to show that taking acyclovir will lower the risk of recurrence over the long term. Plus, no one knows which patients would actually suffer recurrence without taking the drug -- at least half never do.

The study's authors did note that because of the cost, some doctors may prefer to wait until a person has had a second outbreak before prescribing acyclovir. You do not mention whether your sister's problem is a new infection. If so, she may want to ask her doctor whether it would be reasonable in her case to postpone long-term acyclovir until after a recurrence -- in hopes that this never occurs.

As a doctor, I can only make recommendations and explain how to keep one's eyes healthy, but at times patients may not be able to comply, for a variety of reasons -- including cost. If your sister truly cannot afford the drug, she may choose to go without, understanding the risks. But first, she might check with her doctor or the pharmaceutical manufacturer to see if they know of any programs to assist needy patients.