PUBLICATION EXCLUSIVE: TrueTear: The latest buzz

“It was a scratch, not a pick!”
– Jerry Seinfeld

Once in a very long time, something comes along in our eye care world and just electrifies everyone. Taking the pulse of the community finds pretty much everyone charged up about it. As if the dry eye space isn’t hot enough, along comes TrueTear to stimulate the masses.

I’ll be appearing here all night.

By this time you are doubtless aware of the Oculeve story. Young inventor Michael Ackermann translates an aha moment — when you simulate the nose by, say, a gentle tap with a boxing glove, you make tears — and creates an instrument to do just that. “Oculeve” is born after Ackerman rounds up some venture capital usual suspects. A couple of proof-of-concept demonstrations are followed by a successful trial or two, and SHAZAM, Allergan scoops up Oculeve and rebrands it TrueTear.

The science behind TrueTear

There is science here that most of us have not given a whole heck of a lot of thought to since the first year of medical school. The trigeminal nerve has three divisions. Did you remember that the first division (V1) is also called the ophthalmic nerve? Me either. V1 innervates the lacrimal gland, goblet cells and the meibomian glands, collectively referred to as the lacrimal functional unit, or LFU. V1 is further subdivided into the frontal, lacrimal and nasociliary nerves. That is the one that is famous for giving us Hutchinson’s sign of blisters on the tip of the nose in shingles. Note to Brent Saunders: The Hutchinson estate should get royalty payments.

Fifteen years ago we started to see slides depicting the circular feedback loop between the ocular surface and the brainstem. While we think of the trigeminal nerve as primarily a sensory nerve, there is both afferent (sensory) and efferent (end-organ stimulation) flow along V1. These now-famous Allergan slides show that disrupting this circular flow at the afferent end, by inflammation for example, can lead to DED. Afferent signals from the LFU and ocular surface land in the trigeminal nucleus in the brainstem and are processed in the pons. Return flow occurs across both sympathetic and parasympathetic fibers and can result in activation of all three elements of the LFU.

TrueTear takes advantage of the fact that there are fibers of the nasociliary nerve close to the mucosal surface inside the nose. Your “target area” is just under the spot where glasses sit. The soft silicone gel tips of the TrueTear unit easily access this area. Once in contact with the inner surface of the nose, you simply press the large button in the middle of an instrument that looks kind of like one of those disposable leg shaver “egg” things, and BINGO — tears.

Click here to read the full publication exclusive, The Dry Eye, published in Ocular Surgery News U.S. Edition, August 25, 2017.