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Can neurostimulation really help dry eye patients?
TrueTear provides small pulses to stimulate production of patients' own natural tears.
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TrueTear, officially launched just months ago at the American Society of Cataract and Refractive Surgery meeting, is the first-ever neurostimulation device in eye care, offering a drug-free, drop-free option to temporarily increase tear production during neurostimulation in adult patients. It has become an important addition to our armamentarium at our Dry Eye Center of Excellence. TrueTear provides small pulses to stimulate production of patients’ own natural tears. It is Bluetooth enabled and features a connected application, making it the first “smart” device in eye care.
For patients with symptomatic dry eye and who are unhappy with, nonresponsive to, or intolerant of their current regimen, TrueTear (Allergan) is an option. In two clinical trials, TrueTear was shown to be safe and effective for temporarily increasing tear production in adult patients. Patients saw an approximate 2.5 times increase in tear production compared with the control groups. The most common side effects seen in clinical trials were nasal pain, irritation after stimulation, discomfort, burning and nose bleeds, which occurred in 5% to 10% of patients.
What is neurostimulation, and exactly how does TrueTear work? The lacrimal functional unit (LFU) responds to any external or internal stimuli by regulating the production of tears. Upon stimulation, the LFU communicates with the central nervous system (CNS) via the trigeminal nerve, including afferent sensory neurons carrying information from the ocular surface, glands and tissues to the CNS and efferent parasympathetic and sympathetic neurons carrying information from the CNS to the ocular surface, glands and tissues.
Source: Allergan
To explain this a bit more simply to patients, ophthalmologists may tell them that TrueTear causes their eyes to produce their own natural tears using tiny pulses of energy. These pulses activate a natural response through a clever technology called neurostimulation. The TrueTear tip stimulates a nerve in the nasal cavity with tiny pulses of energy, sending out nerve signals to the brain. The brain then sends nerve signals to the tear glands surrounding the eyes to temporarily increase tear production. The glands surrounding the eyes react and temporarily produce real tears.
The device is easy to use, and the tear production is immediate. Some patients report a tingling sensation, tickling or massaging. The sensation may be different depending on the strength of the stimulus that they are using. It takes practice for patients to find the “sweet spot.” It is important to tell patients that the TrueTear tip needs to contact the nerves under the bridge of the nose. The tip should be inserted into the patient’s nose, as far as comfortable, with the buttons pointing toward their lips and face and the tip at the top and front of the nose.
The device is sold directly to patients from the physician’s practice and is not reimbursed at this time. Physicians can purchase TrueTear for $650 per device, which includes one base and a 1-month supply of tips. If practices purchase 35 or more units, the price is reduced to $595 per unit.
- For more information:
- Marguerite B. McDonald, MD, FACS, can be reached at Ophthalmic Consultants of Long Island, 360 Merrick Road, Lynbrook, NY 11563; email: margueritemcdmd@aol.com.
Disclosure: McDonald reports she is a consultant for Allergan.