BLOG: What comes next? Defining goals and setting expectations
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In my most recent edition of The Dry Eye in Ocular Surgery News, I reviewed the bare bones background in which dry eye disease pioneers worked when it came to treatments.
From this barren landscape we have now entered an era of plenty. Doctors who treat patients with dry eye disease (DED) have a treatment cornucopia overflowing with options. In this setting, it is appropriate to now ask: what next?
Before I throw down the gauntlet and declare (demand?) what I feel is needed, let me first say what we do not need: another “me-too” immunomodulator or topical steroid. Let’s be real, OK? A part of the burden faced by patients with DED is what they, and we, have to do to get and keep them on these medications. Need to feel better right away? Cool, I have two steroid drops with on-label indications for your disease and a dozen off-label options if your insurance balks at my first choice. But even the safest steroid options can still cause IOP elevation if you stay on them; I will now need to ask you to visit my office every 3 or 4 months to check your pressure and cover my, ahem, derriere.
How about those immunomodulators, then? They all work about 90% of the time if you give them a long enough runway. That’s half of the problem with these drugs: They almost never make our patients feel better right away. Your patient comes in, she feels lousy, and the best you can do is say, “Trust me, it’ll get better soon come*.” My declaration years ago that it would take three immunomodulators to make the market competitive was epically inaccurate. Patients are paying chemotherapy-like prices for drugs that take weeks or months to kick in.
So, here is my bid, my challenge, my declaration of what should be coming from industry: It’s time for truly disruptive, paradigm-changing treatments. Don’t send me anymore “me-too” medications or treatments unless you are doing so with the intention of disrupting the existing marketplace in that space. Got an immunomodulator in your pipeline? Don’t bother unless it’s less than 10 bucks out of my patient’s pocket and takes less than 30 seconds for me (and my staff) to prescribe.
Do you have a truly new product that will change how we treat dry eye and associated diseases? Awesome. Just don’t make me hold my patient’s hand for weeks waiting for it to start working. I’m reasonable on this one; you don’t need to make someone feel better with the first dose. You get a week. Seven days. They deserve relief that comes quickly, and frankly, we deserve to have treatments that make us as enthusiastic as we are about stuff like cataract surgery.
That’s it. That’s what our little world needs. It’s time for a disruption. It’s time for a truly new quiver of treatments that upsets the applecart of the existing ecosystem. Topple the cost structure. Come up with a treatment that works right away. Our patients deserve both.
So do we.
*“Soon come” is a saying I first encountered in Jamaica that basically means “it’ll happen whenever it happens.”
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