VIDEO: 'Unique' new products in dry eye

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I think we've seen unique new products that have been investigated and now even approved recently in the meibomian gland dysfunction space. I think that what we've seen so much is a lot of activity around improving the aqueous production, as well. But I think what we've seen now in development and recent approval is impacting the meibomian gland, the lipid layer of the tear film. There's a new product that was just approved actually by Bausch + Lomb. It's called Miebo, used to be called NOV03. And really it's perfluorohexyloctane. And what it is, it's a compound that's 100% active drug. Now, why that's important to me is because the fact that inactive ingredients can play a role in the impact of the bioavailability, the tolerability, the efficacy of any medication. But we don't have to worry about inactive ingredients. It's 100% active medication and it really is helping to replenish and really help coat the ocular surface and that lipid layer that we lose from a meibomian gland dysfunction. And the data is pretty remarkable in terms of improvement in tear from breakup time, patient's quality of life assessment scores as well. The impact on daily functionality and based upon the studies, the efficacy was pretty impressive, as well. It'll be a new molecule that will be available to us. It just got approved, so hopefully this fall we'll have the ability to actually prescribe it and give samples to our patients, which I'm very excited about, as well.

Another drug that I think is important to talk about is Demodex blepharitis. A company called Tarsus has just recently approved a molecule called lotilaner. And lotilaner is basically a way to eradicate and kill those little bugs on our lids. Now, it's funny, when I started thinking about demodex, when I knew this was coming out, I started looking at these patients more and have them just look down and to see the actual lid margin. And you can see how impressive so many patients have Demodex blepharitis. Probably my population of patients, probably 20 or 30% if not more, 40% of my patients coming in just for routine dry eye checks. I end up finding a significant Demodex blepharitis. And it's interesting because when I hear colleagues talk about the difficulty diagnosing dry eye patients, whether it's because of the diagnostics, they don't have all the different tools that we have available or different staining opportunities, whether that's, say, fluorescein staining or lissamine green staining, it can be a pain for some doctors. But with diagnosing Demodex blepharitis is probably one of the easiest, most efficient diagnostic tools that we have. All you need to do is focus on the lids, have the patient look down and you can see these little small impacts of the Demodex blepharitis, as well. So I think it's important to recognize that there's a lot more demodex [blepharitis] out there than we thought and to diagnose it is a lot easier than a lot of other diagnostics that we use for other optic surface disease, as well. So I think having a drug that is going to be out there to treat that, and if you look at the data too from their phase three trials, it really is impressive in terms of the eradication rates, as well as the impact on redness scores, tear from breakup time and other scores that we use for ocular surface disease. And that will be hopefully available soon. The date will be coming up later this year, so we'll hopefully have that opportunity, as well.

So I think the MGD space is really unique as well. There's another company, Aldeyra [Therapeutics], that actually has a new compound, reproxalap, which is basically a compound also helping the lipid layer composition. They had their phase three trials and those trials do show significant improvement in tear from breakup time and the other OSDI scores and other ocular surface disease indices that we use to evaluate, as well. So this is also another product, again, focusing on the meibomian glands and the lipid layer composition. I think we'll have a lot of products at our disposal to help treat these patients with meibomian gland dysfunction.

Another product that's interesting too is [from] a company, Glaukos. And they've also had some studies now, not just on the cornea for looking at keratoconus and cross linking, but actually ocular surface disease. They have a transdermal, a lotion, that can go through the lid margin and help with ocular surface disease, as well as in presbyopia. So, it's a whole new concept. Instead of putting a drop on the eye, using a transdermal cream that can penetrate through the lid margin and help with ocular surface disease. They're also in their phase 2a and 2b trials right now. Positive responses so far with the 2a trials. So that's a one that's a little bit further down the road, but again, exciting idea and concept of a transdermal trans-lid cream or lotion, rather than a drop.