What was the biggest innovation in dry eye in the last year?
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There are two areas I am really excited about specifically in the areas of lid margin disease and dry eye disease.
No. 1 is the approval of Xdemvy (lotilaner ophthalmic solution 0.25%, Tarsus Pharmaceuticals) for the management of Demodex blepharitis. This lid margin disease is a very common comorbidity seen in almost 70% of dry eye disease (DED) patients that has a direct impact on the ocular surface.
Having medication has been incredible on multiple fronts. We have never realized the effects of having a one-time FDA-approved therapy that has long-term efficacy, durability and concomitant safety that demonstrates continued erythema improvement in the lid margin, which signifies continued restoration of lid margin health once Demodex infestation has been mitigated. The clinical results I have seen during patient follow-up appointments reinforce and mirror the 85% clinical resolution of their Demodex blepharitis, as seen in the 800-plus patient FDA pivotal trial. Even more importantly, patients often offer their positive feedback of the symptomatic improvement, including less itching, better vision, less redness, and less watering and mattering, particularly in the mornings. As many are preop cataract surgery patients, I was not expecting patients to state that they felt that their vision felt “clearer,” which will require further exploration to explain.
Recently, we have seen topline data on extended use on lotilaner for potential meibomian gland dysfunction (MGD), and there is a direct correlation that demonstrates drastic improvement in signs of patients with Demodex infestation and meibomianitis. Also, long-term data from the Saturn-1 extension study demonstrate that after a one-time 6-week use, 60% of patients do not have a clinical recurrence even after 1 year, without any other lid hygiene performed in the interim, which was unheard of with prior over-the-counter therapies such as tea tree oil or hypochlorous acid products. Now, we can tell our patients that we can mitigate their disease and have a durable effect with a one-time treatment that would be repeated maybe once or twice annually. That is very desirable.
Additionally, we finally have a dedicated prescription for the management of evaporative dry eye disease with Miebo (perfluorohexyloctane ophthalmic solution, Bausch + Lomb).
This drug has been available internationally with good response, and now that we have it here in the United States, it is a nice adjunctive therapy. Not only does it help bind the tear film better, but studies have shown that it gets into the meibomian gland and helps improve the meibum secretions.
Miebo supports and improves evaporative dry eye disease (EDED), which is an ever more important step in the right direction to increasing patient satisfaction in the management process of DED overall because EDED is a part of 86% of the U.S. DED population. It helps stabilize the tear film, and fluctuating vision is one of the most common complaints and symptoms that we hear from our patients. It gives them noticeable results within weeks of therapy vs. months of therapy. Due to its efficacy and quicker onset of action, patients want to use it, instead of us doctors having to coach and constantly encourage them to use a chronic topical therapy.
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- Elizabeth Yeu, MD, is a Healio | OSN Associate Medical Editor.
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