Multidose cyclosporine helps ODs tailor dry eye treatment regimen

Mark Schaeffer

With the availability of a multidose vial of cyclosporine ophthalmic emulsion 0.05%, eye doctors have a new option for tailoring appropriate dry eye therapy for their patients.

The newer formulation contains the exact same drug present in single-dose vials, but in a new packaging with less plastic that offers patients greater convenience. Overall, incorporating Restasis MultiDose (Allergan) into my practice has been seamless, requiring only a subtle change to the way I educate patients.

The multidose bottle, which contains a 1-month supply of cyclosporine, maintains sterility without a preservative via a patented unidirectional valve, which permits no air or contaminants to enter the bottle from the environment. For extra protection, a tiny sponge is positioned inside the cap to absorb any extra residue left on the tip, further helping to reduce the presence of any bacteria.

Eye doctors can be assured that the multidose bottle contains the same drug they have been using in their practice for years, although offering greater flexibility in how it is used. One aspect of treating dry eye that perhaps is underappreciated is the need to establish a relationship between patient and provider. As we learn more about the various triggers and exacerbating factors involved in the dry eye process, it becomes increasingly important to work with patients over time, carefully removing and adding treatments as appropriate.

Due to its chronic and potentially progressive nature (especially absent treatment), dry eye is not something that is treated to a finite endpoint; rather, at every visit with a dry eye patient, I want to ensure he or she is on a positive trajectory where signs and symptoms are continually lessened. This facet of dry eye treatment is why we should not give short shrift to treatment features that offer greater convenience: if patients are on board with the protocol, they are more likely to follow through and achieve the success they want.

With that in mind, a multidose bottle option for a proven therapeutic takes on new importance. In my practice, patients appreciate that the bottle is easier to carry with them compared to traveling with multiple single-dose vials and that it takes up less storage space at home. I have even had a few patients tell me they like the safety of knowing they have their bottle with them for when they need it and do not have to go digging around to find a small vial.

The Restasis MultiDose vial may also be easier to use for patients with dexterity issues. For individuals with arthritis, the larger bottle size may be easier to grip and use correctly. To help patients increase the likelihood of a successful instillation, we encourage them to prime the bottle prior to use: squeeze the bottle halfway, tip it over, release and then squeeze. Some patients may still prefer the single vial, but fundamentally, what is important is having an option to get patients more comfortable with the treatment choices we can offer.

One reason I focus on the relationship and rapport I build with dry eye patients is that it can be a debilitating condition. Patients tend to reach a “new normal” with many life activities; one example may be that contact lens patients may start to normalize taking out their lenses at 5:00 p.m. just because they are irritating. Thus, one of my goals of therapy is to reduce the impact on daily living and to reduce the compromises on quality of life due to their dry eye condition. On the one hand, discovering a patient’s individual goals for his or her vision requires a sense of trust for us to have that conversation. Yet that trust also facilitates the ability to adjust the treatment over time to stay on that positive forward trajectory.

The particulars of a dry eye treatment plan may change over time, but, generally speaking, if we can keep patients compliant with their medication, we have a better chance of getting results and keeping them engaged. We know from years of experience and from clinical trial data that cyclosporine ophthalmic emulsion 0.05% is an important part of reducing inflammation in the eye that triggers or exacerbates dry eye; the multidose bottle simply offers an alternative and more convenient way to achieve that goal. – by Mark Schaeffer, OD

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Mark Schaeffer, OD, practices in a 17-location practice in Alabama that is now a part of MyEyeDr. They practice full-scope primary care optometry with an emphasis on contact lenses and ocular disease. He can be reached at schaeffer.mark@gmail.com

Disclosure: Schaeffer reports he is a consultant for Allergan.