BLOG: Short-term, effective treatment available for dry eye disease
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About 17.2 million American adults received a diagnosis of dry eye disease, as reported in a 2019 Market Scope report.
However, many eye care practitioners suspect the actual number may be higher based on the proportion of our patients with signs or symptoms of the condition, such as burning or gritty eyes, fluctuating vision and contact lens intolerance.
Many patients have chronic symptoms, which we can treat with in-office procedures such as thermal eyelid devices (Lipiflow, Johnson & Johnson; Tear Care, Sight Sciences) and an immunomodulator (Cequa, Sun Pharma; Xiidra, Novartis), among other options. But the symptoms may not always be continuous. Even with chronic therapy, about 80% of dry eye patients suffer inflammation-driven episodes called dry eye flares, and almost half have only rapid-onset symptoms without chronic problems (Brazzell et al.; 2018 Study of Dry Eye Sufferers; 2020 Study of Dry Eye Sufferers; Kala Pharmaceuticals study).
I was surprised when I heard the numbers on dry eye flares, but once I started talking with patients, it became clear that my practice reflects the published data. If I ask patients, “Are there ever times when your eyes feel much worse?” they usually answer, “Yes.” I explain that although dry eye disease (DED) is a chronic, progressive condition, they will likely experience dry eye flares several times a year, and they should contact me when that happens.
Dry eye flares typically happen to my patients who may be doing well on chronic therapy, and then inflammation suddenly hits them. The flare might be triggered by increased digital screen time, seasonal allergies, heat, air conditioning, contact lens wear, air travel or other stressors. Even mask-associated dry eye can bring on a dry eye flare.
To treat dry eye flares, we have traditionally only had the option to prescribe corticosteroids off-label. This approach knocks down the inflammation, but steroids used off label have not been specifically studied for this indication. Risks are associated with higher doses of steroids, particularly if patients use them for a prolonged period. In October 2020, the corticosteroid Eysuvis (Kala Pharmaceuticals) was approved by the FDA specifically for the short term (up to 2 weeks) treatment of the signs and symptoms of DED, including dry eye flares. It’s a 0.25% loteprednol etabonate suspension differentiated by a proprietary technology called Ampplify. This is a surface coated mucus-penetrating nanoparticle (MPP) drug delivery technology that gets through the tear film’s mucus layer, providing both enhanced distribution across the ocular surface and targeted penetration to the cornea and conjunctiva (Popov et al.; Schopf et al.). In clinical trials, Eysuvis demonstrated rapid symptomatic relief and reduction in conjunctival hyperemia with a low incidence of IOP elevation similar to vehicle (Kala Pharmaceuticals data; Korenfeld et al.). Consequently, this low-concentration drug can be a well-tolerated treatment for DED signs and symptoms, including dry eye flares.
In fact, I’ve seen a recent wave of dry eye flares in my practice, triggered primarily by turning on the heat for winter. I’ve prescribed Eysuvis, with very good results. For example, one of our dry eye patients who had generally been doing well came in at the end of December feeling terrible. Her eyes were red and irritated. It was a typical sudden-onset dry eye flare. I treated her with Eysuvis, and relief was quick. My patients tend to begin feeling better in 2 to 3 days.
It’s great to have a safe therapy that’s been studied for dry eye patients and is now FDA-approved for short-term treatment of DED. Its fast action makes Eysuvis a viable first-line prescription therapy option. Because patients get relief quickly, it reinforces the feeling that their doctor understands their condition, knows what’s happening and knows how to treat it with confidence. If they can remove the trigger as well, that’s always beneficial, but many environmental or workplace triggers can be hard to change. On the positive side, patients know that if their triggers induce another dry eye flare, we can treat it quickly and get them the relief they need.
References:
- 2018 Study of Dry Eye Sufferers. Conducted by Multi-sponsor Surveys Inc.
- 2020 Study of Dry Eye Sufferers. Conducted by Multi-sponsor Surveys Inc.
- Brazzell RK, et al. Poster presented at: American Academy of Optometry meeting; October 12-15, 2019; San Francisco, CA.
- Brazzell RK, et al. Poster presented at: American Academy of Optometry; October 23-27, 2019; Orlando, FL.
- Data on file. Kala Pharmaceuticals. Watertown, MA.
- Korenfeld M, et al. Cornea. 2020;doi:10.1097/ico.0000000000002452.
- Market Scope. 2019 Dry Eye Products Market Report.
- Popov A. J Ocul Pharmacol Ther. 2020;doi:10.1089/jop.2020.0022.
- Schopf L, et al. Ophthalmol Ther. 2014;doi 10.1007/s40123-014-0021.
- Survey of 297 patients commissioned by Kala Pharmaceuticals and performed by a third party.
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