BLOG: Growing number of dry eye patients will benefit from ongoing treatment innovation
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Many patients with ocular surface disease have sought relief at their hometown pharmacies with long-proven, branded lubricants.
Competitors entered the field with value-sizing and preservative-free options, which was disrupted in 2023 when the FDA recalled several over-the-counter eye drops due to risk for infection, a never-before-heard-of event. This prompted consumers into eye care offices with concerns.
Dry eye syndrome, or keratoconjunctivitis sicca, comprises a myriad of symptoms that reflect a disrupted tear film homeostasis. Hyperosmolarity, stemming from reduced tear flow or increased evaporation, underlies dry eye disease, leading to conjunctival and corneal apoptosis and subsequent inflammatory cascades with ultimate loss of goblet cells.
While anatomic errors can be corrected through traditional surgical procedures, office-based procedures reduce tear egress or improve meibomian gland flow.
Our armamentarium now includes a variety of collagen and silicone punctal occlusion, one of which is Lacrifill (Nordic Pharma), a lacrimal occlusion product that uses hyaluronic acid gel and lasts for 6 months.
Other treatments target the inflammatory basis of meibomian gland dysfunction through application of thermal and intense light pulses. These procedures can be effective with or without meibomian gland dropout, not only for symptom relief but also to prevent further deterioration. This approach, in conjunction with manual expression, provides a “reset,” or turns back the dial.
Lid hygiene also plays an important role in maintaining a healthy ocular surface. On the pharmacologic side, Xdemvy (lotilaner ophthalmic solution 0.25%, Tarsus) has infused a new zeal toward eliminating Demodex blepharitis.
While branded cyclosporine may have lost its dominance due to a surge in generic entries, it still holds a strong position in treating the ocular surface. Sun Pharma has created excitement in the landscape with Cequa (cyclosporine ophthalmic solution 0.09%) and its unique nanomicellar delivery vehicle, as has Bausch + Lomb with Miebo (perfluorohexyloctane ophthalmic solution), which supplements its acquisition of Xiidra (lifitegrast ophthalmic solution 5%). Harrow’s Vevye (cyclosporine ophthalmic solution 0.1%) addresses both evaporative and inflammatory dry eye.
In addition, Oxervate (cenegermin-bkbj ophthalmic solution 0.002%, Dompé) is a recombinant human nerve growth factor designed to support corneal innervation and integrity. Others are investigating recombinant proteins as potential treatments to increase lubricants and conjunctival goblet cells (Zhai Y, et al). These are just a few of the innovative ways industry is bringing new treatments to the forefront.
Most providers bill dry eye during their routine eye exams to patients’ vision plans; however, using evaluation and management codes or ophthalmic office visit codes are appropriate to bill to medical insurance plans. Be sure that your clinical findings match your appropriate coding.
The role of dry eye in a surgical ophthalmology practice has taken on new relevance — whether preoperatively with unstable biometrics, medication noncompliance or postoperatively with refractive patients’ fluctuating vision. With patient expectations soaring, providers must prioritize dry eye management to optimize visual outcomes.
As dry eye’s prominence grows, it underscores the need for comprehensive care and ongoing innovation in ocular surface treatments.
References:
- FDA warns consumers not to purchase or use certain eye drops from several major brands due to risk of eye infection. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-consumers-not-purchase-or-use-certain-eye-drops-several-major-brands-due-risk-eye. Updated Feb. 1, 2024. Accessed July 22, 2024.
- Zhai Y, et al. Int J Mol Sci. 2022;doi:10.3390/ijms23105458.
For more information:
Swati J. Parekh, MD, FAAO, is an anterior segment eye surgeon and co-founder of EyeCare Consultants of NJ, chair of the department of ophthalmology at St. Joseph’s Health and clinical assistant professor of ophthalmology at the Rowan-Virtua School of Osteopathic Medicine. She can be reached at besite@gmail.com.
LaCendra Morrison, CPC, is a professional coder with AAPC and member of the American Academy of Ophthalmic Executives. She can be reached at penny@mbcspecialists.com.
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