Eyeworld

I DRY EYE DEVELOPMENTS N FOCUS 54 | EYEWORLD | JUNE 2019 Practice) and based on a number of publica- tions on scleral lenses in general, Dr. Jacobs said. Although scleral lenses, including the PROSE device (prosthetic replacement of the ocular surface ecosystem, BostonSight), are more commonly used for irregular corneas rather than ocular surface disease or dry eye, the lenses tend to be well-tolerated in patients with GVHD, Stevens-Johnson syndrome, and CNVII palsy. "The benefit in mild to moderate dry eye or in contact lens intolerance has yet to be demonstrated," Dr. Jacobs said. In her experience, patients with mild to moderate dry eye and excellent vision are usual- ly bothered by the wetting and debris issues that accompany scleral lens wear. "If an in-office trial yields an 'Ah!' effect, then it's worth going forward with fitting, training, and dispensing. If the patient's response is equivocal, I don't recommend [them]," she said. Old-school and emerging treatments Despite the newer, exciting treatments available, the physicians interviewed still have their favor- ite long-time standbys, including punctal occlu- sion and in-office procedures for meibomian gland dysfunction. Dr. Jacobs said she is a fan of newer extended-wear dissolving plugs made of polymers similar to Vicryl sutures. "Labeling varies, but in my hands they have clinical impact for 8 to 12 weeks," she said. Among the newer emerging therapies, Lu- bricin (Lubris Biopharma) is one that is attract- ing attention. Lubricin, a recombinant version of the human protein lubricin, is still in clinical trials. "Mucin quantity and quality are underap- preciated in the field of dry eye, and Lubricin may address those deficits in some patients with dry eye," Dr. Jacobs said. Recombinant human nerve growth factor cenegermin (Oxervate, Dompé), currently ap- proved for neurotrophic keratitis but in clinical trials for dry eye, may have an exciting future role, Dr. Akpek said. Newer formulations of cyclosporine will also be a welcome addition for patients, Dr. Galor said. significant improvement in tear film breakup time, Schirmer's test, ocular surface staining, or artificial tear use. However, there was a reduc- tion in the frequency of eye closing at 3 months and a significant reduction in dry eye symptoms among the treated group. Dr. Dhaliwal sees encouraging results with acupuncture for dry eye. "We've seen some dramatic responses, and we've seen some that were not as overwhelming. People feel they are generally better and that they are using fewer artificial tear supplements," she said. Dr. Dhaliwal, who is a licensed acupunctur- ist, will perform two treatments that are 1 day apart. Patients are encouraged to come back once a year. Some do, while others seem to be fine after a one-time acupuncture treatment. Autologous and allogenic serum tears The use of autologous serum tears can help certain dry eye patients. However, accessing tears can be difficult, Dr. Akpek said. Some- times patients do not have good veins to give the blood that is used to create tears. That's why she's encouraged to read more research about allogenic tears, with blood donations given by healthy donors. "We don't know exactly why serum tears work," Dr. Galor said. "However, most patients with ocular surface disruption report symptom improvement with their use," she said. "Some researchers have published promising data on the use of serum tears for neuropathic ocular pain, but in my hands, it has not worked as well as in individuals with immune-associated dry eye." The latter includes individuals with GVHD and Sjögren's, she said. Deborah S. Jacobs, MD, also sees mixed results with autologous serum tears depending on the patient. "It's impossible to predict who will perceive benefit. If the patient does not perceive benefit, they will not persist with the inconvenience and expense of using autologous serum tears," she said. Scleral lenses There has been a large increase in the apprecia- tion and use of scleral lenses in the past 5 years, according to publications from the SCOPE group (Scleral Lenses in Current Ophthalmic continued from page 53 Financial interests Akpek: None Dhaliwal: None Galor: None Jacobs: None

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