Eyeworld

56 | EYEWORLD | DECEMBER 2019 C ORNEA DEVICE FOCUS By Rich Daly EyeWorld Contributing Writer • Patients with traumatically based nerve injury "In patients where I think there is a neurogenic component, TrueTear moves way up the algorithm, right behind the basic tear replacement, nutrition, and anti-inflammatory medication," Dr. Sheppard said. "I've had great success with TrueTear in patients for whom anti-inflammatories have failed." How it works A neurostimulator approved by the FDA in 2017, TrueTear uses two silicone prongs placed in the nose to stimulate the anterior ethmoidal nerve, which creates a reflex arc that stimulates the nerve that causes tearing, said Dr. Pflug- felder. The tear glands react by temporarily creating normal, physiologic tears. Tear analysis confirms equivalent con- centrations of total lipids, proteins, lysozyme, A s the dry eye device market becomes increasingly crowded, some surgeons are finding areas where one device is especially effective. The nasal nerve stimulator Tru- eTear (Allergan) is a more expensive dry eye treatment than artificial tears, Stephen Pflugfelder, MD, said, but "because the patients are stimulating their own tears, it could be a mainstay in therapy with patients who are willing to use it." Patients Dr. Pflugfelder finds the device serves well include: • Patients who read often and whose eyes get dry toward the end of the day • Patients comfortable using it • Patients who fly often "That's been my most frequent usage," Dr. Pflugfelder said of frequent fliers. "But there's no reason why it couldn't be used daily as a substitute for artificial tears." William J. Faulkner, MD, has used TrueTear as a secondary or tertiary choice. Meibomian gland dysfunction (MGD) "is rampant and should be addressed in all dry eye patients," Dr. Faulkner said. "Additionally, immunomodulators and even steroids would be trialed first." He said a developmental drug using nasal spray to achieve the same goals as TrueTear may be a "game changer." John Sheppard, MD, has found moving TrueTear up the treatment algorithm can be very helpful in severe dry eye patients referred to him. "I tend to get sicker patients who have been through a lot of things," Dr. Sheppard said. "If I am referred a new dry eye patient who is taking nothing but tears, it's very unlikely the patient will be immediately started on TrueT- ear." Other patients served well by TrueTear, accord- ing to Dr. Sheppard, include: • Patient subgroups frustrated by traditional treatments • Patients with very abnormal corneal nerves as shown by confocal microscopy Where does TrueTear fit in dry eye options? TrueTear Source: William J. Faulkner, MD About the doctors Stephen Pflugfelder, MD Professor and director Ocular Surface Center Department of Ophthalmology Baylor College of Medicine Houston William J. Faulkner, MD Director, Scott E. Burk Urgent Eye Clinic Cincinnati Eye Institute/ Cincinnati Vision Partners Assistant clinical professor Department of Ophthalmology University of Cincinnati Cincinnati John Sheppard, MD Professor of ophthalmology, microbiology, and molecular biology Clinical director, Thomas R. Lee Center for Ocular Pharmacology Eastern Virginia Medical School Norfolk, Virginia Reference 1. Faulkner WJ, Granat S. Intra- nasal neurostimulation for dry eye: first impressions. Curr Tre Ophthalmol. 2019;2(1):123–125. Relevant financial interests Faulkner: None Pflugfelder: Clinical trial with Baylor College of Medicine Houston Sheppard: Allergan continued on page 59

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