Eyeworld

86 | EYEWORLD | APRIL 2020 C ORNEA preparation have a direct effect on meibomian glands that can alleviate meibomian gland-relat- ed ocular surface lid disease," he said. There is also promise for hyaluronic acid. It is approved as a prescription topical agent for dry eye in Japan, Dr. Sheppard noted. However, repeated failures have occurred in trying to obtain approval in the U.S. Other ophthalmic lubricating preparations that include hyaluronic acid are Oasis Tears (Oasis Medical), Blink (Johnson & Johnson Vision), and Refresh Relieva (Allergan), Dr. Sheppard said. Another avenue is a uniquely delivered compound being explored by Oyster Point Pharma. This product, a nicotinic agonist nasal spray, targets the upregulation of natural tear production, similar to the TrueTear (Allergan) approach, but the latter relies on intranasal electrical stimulation. "It's based on a common pathway feeding these trigeminal neurorecep- tors that induce the production of normal tears," Dr. Sheppard said. "The final jury is not in yet, but the data are becoming more and more promising." Dr. Sheppard said he is hopeful that one or more of these options may eventually expand the pharmacologic arsenal available to eyecare providers with truly synergistic modalities. without much product in the bottle, Dr. Shep- pard said. Still, he said he's been able to use the oral antibiotics successfully, capitalizing on their anti-microbial, anti-inflammatory, and meibo- mian-regenerative activity. Doxycycline supports corneal epithelial adhesion by downregulating MMP-9 as well as collagenases. There's also a minocycline gel for ocular surface disease and meibomian gland disease in clinical trials, Dr. Sheppard said. Demodex, mites that live at the base of the lashes, are also correlated with dry eye symp- toms. For these, Dr. Galor finds tea tree oil a useful strategy. Dr. Sheppard finds hypochlor- ous acid preparations useful for Demodex. Emerging agents Dr. Sheppard estimates there are nearly three dozen different companies working on other medical therapies for dry eye conditions. "The nearest to approval is CyclASol from Novaliq, which is a cyclosporine preparation in a truly unique vehicle," Dr. Sheppard said. CyclASol is a water-free, semi-fluorinated alkane that produces a 20-microliter drop. As a water-free preparation, it requires no preservative with a lower risk of infection, Dr. Sheppard said. "Also, it turns out that the semi-fluorinated alkanes alone in a higher molecular weight continued from page 85 ASCRS Online Tools Barre Toric Calculator Astigmatism Double Angle Plot Tool Post-Refractive IOL Calculator Hill-RBF Calculator Barre Rx Formula Find the tools, resources, and education you need to enhance your practice and improve your outcomes at: ascrs.org/tools

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