Eyeworld

SUMMER 2024 | EYEWORLD | 57 C I WISH I HAD … by Liz Hillman Editorial Co-Director About the physicians Kenneth Beckman, MD Director of Corneal Surgery Comprehensive Eyecare of Central Ohio Westerville, Ohio Christopher Rapuano, MD Chief of the Cornea Service Wills Eye Hospital Philadelphia, Pennsylvania coverage is better than it used to be, but it's harder to get covered than Restasis." Dr. Beckman said he thinks the difference for Vevye could be in the vehicle, which is a wa- ter-free solution that could help the drug stay on the surface of the eye longer. "Cyclosporine has the longest track record of this immunomodulator to quiet down inflam- mation on the ocular surface and increase tear production. So right away we have a tried and true, proven product," Dr. Beckman said. He added that the vehicle could provide "greater bioavailability of the active ingredient, so it's staying on the eye for a long time and it gives more ability for the cyclosporine to penetrate." Miebo (perfluorohexyloctane ophthalmic solution, Bausch + Lomb) This topical drop was approved to treat the signs and symptoms of dry eye disease in May 2023. It is the first prescription drop approved to target tear evaporation. Dr. Beckman said F or years, ophthalmologists had limited prescription options for patients ex- periencing dry eye and ocular surface disease. In the last decade, the number of available options has grown with several receiving approval in 2023. Now, a year later, Kenneth Beckman, MD, and Christopher Rapuano, MD, are sharing their thoughts and experiences with these new options, in addition to perspectives on where they fit in the growing ocular surface market. "I'm happy to have more options," Dr. Rapuano said. "The truth is, we have tons of ocular surface disease patients who are not responding to the current treatments that we have. You do have to try different things. I per- sonally like having the different options." Vevye (cyclosporine ophthalmic solution, 0.1%, Novaliq) Vevye received FDA approval in June 2023 for treatment of signs and symptoms of dry eye. It is the third cyclosporine option in the ocular surface/dry eye market in addition to Restasis (cyclosporine ophthalmic emulsion, 0.05%, AbbVie) and Cequa (cyclosporine ophthalmic solution, 0.09%, Sun Ophthalmics). Dr. Rapuano said he doesn't have direct experience with Vevye, but from what he understands, it seems to begin working at 4 weeks, while the other options take a little bit longer. Also compared to Cequa and Restasis, Dr. Rapuano said that Vevye is approved for signs and symptoms of dry eye, whereas Cequa is indicated for increased tear production, and Restasis is indicated to increase tear production in patients with ocular inflammation associated with dry eye. "As far as I'm concerned that's for marketing concerns," Dr. Rapuano said. "The proof will be in the pudding; we'll see whether it's better than Restasis, Cequa, or Xiidra [lifitegrast ophthal- mic solution, 5%, Bausch + Lomb]. Will it be less irritating? In my experience, Cequa is less irritating, and it's better tolerated by patients than Restasis. Cequa is almost twice as strong as Restasis, so I do like it a lot. The downside is it's a newer medication, and it's harder to get in- surance coverage for it than Restasis. Insurance Wish granted: more ocular surface options continued on page 58 Severe blepharitis with prominent collarettes sheathing the base of many of the eye lashes, indicative of Demodex mites Source: Christopher Rapuano, MD

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