Eyeworld

WINTER 2024 | EYEWORLD | 61 C [varenicline, Viatris], which I'll often use in patients who have multifactorial etiologies for their dry eye or those who cannot tolerate an- other eye drop on their ocular surface, MIEBO [perfluorohexyloctane, Bausch + Lomb], for those patients who need a little better than OTC lubricant options but may not have severe enough symptoms to warrant immune modula- tors, or XDEMVY [lotilaner, Tarsus], in patients with more obvious signs or symptoms of Demo- dex blepharitis. For treatment-resistant dry eye, I will often consider autologous serum tears, and in neurotrophic disease I will reach for Oxervate [cenegermin-bkbj, Dompe]. Lastly, we must not forget options for systemic treatment of ocular surface disease, such as doxycycline in patients with severe meibomian gland disease or ocular rosacea." As Dr. Shah mentioned, there are various products and treatments available for different stages of dry eye disease, and both Dr. Shah and Dr. Canseco discussed some of the more recent product approvals in this space, including MIEBO, XDEMVY, Lacrifill (Nordic Pharma), and VEVYE (cyclosporine, Harrow). Dr. Canseco has seen a shift in the way physicians can help patients address dry eye. Previously, the physician might have jumped to artificial tears. "We know that didn't help every patient," she said. "We now know and under- stand the pathophysiology behind ocular surface disease and dry eye, and we know there are many different components, and now, we can address the different components of dry eye." She has found XDEMVY particularly useful in her practice. "We've always known about blepharitis as one of the main problems of ocu- lar discomfort," she said. "Patients complaining of itching, irritation, feeling like there's some- thing in the eyes, misdirected lashes—with all of these complaints, we've tried our best to treat them. My handout still includes ways in which we've treated blepharitis before, like cleaning up the lids, using baby shampoo, tea tree oil, etc. It's awesome that we now have a very specific and effective treatment regimen for patients who are affected by Demodex blepharitis." Dr. Canseco said results with XDEMVY are great, and it's well tolerated as opposed to some other regimens where patients complain the treatment itself (tea tree oil) is irritating. XDEMVY specifically kills Demodex mites and gets to the root cause of the problem. "I would challenge physicians to start using it on all patients who have collarettes. What you want to do is have patients look down at the slit lamp so you don't miss it," she said. Dr. Canseco has also been excited to incor- porate Lacrifill into her practice. "When patients have aqueous deficiency and using tears isn't feasible, I think using some form of a punctal plug is helpful," she said. "Lacrifill is the first in its category. [It's] like a filler, and we fill the lacrimal system," she said. "We go through the puncta, and one great advantage is we can do all four puncta. The beauty is that it lasts for about 6 months. Patients don't feel it, and it will conform to their anatomy." Lacrifill also has elasticity like a gel, so Dr. Canseco said it will fill crevices, getting deep in the canalicular system and providing relief for patients. continued on page 62 Demodex blepharitis in a patient evident while looking down on slit lamp exam; notice collarettes and misdirected lashes Source: Elvia Canseco, MD

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