Eyeworld

62 | EYEWORLD | WINTER 2024 C ORNEA Relevant disclosures Canseco: Tarsus Shah: None Contact Canseco: cansecoelvs@gmail.com Shah: shailys123@gmail.com Dr. Canseco said MIEBO is a new version of a lubricating tear that helps coat the ocular surface. Though she doesn't have as much expe- rience with MIEBO because of coverage issues, she said it does help patients feel better quickly. It provides a thin and smooth coating to the su- perficial layer on the ocular surface. "I have had patients say they see better when using MIEBO. It's easy to use and well tolerated, and patients get relief quickly." Similarly, Dr. Canseco said she has had a good experience with VEVYE; she said this is a well tolerated product. "One thing we struggle with when we use cyclosporine for inflamma- tory dry eye treatment is it's a little uncomfort- able," she said. "Patients can have burning or stinging. Getting patients to stick to the regimen can be a challenge because they're already un- comfortable from the disease, then they're using a drop that might not be super comfortable in the beginning." Dr. Canseco said it's a good option for those who are comfortable treating patients who would benefit from cyclosporine treatment. "It's a great option for patients who might need a more comfortable immune-modu- lating drop from the get-go," she said. Dr. Shah has similarly been pleased with many of the new options in dry eye therapy. "So many patients suffer from a condition that, until recently, had very limited treatment options." Dr. Shah has found that MIEBO works par- ticularly well in her patients with more obvious evaporative dry eye and in those patients who have failed OTC lubricants but do not have the signs or symptoms to warrant immune modulators or other prescription treatments. "Patients find MIEBO incredibly soothing upon instillation, and the symptom relief seems to last longer for many of my patients." She also thinks that VEVYE is a great new form of cyclosporine. "I love that it has perfluo- robutylpentane as its vehicle; it provides similar soothing effect and immediate relief upon in- stillation as MIEBO but also carries the immune modulating effect of cyclosporine that we are all familiar with," she said. She finds that patients with more symptomatic inflammatory dry eye (those with burning and irritation especially on instillation of eye drops) tend to tolerate VEVYE sooner than expected and often without the need for concomitant steroid treatment. Dr. Shah said XDEMVY is the first treat- ment option that is uniquely dedicated to the eradication of Demodex. "I've been able to com- plete treatment courses for several patients now and have seen remarkable results—complete resolution of visible collarettes and great symp- tom relief. It's been a game changer, particularly for those patients who have suffered for years without much relief from traditional treatment options such as doxycycline, tea tree oil scrubs, or other topical or systemic anti-parasitic treat- ment options. "My approach to dry eye has and contin- ues to evolve significantly over time," Dr. Shah said. "I think early on in my training, I failed to recognize just how seriously dry eye should be taken. Patients with dry eye suffer in a multi- tude of ways, ranging from mild irritation to severe burning, redness, blurry vision, and often prolonged and severe pain," she said. "I think dry eye has to be approached from a place of empathy. Often, these patients have been suffer- ing for years, dismissed as having a 'less serious' condition, or just not found great treatment options for their particular form of dry eye. Leading with empathy and reassuring patients that I will work my hardest to find a solution for them is of utmost importance." Dr. Shah added that she has developed a general algorithm for implementing treatment options depending on presenting history and exam, "etiology" of the dry eye, and what treatments have been tried and failed already. "I also try to always stay up to date on the latest treatment options so that I can offer my patients something that is tailored specifically to their needs." Dr. Canseco said her biggest shift in ap- proaching dry eye has been to adjust her think- ing and realize that there are many different etiologies that result in dry eye. "I need to address the specific problems, or I won't really help the patient," she said. Rather than just re- lying on certain treatments, Dr. Canseco tries to ensure that she's looking at the whole picture. She spends time figuring out the goal for each individual patient. Dr. Canseco said that there are many ways for eyecare professionals to learn about these new options for treatment and stay up to date. "With all these advances in the management and treatment of ocular surface technology and management, we encourage people to attend conferences [and] seek local opportunities to learn so we can provide relief to patients." continued from page 61

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