Eyeworld

48 | EYEWORLD | SUMMER 2025 C ORNEA CHANGING MINDSETS About the physicians Preeya K. Gupta, MD Cornea, Cataract & Refractive Surgery Managing Director Triangle Eye Consultants Raleigh, North Carolina John Sheppard, MD Professor of Ophthalmology Eastern Virginia Medical School Medical Director Lions Eye Bank of Eastern Virginia Regional Medical Director EyeCare Partners Norfolk, Virginia Christopher Starr, MD Director, Refractive Surgery Director, Ophthalmic Education Co-Director, Cornea, Cataract, Refractive & Ocular Surface Fellowship Weill Cornell Medicine New York Presbyterian Hospital New York, New York by Ellen Stodola Editorial Co-Director Dr. Gupta called this a "really interesting molecule," noting that it has been studied in more than 2,000 patients, which is a large num- ber for a dry eye trial. "This will potentially be the first drug to work upstream in the inflam- matory process, and I think it's always nice to have different mechanisms of action. I think that might help it to have a broader application because we can treat inflammation earlier in the pathway. That might have an impact on its ability to treat both signs and symptoms of dry eye disease." The company met its endpoint for symp- toms using a controlled adverse environment, and that data was submitted in 2024, Dr. Sheppard said. This product can treat both allergy and dry eye. We are anticipating with great excitement that the approval process will proceed, he added. "I think this is a truly unique pathway. You can specifically inhibit these agents in the body and produce an anti-inflammatory effect," Examining the dry eye pipeline Dr. Starr uses the non-contact Corneal Esthesiometer Brill to check corneal sensation. Source: Christopher Starr, MD W ith dry eye presenting as an in- creasingly common issue, many companies are exploring options to treat these patients. New products in development are seeking to address different aspects of dry eye, with various mechanisms of action. John Sheppard, MD, said discussing the dry eye pipeline at this point in time is intriguing, particularly because of the activity in the area. "Three years ago, the conversation would have been completely different," he said. Dr. Sheppard noted some of the more recent approvals in the dry eye space, like EYSUVIS (loteprednol etabonate ophthalmic suspension, Alcon), MIEBO (perfluorohexyloctane oph- thalmic solution, Bausch + Lomb), and VEVYE (cyclosporine ophthalmic solution, Harrow). Previously, we had cyclosporine with no com- petition, he said. "It took a much longer time to get lifitegrast approved for both signs and symptoms." The pipeline is expanding dramatically, and there are many with different mechanisms of ac- tion, he said. "We have so many different choic- es and soon will have more, and that will allow us to really customize treatment for patients." Dr. Sheppard, along with Christopher Starr, MD, and Preeya K. Gupta, MD, discussed some of the products in the dry eye pipeline, how some of these products are unique in their mechanisms of action, and which patients they will target. Reproxalap (Aldeyra Therapeutics) According to the company, reproxalap is a first-in-class small-molecule modulator of RASP, which are elevated in ocular and systemic in- flammatory diseases. This is a potent topical anti-inflammatory drop that works further upstream from steroids and therefore does not share the same side effect profile, Dr. Starr said. Its broad upstream anti-inflammatory MOA provides rapid efficacy and may ultimately provide a novel treatment for dry eye disease, allergic conjunctivitis, conjunctival injection, and other ocular surface inflammatory diseases.

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