Eyeworld

65 EW CORNEA February 2016 were in keeping with the combined results of the first two trials. Howev- er, this alone will not provide 100% relief, Dr. Yeu noted. It will likely call for a synergy among different treatments and modalities such as conjunctivochalasis repair or ther- mal pulsation therapy to lid margins in conjunction with different topical therapies, Dr. Yeu said. Dr. Pflugfelder noted that there is the possibility that lifitegrast can be used in conjunction with Restasis. "Because they have differ- ent mechanisms of action, it's possi- ble that they would be synergistic," he said. "It will probably depend on clinical experience and patient response to the drugs to see if there's one that's preferable and one that doctors would prefer under certain situations." Going forward, Dr. Pflugfelder is optimistic about dry eye treatment. "I think even in the last 5 years, there's been a greater understanding about mechanisms and dry eye," he said, adding that with that infor- mation potentially allowing for the development of new drugs to target the mechanism more specifically, the future here is bright. EW Editors' note: Dr. Pflugfelder has finan- cial interests with Shire. Dr. Yeu has financial interests with Allergan, Shire, Rapid Pathogen Screening (Sarasota, Fla.), TearLab (San Diego), and TearScience (Morrisville, N.C.). Contact information Pflugfelder: stevenp@bcm.tmc.edu Yeu: eyeulin@gmail.com Emerging agent Dr. Yeu views lifitegrast as exciting for dry eye patients because this not only prevents T-cell activation but also appears as if it can have some of the onset of action closer to a steroid. "The way lifitegrast works is it's not specifically on the T-cells itself," Dr. Yeu said, adding that it's an integrin inhibitor, with such receptors present on both corneal and conjunctival cells. It is those corneal and conjunctival receptors that, with the aid of integrin mole- cules, bind to the LFA receptors of the T-cells. Inhibiting integrin gives lifitegrast a 2-pronged effect. "Not only does it prevent the binding of the T-cells to the corneal and conjunctival cells, but it can also un- bind those that are already bound, thus inactivating those cells," Dr. Yeu said. All 3 clinical trials showed very rapid symptom relief, in the order of just 10 to 14 days, she said, adding that lifitegrast doesn't have the side effects that steroids do. "There's no issues with intraocular pressure or cataractous changes," she said. While lifitegrast has not yet re- ceived FDA approval, Dr. Yeu is opti- mistic that this may be coming soon since the latest clinical trial results That's all you need! One-size-fits-all punctum plug eliminates sizing and simplifies stocking Pre-stretched shape (on inserter) avoids dilation and facilitates insertion Expanded shape (once inserted) assures snug fit and virtually eliminates pop-out Soft collar prevents migration and provides patient comfort FCI-Ophthalmics.com 800.932.4202 Plug into FCI for Dry Eye Treatment and watch the SnugPlug insertion video. Visit PlugintoFCI.com for promotional pricing ™ " Once the inflammation is present in the tear film, this leads to damage not only to the lacrimal gland but also to the actual surface, including the lid margin. Whatever the cause was to begin with, it often ends up being a mixed etiology picture, especially as the disease progresses. " –Elizabeth Yeu, MD

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