Eyeworld

65 EW CORNEA July 2016 "We realized that some of the patients, even though they had a unilateral implant on in 1 orbit, were actually getting bilateral tear- ing. … It became pretty obvious that our best responding patients were getting an activation through an af- ferent reflex of the tearing process," Dr. Ackermann said. While having lunch with a colleague, Jim Loudin, PhD, and dis- cussing other reflex pathways that could be used to stimulate this tear production, the possibility of using the nasal pathway came up. "The next thing we knew, we were finishing up lunch pretty quickly and were getting back to start that process," Dr. Ackermann said, adding later that the nasal pathway's effect on tear production was known before, but no one had thought to tap it for dry eye treat- ment. A study published earlier this year in the Journal of Neural Engi- neering described the actual pathway stimulated by the system. This study was conducted to evaluate the earli- er implant version of the device and use of the the nasal reflex device in rabbit subjects. It found that while electrical stimulation of the lacrimal gland was effective at producing tears, stimulation of the afferent ethmoid nerve (nasal) pathway was more effective. 2 What's more, this latter stimulation activated other glands that secreted lipids and pro- teins, creating a more satisfying and natural dry eye treatment. "It turns out this activation was much more potent," said 1 of the study authors Daniel Palanker, PhD, professor, Department of Ophthal- mology and Hansen Experimental Physics Laboratory, Stanford Uni- versity, Stanford, California. "It's a more natural kind of tears that are secreted." Dr. Palanker said dry eye pa- tients with electro-neural stimulated tears had improved symptomatolo- gy and corneal staining in clinical trials, which he said indicates that their disease was "reverting." Dr. Ackermann said Allergan hopes to submit the Oculeve Intra- nasal Tear Neurostimulator to the U.S. Food and Drug Administration for approval this summer. "We're very optimistic about the device," he said. "[We've had a] very positive response from patients and clinicians, and I think the future is bright." EW References 1. Asbell PA, et al. Ophthalmologist percep- tions regarding treatment of moderate-to-se- vere dry eye: results of a physician survey. Eye Contact Lens. 2010;36:33–8. 2. Brinton M, et al. Electronic enhancement of tear secretion. J Neural Eng. 2016;13:016006. Editors' note: Dr. Ackermann has financial interests with Allergan. Dr. Palanker does not have any financial interests related to his comments. Contact information Ackermann: michael@Oculeve.com Palanker: palanker@stanford.edu Join the largest subspecialty society representing the fields of cornea and external disease. Member Benefits • Cornea: The Journal of Cornea and External Disease • Annual Meetings: Select discounted registration at membership events and educational programs • Exclusive eligibility for the International Corneal Training Grant Program ~ Cornea ED • Kera-net: The online forum for the exchange of clinical and scientific information • Cornea Society News mailed quarterly Save the Date World Cornea Congress VIII Singapore 2020 July 8-9, 2020 www.CorneaSociety.org " Neurostimulation is a very widely used type of technology. What's so neat about it is it offers clinicians the opportunity to allow patients to treat themselves by activating their own tear production system. " –Michael Ackermann, PhD

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