Eyeworld

EW FEATURE 54 Dry eye disease update • November 2017 Patient with cornea punctate epithelial erosions (left) and corresponding fluorescein staining indicative of dry eye disease and unstable tear film (right) Source: Preeya Gupta, MD Aqueous deficient dry eye disease; lissamine staining of cornea and conjunctiva Source: Vincent de Luise, MD with Xiidra because of side effects such as burning or blurred vision. Dr. Gupta has many years of clinical experience with Restasis and finds it helpful. "I have used Restasis off-label in many patients to help with certain corneal conditions asso- ciated with chronic inflammation," she said. Dr. de Luise also recommends Restasis and advises short-term use of an ester steroid like loteprednol to "kick start" the anti-inflammatory process as Restasis takes effect. In some patients, Xiidra does indeed work faster, he added. It also may be a good option for patients when Restasis does not work. How- ever, insurance issues are often a deciding factor. "Restasis has been approved since 2003 and is on most formularies. Xiidra is now on many formularies, but there are still some issues with coverage," Dr. de Luise said. As Xiidra and Restasis are not available in Japan, Dr. Tsubota could not comment on their effective- ness. However, he noted that with the Tear Film Oriented Therapy he targets aspects of dry eye disease beyond just inflammation. "There are many targeted therapies for the tear and mucin layers, or MGD treat- ment for the lipid layer," he said. Dry eye experts are adding other new treatments to their armamentarium. "The newest treatment that I have been using for my moderate to severe patients is amniotic cyto- kine extract drops," Dr. Gupta said. "These drops are made by Ocular Science [Manhattan Beach, Califor- nia] via a compounding pharmacy Dr. de Luise cited various thera- pies under development, including lubricin and the KPI-121 nanoparti- cle (Kala Pharmaceuticals, Waltham, Massachusetts), currently in Phase 3 trials. One other product of interest to Dr. de Luise is tavilermide (MIM-D3, Mimetogen, Gloucester, Massachu- setts), a mucin agonist that may help patients with dry eye. "Cur- rently, there is no FDA-approved medication that specifically targets evaporative dry eye. Tavilermide could be one of those agents," he said. EW References 1. Kobayashi A, et al. Effects of a new eyelid shampoo on lid hygiene and eyelash length in patients with meibomian gland dysfunction: A comparative open study. J Ophthalmol. 2016;2016:4292570. 2. Lambiase A, et al. A two-week, randomized, double-masked study to evaluate safety and efficacy of lubricin (150 μg/mL) eye drops versus sodium hyaluronate (HA) 0.18% eye drops (Vismed) in patients with moderate dry eye disease. Ocul Surf. 2017;15:77–87. Editors' note: Dr. Gupta has financial interests with Allergan, Novartis (Basel, Switzerland), Ocular Science, and Shire. Dr. Tsubota has financial interests with MediProduct. Dr. de Luise has no financial interests related to his comments. Contact information de Luise: eyemusic73@gmail.com Gupta: preeyakgupta@gmail.com Tsubota: tsubota@z3.keio.jp Taking continued from page 53 and are shipped to the patient. They store them in the freezer and then open one vial per day." Dosing is one drop twice a day. "I have had patients significantly improve with respect to corneal staining and symptoms," she said. Dr. Gupta has also begun to use the TrueTear Intranasal Tear Neuro- stimulator (Allergan) to stimulate tear production, meibum secretion, and goblet cell degranulation. "Pa- tients can use this 'on demand' at home to help with symptoms of dry eye disease," she said. A newer product developed in Japan called Eye Shampoo Long (MediProduct, Tokyo, Japan) could potentially be helpful to patients with MGD, Dr. Tsubota said. In a study with 10 patients who used Eye Shampoo Long, there was a signifi- cant improvement in symptoms. 1 Dry eye pipeline Ophthalmologists say they are en- joying this time of a larger number of options available or under devel- opment for dry eye. One upcoming product that Dr. Gupta is watching is P-321 (Parion Sciences, Durham, North Carolina), an ENaC inhibitor that blocks tear loss through the absorptive pathway. So far, a Phase 1/2a study has been done in 53 patients, according to the Parion Sciences website. Another agent she is optimis- tic about is recombinant human lubricin (PRG4, Lubris BioPharma, Framingham, Massachusetts), which is found on knee cartilage and other tissues throughout the body. Lubricin had a greater than 72% reduction in foreign body sensation, burning/stinging, pain, and other factors in a small clinical trial. 2

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