Eyeworld

53 EW CORNEA April 2018 tions that as with any of the anti- inflammatories, you've got to pick the right patient. "The elderly pa- tient with severe meibomian gland "I find that starting them on more natural products provides them with the opportunity to wrap their heads around the fact that they have a chronic disease that's progressive and requiring lifelong treatment," she said. Dr. Matossian brings such patients back after about 8 weeks, allowing time for the omega-3 supplement to kick in. She then repeats MMP-9 testing, as well as tear osmolarity. "If the InflammaDry test [Quidel, San Diego] is positive, I start them on Xiidra," she said. If the patient's insurance plan allows for this, Dr. Matossian will write a prescription for Xiidra. Sometimes, however, the product is not covered, or a pre-authorization is required, in which you have to prove that the patient has used arti- ficial tears or Restasis and failed with these in the past. Discussing potential side effects In cases where the patient is placed on Xiidra, Dr. Matossian always mentions the potential side effects. "I tell them about the dysgeusia and the discomfort or irritation upon instillation," she said. "This way we minimize calls from concerned patients." Then Dr. Matossian brings the patient back in another 2 or 3 months, even though she knows lifitegrast typically works quicker. This gives the patient a chance to get used to adding a prescription medication to their daily regimen and time for them to notice im- provement in their symptoms. "I tell them it's a stackable disease; we stack different treatments until I can document objective improvement and patients notice increased com- fort with their eyes," Dr. Matossian said. "When I see patients back, most are pleased with the results they've gotten with Xiidra." Occasionally there are some who are unhappy with the medi- cation, she noted. "A few patients say, 'The burning was too much,' or I had one person say 'The taste was horrific.'" Dr. Hovanesian likewise gives patients the potential downsides of lifitegrast upfront. "I give them every bit of information that could derail their success," he said. "I tell them it can be pricey, and we always offer information on the access program." He also details the issues with stinging as well as the altered taste that may arise, explaining that both of these tend to get better over time. To deal with the taste, he advises patients to brush their teeth after they've taken it to help get the flavor out of their mouth. For Dr. Holland, the response with the lifitegrast has been excel- lent in most cases. However, he cau- continued on page 54

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