Robust pipeline of new treatments may ease dry eye symptoms

Dr. Laura Periman administers intense pulsed light therapy for dry eye. Photo courtesy of Dr. Laura Periman/Periman Eye Institute
Dr. Laura Periman administers intense pulsed light therapy for dry eye. Photo courtesy of Dr. Laura Periman/Periman Eye Institute

NEW YORK, Feb. 23 (UPI) -- The estimated 20 million people in the United States who suffer from various forms of dry eye disease soon may have expanded options to treat their symptoms, experts told UPI.

These include prescription eyedrops that target the underlying causes of the disorder, as well as drops to relieve its most troubling symptoms, such as eye redness and itchiness.


Also being used is intense pulsed light therapy, which uses gentle pulses of light to target the skin around the eyes, reducing inflammation of the eyelids and enabling tear production.

In addition, with more choices, eyecare practitioners expect that their patients may see a reduction in treatment costs, which can be as high as $400 per month for some prescription drugs, depending on insurance.

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"I suffer dry eye myself, so I know how it feels -- and the key for the dry eye sufferer is to provide them with a sense of hope," ophthalmologist Dr. Laura M Periman told UPI in a phone interview.


"There are things we can do and there are great innovations coming that'll help you," said Periman, founder and director of dry eye services and clinical research at the Periman Eye Institute in Seattle.

Surprisingly complex condition

The most common symptoms of dry eye, redness and itchiness, sound mundane, at least at first blush. But the condition actually can have profound effects on sufferers' vision, ophthalmologist Christopher E. Starr said.

Dry eye also can cause a stinging or burning sensation in the eyes, which can be painful, and some will experience stringy mucus in or around their eyes, light sensitivity, problems with night driving and blurry vision or eye fatigue, he said in a phone interview.

"One of the things that makes this area very complex is the term 'dry eye disease,' because dry eye is actually one of many ocular surface disorders that have similar, overlapping symptoms," said Starr, an associate professor of ophthalmology at Weill Cornell Medical College in New York City.

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The redness from dry eye can be severe enough that sufferers experience self-esteem issues, for cosmetic reasons, Periman added.

Dry eye disease is actually a spectrum of conditions that affect the eyes and the area of skin around them, including the eyelids. All of these conditions disrupt the tear film that keeps the surface of the eyes lubricated, smooth and clear, according to the Mayo Clinic.


It often occurs with age or as a result of allergies or certain autoimmune diseases, such as Sjogren's syndrome, rheumatoid arthritis and lupus, as well as thyroid disorders.

Medications can be to blame

Certain medications, including antihistamines, decongestants, hormone replacement therapy and antidepressants, as well as those for high blood pressure, acne, birth control and Parkinson's disease also can lead to dry eye.

James Prudden, an editor in his 60s, told UPI in a phone interview that he developed dry eye after starting treatment for high blood pressure four years ago.

"Almost immediately after starting the blood pressure medication, I found it was difficult to open my eyes in the morning," said Prudden, who lives in upstate New York.

Another common cause of dry eye is contact lens wear, which can lead to corneal nerve desensitivity in some, Starr said.

Similarly, laser vision correction can cause nerve damage that affects tear production, he said.

"Dry eye is the No. 1 complaint that brings patients to an eye doctor," ophthalmologist Dr. Marguerite McDonald told UPI in an email.

However, "many people suffer in silence, incorrectly assuming that it is just a normal part of aging and that nothing much can be done," said McDonald, a clinical professor of ophthalmology NYU Langone Medical Center in New York City.


Effective, but expensive treatments

Historically, there weren't a lot of effective treatments for dry eye, though that began to change over the past 40 or so years, Periman said.

"We had artificial tears, and that's it."

Significant progress was made in the 1980s, when the Food and Drug Administration approved Restasis, a branded form of cyclosporine, Starr said.

Considered a very effective treatment for dry eye, Restasis, a prescription eyedrop developed by drugmaker Allergan, can be expensive.

Prudden, who was initially prescribed Restasis for his dry eye after artificial tears failed to resolve his symptoms, told UPI he spent as much as $400 for a three-month supply.

"It works, but it's hard to justify the expense," he said.

"For many patients, the cost of treatment often means they go without, so it's often untreated or undertreated," Starr said.

Other medications can help

Other eye medications cleared for use in dry eye include another form of cyclosporine, called Cequa, as well as lifitegrast, which is sold under the brand Xiidra, McDonald said.

All "are very effective, medicinal eyedrops that are taken twice daily and help produce more and higher-quality tears," she said.

In addition, a twice-daily prescription nasal spray called varenicline, branded as Tyrvaya, helps users produce "more of their own, natural tears," McDonald said.


Another relatively new option is the use of intense pulsed light therapy, which uses gentle pulses of light to target the skin around the eyes, reducing inflammation of the eyelids and the tear film, Periman said.

The treatment can also improve the function of the meibomian gland, which is involved in tear production, and kill off Demodex mites, which hide in the facial hair and eyelash follicles, she said.

When Demodex accumulate around the eyelashes, they can cause eyelid redness, itching, tenderness, skin discoloration and sometimes even blurred vision.

OptiLight, manufactured by Lumenis, is the only IPL platform that is FDA approved for dry eye associated with meibomian gland dysfunction, Periman said, though it can cost as much as $700 per treatment and may not be covered by insurance, research suggests.

New options

After a "barren" period of 15 years, in which there were few innovations for dry eye, the next several years promise to be just the opposite, Starr said.

A recent report from healthcare research firm DelveInsight suggests there are more than 50 drugs for dry eye in the development pipeline.

Several of these treatments could receive FDA approval this year, Periman and Starr said.

One of the conditions behind dry eye is blepharitis, which is caused by Demodex accumulation, and a new eyedrop called Lotilaner 0.25% ophthalmic, made by Tarsus Pharmaceuticals, targets the condition specifically, effectively killing the mites, they said.


In clinical trials, Lotilaner, which is expected to receive FDA approval in August, was found to reduce the presence of Demodex on the upper and lower eyelids, and was well tolerated without eye irritation or other significant side effects, Starr said.

Meanwhile, another eyedrop expected to gain FDA approval this year is perfluorohexyloctane, or NOV03, from Bausch and Lomb. It is designed to treat dry eye disease caused by meibomian gland dysfunction, Periman said.

The drop works by stabilizing tear production and reducing tear evaporation, two complications of meibomian gland dysfunction, she said.

In a clinical trial published in December by the journal Ophthalmology, NOV03 was found to reduce eye dryness, as well as improve symptoms of "burning" and "stinging."

A third new eyedrop, called reproxalap, is a promising anti-inflammatory that works by stopping the inflammation cascade at the "headwaters" of dry eye, Periman said.

This means the drop works to reduce the eye inflammation that causes dry eye in the first place, preventing inflammation in the tear ducts from reducing tear production, said Starr, who as a consultant with the drug's manufacturer, Lexington, Mass.-based Aldeyra, has been involved in the clinical trials.

In clinical trials, the drug has been shown to reduce eye dryness and other signs of inflammation, including redness and irritation.


Improvement seen

"People treated with it saw improvement in eye redness, and that's a big deal for patients because redness has a huge impact on their self-esteem, their appearance, their quality life," Periman said.

In addition to these eyedrops, researchers at the Los Angeles-based Terasaki Institute for Biomedical Innovation say they have developed a contact lens designed to prevent contact lens-induced dry eye by facilitating tear flow in response to normal eye blinking.

The approach can relieve the discomfort, visual impairment and risk of inflammation experienced by millions of contact lens wearers, they wrote in an article published in December by the journal Small.

However, this technology is still in the early stages of development and has yet to undergo clinical trials, which are required for it to be approved and brought to market, a process that can take several years.

"The landscape now is hard for dry eye patients -- by the time they get to a dry eye expert like myself, they've already spent all this money and they're frustrated and they're not getting the results they want," Periman said.

Still, "I deeply, deeply believe, in the very depths of my soul, that we will continue to develop meaningful innovations that help people," she said.


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