Dry eye is a common condition affecting millions of people globally. While standard treatments for dry eye exist, what can be done when standard treatments don’t work?
In the April 2023 edition of Eversight's Webinar series, Mark Milner, MD of Golden Eye in Palm Beach Florida—an expert in cornea and dry eye—discusses innovative dry eye therapies that can supplement standard options. These can be divided into five categories: compounded medications, biologics, neurostimulation, immunosuppression and anti-infectives.
Compounded medications
Compound meds are tailored to an individual patient's needs. They can involve off-label use of commercially available drugs or different concentrations of a commercially available drug. For example, Dr. Milner suggests using albumin drops or 2.0% cyclosporine for patients who cannot get autologous serum.
Biologics
In recent studies, cryopreserved amniotic membrane (Prokera) has been found to significantly decrease the signs and symptoms of dry eye disease when compared to conventional therapy. Moreover, it also showed an increase in corneal nerve density and corneal nerve sensitivity, indicating regenerative healing.
A study of patients who failed conventional therapy showed that cryopreserved amniotic membrane led to statistically significant improvements in signs and symptoms of dry eye disease. These patients received a single application of amniotic membrane and were followed up at three months.
In addition to amniotic membrane, amniotic drops containing cytokines, growth factors, and hyaluronic acid are also available. BioTissue is currently working on umbilical cord drops, which are expected to have high levels of fetal healing and regenerative properties.
Neurostimulation
Electrical or pharmacologic neurostimulation is another available treatment for dry eye disease. Pharmacologic neurostimulants work by stimulating nerves from the nose, that travel through the trigeminal nerve to the lacrimal glands, and cause tear production. Tirvaya 0.03 milligrams, a nicotinic acetylcholine receptor agonist is currently commercially available. There is an electrical stimulation implant available called TrueTear, but according to Dr. Milner, this never really caught on due to its invasive nature.
However, a new non-invasive device called TearRestore has been developed that uses thermoelectric cooling and heating to stimulate tear production. It is a handheld device that the patient places over their closed eyes for 3-5 minutes. The device is able to modulate the temperature of the eyelids and improve tear production, and it has been shown to be effective in clinical studies. TearRestore is currently awaiting FDA clearance for use in the United States.
Immunosuppression
Immunosuppressive agents such as 0.1% cyclosporine are available commercially for the treatment of dry eye. New treatments like reactive aldehyde species (RASP) inhibitors are also in development and showing promise.
Anti-infectives
Dr. Milner discusses a new anti-demodex treatment to help to treat patients affected by these microscopic follicle mites.
Dr. Milner finishes with a brief overview of the innovative treatments that may be available in the future or are currently in development. Overall, it is important to remember that dry eye is a complex disease and there is no one-size-fits-all treatment for patients. In fact, dry eye is most often a multi-treatment disease.
The webinar ends with a spirited question-and-answer session that highlights some great tips for both online and compounding pharmacies. Check out the resources below!
Dry Eye Treatment Algorithm: Dr. Milner’s algorithm for the treatment of dry eye is published, free and available here.
- Scripthero: mentioned by Dr. Milner as a way to get discounted Cequa in cases where it is being used in combination with Restasis and therefore not covered for the patient.
- VLS Pharmacy: Dr. Milner recommends using this pharmacy for a variety of compounded medications.
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About the author
Michael Szkarlat
Partner Development Director
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Michael has been with Eversight since 2016 and has recently worked to develop Eversight's educational wet lab programs for EK surgery and a standardized protocol for DALK practice in a wet lab setting. His eye banking experience is rooted in the preparation of corneal grafts and spent nearly five years as Eversight’s Medical Director designee in charge of training clinical team members to prepare corneal tissue for DMEK and DSAEK surgery. In his time at Eversight, Michael has presented at scientific conferences, been involved in clinical research and developed innovations in tissue processing. He was named an IAPB Eye Heath Hero in the innovations category. Michael is passionate about community-based eye banking and honoring the precious gift that is donation. When not at work, he enjoys traveling with his wife and baking artisan sourdough bread.