Off the Cuff: Exciting Developments in the Dry Eye Treatment Landscape

There has been significant movement in the dry eye space over the past several months including new approvals and acquisitions. These developments represent an exciting time in the field of dry eye care, as well as a dramatic shift. With all these developments, I have been telling many of my dry eye and ocular surface disease patients that although I wish they didn’t have dry eyes, now would be the best time because of the numerous treatment options at our disposal with many more on the way.

 

Bausch + Lomb saw the approval of Miebo, the acquisition of Xiidra from Novartis, and the Blink line of artificial tears from Johnson & Johnson Surgical Vision. By adding these new treatments to Lacrisert and Biotrue Hydration Boost lubricating drops, Bausch + Lomb has built a robust portfolio and has positioned itself as a leader in the dry eye space for the foreseeable future. For those unfamiliar with Miebo, it is perfluorohexyloctane, which is a water-free, semifluorinated alkane originally developed by Novaliq. Additionally, because it does not contain water, it is intrinsically preservative-free as microbes are unable to grow within it. From a mechanistic standpoint, Miebo essentially works as a tear film stabilizer as it helps prevent premature evaporation of the tear film, which makes Miebo the first FDA-approved drop to target the signs and symptoms of dry eye associated with MGD and evaporative dry eye. The pairing of Miebo with Xiidra makes perfect sense, as Bausch + Lomb now has treatment options for both the evaporative and inflammatory components of dry eye, respectively. I have been discussing Miebo with all my dry eye patients since its approval and the response has been one of overwhelming excitement, and I am looking forward to adding this drop to my treatment arsenal.

Vevye, which was originally developed by Novaliq and has been acquired by Harrow (which also just purchased Verkazia and Freshkote among other ophthalmic products from Santen), also recently received approval, and leverages the use of a water- and preservative-free semifluorinated alkane (in this case perfluorobutylpentane) as a vehicle for cyclosporine. Because this vehicle is water-free, has no pH or osmolarity, and contains no preservatives or surfactants, it does not disrupt the tear film and ocular surface. This vehicle allows for significantly increased contact time with the ocular surface increasing the bioavailability of the cyclosporine. This has traditionally been an obstacle for the naturally hydrophobic agent. This increased contact time allows for an improvement in signs and symptoms of dry eye in as little as four weeks. This represents a potentially major shift in the way we think about the traditionally slow-acting immunomodulator. Ideally, the days of waiting months to assess the efficacy of these medications will become a thing of the past.

Excitingly, the dry eye and ocular surface developments don’t end with Miebo and Vevye. Tarsus has a PDUFA (Prescription Drug User Fee Act) decision of approval date of August 25th for TP-03 (lotilaner ophthalmic solution), which would represent the first FDA-approved therapy for Demodex blepharitis. Additionally, we have a PDUFA date of November 23rd for Reproxalap by Aldeyra, an anti-inflammatory drop with a novel mechanism as a reactive aldehyde species inhibitor, which has been shown in clinical trials to provide rapid relief from dry eye-related inflammation. These represent therapies that will likely be available in the near future, and there are countless others in earlier stages of development that I plan on talking about more as they get closer to approval.

Cory J. Lappin, OD, MS, FAAO

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Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.