The Dry Eye Digest

Volume II, Issue 1 - July 1, 2006

Journal Roundup

American Journal of Ophthalmology

Smoking and dry eye: The title of this study (below) in the June issue pretty much says it all. The difference between smokers and controls was actually quite remarkable - smoking more than halved TBUT, for example (5.41 in smokers, 11.20 in controls) and reduced corneal sensitivity by about a third. Smoking associated with damage to the lipid layer of the ocular surface. Altinors et al, AJO June 2006 Vol 141 No 6 Pp 1016-1021. Click here for abstract.

Archives of Ophthalmology

Research on immunoinflammatory responses continues: This study at Schepens identifies a chemokine receptor as a potentially useful target in developing treatments for dry eye. Chemokine receptor CCR5 expression in conjunctival epithelium of patients with dry eye syndrome. Gulati et al, Arch Ophthalmol 2006 May;124(5):710-6. Click here for abstract.

BMC Ophthalmology

Fluorophotometer useful in dry eye diagnosis? Based on the abstract the results sound pretty impressive. However all they were testing was people with low Schirmer scores. We'd be interested to hear how this fares with patients who are symptomatic without being excessively aqueous deficient. Fluorophotometry as a diagnostic tool for the evaluation of dry eye disease. Fahim et al, BMC Ophthalmology, 2006 May 26;6(1):20. Click here for abstract.

Bone Marrow Transplantation

Autologous serum eyedrop contamination risks. In this study of HPCT patients, 32% had dry eye. Of interest and concern to us is their finding that six of 11 autologous serum eyedrop samples were contaminated after 30 days of use. We can't afford to subscribe to every journal on the planet but we sure would be interested to know what their AST preparation and handling protocols were like. Risk factors and characteristics of ocular complications, and efficacy of autologous serum tears after haematopoietic progenitor cell transplantation. Leite et al, Bone Marrow Transplant, 2006 Jun 19; [Epub ahead of print]. Click here for abstract.

Ceska a Slovenska Oftalmologie

A glowing report on SmartPlugs. Overwhelmingly positive results both in terms of visual performance and alleviation of symptoms and signs of dry eye. Wish they'd commented on duration & extrusion rates in the abstract since we can't read Czech. Visual functions' detailed evaluating in patients with Sjogren's syndrome before and after intracanalicular implants' (Smart Plug) insertion--(first results). Hejcmanova et al, Cesk Slov Oftalmol 2006 May;62(3):183-9. Click here for abstract.

Chinese Journal of Integrative Medicine

Something other than drops, drugs and plugs: We'll be lazy and simply quote from this very readable abstract, just this once: "The authors are making a comprehensive discussion on the methods and curative effects of treating dry eye by traditional Chinese medicine and by integrative Chinese and Western medicine in recent years, so as to introduce the distinctive features of the traditional Chinese medicine and integrative Chinese and Western medicine in this field." A survey on treatment of dry eye by traditional chinese medicine and integrative chinese and Western medicine. Zhou et al, Chin J Integred Med, 2006 Jun;12(2):154-9. Click here for abstract.

Cornea

New SmartPlug complication: A case report in the May issue of Cornea details two separate incidents of pyogenic granuloma formation two years after insertion of SmartPlugs. One case required surgery; in the other, the growth got smaller after the plug was irrigated out. Pyogenic granuloma formation following placement of the Medennium SmartPLUG punctum plug. Chou et al, Cornea May 2006 Vol 25 No 4 Pp 493-495. Click here for abstract.

The sexy side of dry eye: The title's a bit of a mouthful (no pun, er, never mind) and it's predictably technical but for those of you following hormonal research in ocular surface disease, see this study on sex steroids: 'Identification of Steroidogenic Enzyme mRNAs in the Human Lacrimal Gland, Meibomian Gland, Cornea and Conjunctiva' presented by Schirra et al (Cornea, May 2006, Vol 25 No 4 Pp 438-442).

Experimental Eye Research

One of those again... There oughtta be a law against abstracts with an average of more than 10 syllables per word. Especially since with authors like these, we know this stuff is important and we want to understand it. The title is crystal clear but we confess to getting crossed eyes in the middle of the first sentence. Corticosteroid and doxycycline suppress MMP-9 and inflammatory cytokine expression, MAPK activation in the corneal epithelium in experimental dry eye. De Paiva et al, Exp Eye Res 2006 Sep;83(3):526-35. Epub 2006 Apr 27. Click here for abstract.

Eye & Contact Lens

Care for popcorn while you watch 'em duke it out? Allergan vs. Alcon, round 362. (Refresh Liquigel vs Systane.) Suitable for amusement if not information: follow-up period was a grand total of 7 days. Allergan wins this round. Comparison of initial treatment response to two enhanced-viscosity artificial tears. Noecker. Eye & Contact Lens, 2006 May;32(3):148-52. Click here for abstract.

International Review of Cytology

Cell and molecular biology of human lacrimal gland and nasolacrimal duct mucins. Paulsen F. Int Rev Cytol 2006;249:229-79. Click here for abstract.

Investigative Ophthalmology & Visual Science

Apical corneal barrier disruption in experimental murine dry eye is abrogated by methylprednisolone and doxycycline. De Paiva et al. Inv Ophthal & Vis Sci, 2006 Jul;47(7):2847-56. Click here for abstract.

Conjunctival cytokine expression in symptomatic moderate dry eye subjects. Narayanan et al, Invest Ophthal & Vis Sci 2006 Jun;47(6):2445-50. Click here for abstract.

Another dry eye diagnostic: Appears to correlate very well with other objective diagnostic testing. We'd be interested to know whether & how it correlates with symptoms. Strip meniscometry: a new and simple method of tear meniscus evaluation. Dogru et al, Invest Ophthal & Vis Sci 2006 May;47(5):1895-901. Click here for abstract.

Journal of Cataract & Refractive Surgery

Publish all you want, but... We still won't applaud any of you for trying to figure out ways to do LASIK on people with pre-existing dry eye. However, if the patients are going to get it done no matter what we say, we're not displeased to hear that you're paying attention to the specific effects of dry eye drops of various sorts after surgery. Safety and efficacy of cyclosporine 0.05% drops versus unpreserved artificial tears in dry-eye patients having laser in situ keratomileusis. Salib et al, Jour Cat Refract Surg, 2006 May;32(5):772-8. Click here for abstract

Journal of Ocular Pharmacology and Therapeutics

Anything to relieve the burning, doc! Patients in this study seemed both happier and better off with Keterolac during their initiation to Restasis. Ketorolac during the induction phase of cyclosporin-A therapy. Schechter. Jour Ocul Pharmacol Ther, 2006 Apr;22(2):150-4. Click here for abstract.

Journal of Refractive Surgery

Careful with the wonderdrug du jour, please: Mitomycin C is becoming increasingly popular of late as a means of reducing the risk of subepithelial corneal haze in PRK patients, but rational guidelines for its use are about as scarce as knowledge of the long-term risks, as pointed out in two recent studies in the Journal of Refractive Surgery: 1) According to a case study presented in May's issue, intraoperative use of mitomycin C during PRK may induce or exacerbate tear deficiency. See Dry eye after photorefractive keratectomy with adjuvant mitomycin C, Kymionis et al, Jour Refract Surg 2006 May 22;5 pp 511-513 or click here for abstract. 2) For an excellent and rather sobering study about MMC, see Effect of Prophylactic and Therapeutic Mitomycin C on Corneal Apoptosis, Cellular Proliferation, Haze, and Long-term Keratocyte Density in Rabbits, Netto et al, Jour Refract Surg 2006 Jun 22;6; click here for abstract. Sigh - still no free lunch for high myopes getting refractive surgery.  

Ophthalmologica

Of red eyes and dry eyes: This is an interesting survey of ophthalmologists and GPs from 9 eastern European and middle eastern countries who recorded details of all visits from patients with red eyes for a 20-day period. 25% of patients were diagnosed with dry eye. GPs were apparently exceedingly aggressive with the topical antibiotics and steroids. The differential diagnosis of red eye: a survey of medical practitioners from eastern europe and the middle East. Petricek et al, Ophthalmologica, 2006;220(4):229-37. Click here for abstract.

Orbit

Dry eye plus dry eye equals.... Something like blepharoplasty after LASIK? (shudder). Upper lid blepharoplasty in patients with LASIK. Griffin et al, Orbit 2006 Jun;25(2):103-6. Click here for abstract.

Progress in Histochemistry and Cytochemistry

Sounds interesting. Now if we only knew what it meant. Difficult to formulate any intelligible summary from the abstract, but this is a topic of intense interest to us so if a subscriber to the publication feels any burning desire to share some of the details, we'd be all ears. Mucins and TFF peptides of the tear film and lacrimal apparatus. Paulsen et al, Prog Histochem Cytochem, 2006 Jul 17;41(1):1-53. Epub 2006 May 23. Click here for abstract.

What's in the Pipeline

Phase III Clinicals (or thereabouts)

OTSUKA-NOVARTIS/REBAMIPIDE: Phase III clinical trials ongoing. This still seems to be the furthest along of anything in the current pipeline, though we're hearing rumors of, er, 'issues' from current or former study sites. And we've heard some modestly positive reports. Click here for initial screening checklist and list of study centers.

NOVAGALI/NOVA22007: Cyclosporine emulsion. Recently started Phase III clinicals after obtaining new funding. Click here for most recent press release.

NASCENT/ iDESTRIN (NP50301): Estrogen ester compound (topical eyedrop). Phase IIb clinical completed, now all we need is money to move forward. Latest report was in early January (click here for press release) stating good results from Phase IIb with "no drug related serious adverse effects". Click here for Nascent's page.

SENJU-ISTA/ECABET SODIUM: Mucin secretagogue. Expecting to start Phase III trials in 2007, having reported positive results from Phase IIb studies in February 06. Ista claim that this is the first drug to show efficacy in clinicals against both signs and symptoms of dry eye. Click here for most recent press release and here for ISTA's main (albeit very outdated) page on this.

Phase II clinicals

NOVARTIS / PIMECROLIMUS (AMS981): Recruiting for Phase II clinicals. Click here for more info (or patients interested in signing up click here).

LANTIBIO/MOLI1901: Currently undergoing Phase II trials in the US following positive results in european Phase I studies. Click here for a, uh, colorful graphic about the mechanism of action. What is it? Cystic fibrosis drug being attempted as a dry eye treatment.

Somewhere in limbo

ALLERGAN/ANDROGEN TEARS: Hellloooo, anybody out there? Last we heard something was supposed to be presented at ARVO. Was it? Does anybody know anything? Some Phase IIs had been completed. We are anxious to see this drug on the market. Why has everything come to a standstill since Allergan took it on? Anybody with intelligence about developments please let us know.

INSPIRE/"PROLACRIA" (DIQUAFOSOL TETRASODIUM): We flipped a coin and decided they'd opt for DNR in late April but we were apparently wrong. They now have a name for the product, if nothing else. We haven't seen anything really fresh about their FDA 'discussions'. Click here for Inspire's inspiring pages about it.

On the horizon

CAN-FITE/BIOPHARMA/CF-101: CF101 is currently in clinical trials as a treatment for rheumatoid arthritis. The company has announced that it will shortly initiate another clinical study to test the drug's efficacy in treating dry eye symptoms. Click here for more.

OTHERA/OT-551: This is in Phase II clinical for preventing cataracts in patients who have undergone vitrectomy. Othera has stated they expect to begin Phase II clinicals for two additional indications, AMD and dry eye syndrome, next year. Click here for more.

SENJU/LACRITIN: It's very early stages yet but we've been keeping an eye on this for well over a year and think it's one of the most interesting and promising things coming down the pipeline. Some results of rabbit eye studies presented at ARVO recently. Click here for some updates & abstract from ARVO posted in Dry Eye Talk.

PAI-2: Research being done at University of Pennsylvania and Temple University; data presented at ARVO recently. Not a whole lot of info but it sounds interesting. Click here for more.

Obituaries

ALCON/15-HETE: Mucin secretagogue. We never actually read an official 'dead in the water' notice anywhere so we've been kindly keeping this on the roster in hopes its resuscitation or death would become easier to confirm. Nothing came to our attention so this is the last time we will list it.

Dry Eye in the News

Editor's note: We are so pleased to see the increase in general press coverage of dry eye! We don't even begrudge seeing several months of warmed-over articles about the Harvard tuna study and thinly veiled infomercials for 'the only prescription dry eye drug' while we patiently await some good quality in-depth health coverage. It's enough to know that dry eye is finding its way into the news more and more so that people can learn about what it is and how they can get help. And hey, if you're a reporter interested in writing some of that 'good quality in-depth health coverage' about dry eye, we'd love to help, so give us a call.

30 June: Dry Eye Hot Spots

Forbes' coverage of the NWHRA top 100 dry eye hot spots in the USA list. Also covered on our editorial page.

28 June: Texas Tops Nation's Dry-Eye Spots

Ditto from NBC5 in Dallas/Fort Worth, bragging about their state nabbing 4 of the top 5 dry eye rankings.

28 June: Consuming Omega 3s could reduce dry eye in women

What was that we were saying about warmed-over coverage of the Harvard report? No no, that's OK, we really do sincerely applaud the Rock River Times' efforts, truly we do. And Jeff, you've outdone yourself. We got no fewer than 7 pages of Google hits on 'tuna and gilbard and dry eye'.

23 June: Clinical Trial Targets Cure for Dry Eyes

NBC5 again. Coverage of Dr. McCulley's (UTSW) clinical trial on benefits of Omega 3s for dry eye.

22 June: Some treatment for dry eye and mouth

UPI. About as inspired and informative as the title.

20 June: The Drug CF101 Is Not Metabolized in the Liver and Can Be Used as Potential Therapy for Liver Related Conditions

Genetic Engineering News. Can-Fite BioPharma Ltd is planning another clinical trial of CF101 as a treatment for dry eye symptoms.

12 June: PDA Users Reporting Eye Strain Problems

NBC10. Well, duh, did you really think reading a 2" screen would be easier than reading a 20" monitor? But the article at least has the merit of pointing out that staring at a screen causes dry eye symptoms.

1 June: Tear production

From WSOC-TV. Wow - the introductory paragraphs are really quite a respectable overview of dry eye! Nice going. And we luuuv reports that don't just focus on drugs but get to the practical quality-of-life aids like eyewear, humidifiers and so on. The rest of the article is about saliva gland transplants as a dry eye treatment.

From the editor's desk

July 1, 2006

NEW TO THE DRY EYE ZONE? Let me introduce myself... My name is Rebecca and I run this website and company and write the newsletter and that's all you need to know about me right now, although you'll probably learn a bit more along the way if you do much reading on this website or on Dry Eye Talk. (By the way... if you haven't registered on Talk yet, please do. It's free, it's easy, it's a terrific group of people and we get into some fascinating discussions on anything and everything related to dry eye.) If you ever need to get in touch with me, you can always reach me by email or phone.

YES, THIS IS NOW A MONTHLY! I finally bit the bullet. Mind you, I was actually rather attached to my original concept of an 'irregular' newsletter. What's the fun in being predictable? Unfortunately, the reality is that I've always been one of those deadline-oriented people... you know, the ones that always wrote the report at 3 am the day before it was due? No hard & fast deadline meant it just never seemed to get done and much as I enjoy catching up on medical literature, it's always been the first to go when the daily fires push things off the bottom of the priority list and onto the do-it-sometime stack. Last time I tried to lift the stack, I found it was heavier than my daughter. So, it was time for a change. From now on, deo volente, you'll be seeing new stuff on these pages around the beginning of each month.

WHAT THIS PAGE IS FOR: Every now and then I get the urge to ramble about something.

So, on to this month's ramble....

Dry Eye Hot Spots (NWHRC)

National Women's Health Resource Center recently released a list of their assessment of the top 100 cities with environmental conditions most likely to aggravate dry eye. But if you figure they're all in Nevada, just because the list starts with Las Vegas, you're way off (after all, how many cities ARE there in Nevada?).

The rankings were produced with a weighted average of the following six criteria:

• altitude
• humidity levels
• pollution
• temperature
• wind
• ocular allergy irritants

Of course, we could have saved them a lot of time and money by letting them know that you really only need one criterion: AIR CONDITIONING (or HEATING, depending on your latitude.) Did you feel that breeze? It was the collective sighs of 15 million fellow Florida residents, rapidly followed by those of 10 million in Michigan. But hey, nobody asked us, and who are we to butt in anyway.

It's an interesting list, and it's spawned at least a little coverage, including Forbes and Medical News Today (UK) so far. If nothing else it's going to give lots of people bragging rights. Make that complaining rights. ('After all, I live in the 6th worst dry eye city in America!')

Anyway, here's the top 25 in NWHRC's list. I've taken the liberty of correcting their typing. Well, maybe they did mean to have two twos, nineteens, twenty-sixes and so on, but it still looks funny. For the complete list of 100, click here.

1. LAS VEGAS, Nevada. (No-brainer, even without factoring in the smoke in the casinos.)
2. EL PASO, Texas.
3. LUBBOCK, Texas. (Home of the first international symposium on dry eye back in 1984, ironically but not coincidentally.)
4. MIDLAND/ODESSA, Texas.
5. DALLAS/FORT WORTH, Texas. (Do I sense a pattern here?)
6. ATLANTA, Georgia. (Proof at last that humidity is not a cureall for dry eye.)
7. SALT LAKE CITY, Utah. (Naw.)
8. PHOENIX, Arizona. (Average high temperature this month is 105 degrees.)
9. AMARILLO, Texas. (At that size surely they could have lumped it with Lubbock. On second thought they might as well have listed 'West Texas'.)
10. HONOLULU, Hawaii. (Don't worry, if you were justifying your vacation on the basis it will help your eyes just switch to Kauai.)
11. OKLAHOMA CITY, Oklahoma.
12. ALBUQUERQUE, New Mexico. (Last time I tried to get some advice for a patient there, the doctors just rolled their eyes and said 'She needs to move.')
13. TUCSON, Arizona.
14. NORFOLK, Virginia (And they call this urban renewal?)
15. NEWARK, New Jersey. (OK I'll stop now.)
16. BOSTON, Massachusetts. (Oops, I take it back. Beantown residents with dry eye at least have some great nearby resources for treatment.)
17. DENVER, Colorado.
18. PITTSBURGH, Pennsylvania.
19. BAKERSFIELD, California.
20. WICHITA, Kansas.
21. DAYTON, Ohio.
22. KANSAS CITY, Missouri.
23. NEW YORK, New York.
24. PHILADELPHIA, Pennsylvania.
25. BALTIMORE, Maryland.

Our headquarters (Tampa) came in at a respectable #45. I'm surprised that Houston was way down there at #79 - seems like we get calls from dry eye patients in Houston every other day.

I have a strange, nagging feeling about this list. Ah, yes, I've got it now! Somebody please tell me what the point of it is, other than to make headlines. I mean seriously, now that you've ruled out every major metropolitan area where the sun shines more frequently than Seattle and Portland, and most of the small towns in Texas, where is someone with dry eye and money to burn supposed to pull up roots and move to? Can't you at least give us a hint, like which Caribbean islands are most benign for dry eye?

Now pardon me while I go write the newsletter, before my first attempt at a schedule goes up in smoke! See you in a month.

Rebecca Petris
The Dry Eye Zone

About The Dry Eye Digest

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The Dry Eye Digest is The Dry Eye Zone's free monthly newsletter for doctors and patients who want to keep up with research developments and industry news. It's written by Rebecca Petris and is based on our own research supplemented by information sent to us by readers. It's a labor of love and is not sponsored or subsidized by anyone.

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