The Dry Eye Zone

Rebecca's Blog

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Musings about Dr. Holly's Drops and OTC vs Rx

Recently several people on Dry Eye Talk who have been suffering with severe dry eye for a long time have reported results ranging from new & good signs to major sustained improvement to near remission using Dr. Holly's Drops - primarily Dwelle & Dakrina, sometimes supplemented by NutraTear. This has been very exciting as well as gratifying.

It's been a long & hard road trying to keep those products alive in this tiny venture. Looking back over the years of DEZ I see so many mistakes (20/20 hindsight and all...). Of late I have often felt that I have not served the community well by being relatively reticent about the drops on DryEyeTalk in the past. I had a longstanding fear of being perceived as just using the board for marketing and so I probably went too far the other way to compensate. I also struggle with being unable to personally articulate the science of them very well (I'm in awe of people who not only understand but can explain...!)

You'd think that if the drops are all they're cracked up to be, there wouldn't be a need for anyone to talk them up in the forums. However..........

A major challenge with Dr. Holly's drops, in my opinion, is the mixed blessing of their over-the-counter status.

It's a blessing because it makes it possible to sell them at a relatively low price and since no prescription is required they are available to everybody.

However, OTC drops set people up with certain expectations (usually very low) as well as a completely different approach to trying them.

"Artificial tears" - as we refer to most OTC lubricant eye drops - are in general expected to give immediate and temporary relief at best and so that is how people use them - and judge them. So many, perhaps most people do not try any OTC drop for very long unless it has an immediate feelgood factor. And of course that is how the vast majority of the medical community view anything OTC.

But Dr. Holly's drops, or at any rate Dwelle and Dakrina (the two with the highest oncotic pressure) just don't lend themselves to that kind of "been there tried that didn't work" quick trial. They require diligent compliance. Sometimes they are actually uncomfortable, especially in the beginning. The overall experience can be more like an Rx drop.

Think how differently you feel about an Rx than an OTC. Whether or not it hurts, if you were "prescribed" it and instructed to use it twice a day, and especially if you dished out $50 just for the copay, you just keep using it for the period you were told to. People have completely different expectations and tolerances with Rx drops.

So in my view the OTC status of Dr. Holly's drops has held them back - both because of how consumers naturally view them, and because of how the vast majority of doctors view them. I learned this the hard way when I started the company and ran a large sampling program with hundreds of doctors. Although it was very educational for me (as a total newcomer to the industry), it was also a waste of time and money because so few doctors were willing to select patients carefully AND instruct them carefully. Most of them, no matter how hard you tried to impress on them how to use the drops, clearly just added the samples to their "tear sample" drawer from which they handed out whatever they had to any patient with dry eye of any kind.

There are exceptions to that of course. There are several corneal specialists as well as excellent optometrists around the country who treat Dwelle more like an Rx - they match the product to the patient deliberately, write it on a prescription pad, tell them where to buy it, and tell them exactly how many drops to use and when.

Not coincidentally, those are the doctors who get results.

One last comment....

Those of you on DryEyeTalk have undoubtedly seen many of Rojzen's comments about her experiences with Dwelle. This is probably the most exciting, inspiring and intriguing development I've come across in quite some time. Despite total meibomian gland atrophy and years of 24/7 dependency on moisture chamber glasses due to a zero tear break-up time, she's experienced a near complete turnaround of symptoms with patient, careful use of Dwelle - amazingly, just a couple of drops a day. Even though I've been a fan of these drops for so many years now, her experience has floored me and altered my understanding of the drops' potential. I'm still digesting the implications.

The classic way to look at dry eye is at the "three-layered tear film" level. Diseased lacrimal glands, can't make aqueous tears? Trap 'em, supplement 'em, maybe find a way to make more by reducing inflammation. Diseased meibomian glands, can't make oil? Heal and maintain the meibomian glands to make more and better meibum. Depleted goblet cells, can't make mucin? Scratch your head and pray for successful clinical trials of new drugs. And all these things are probably right and good. Problem is, as the DryEyeTalk forums are, at times, such a painful testimony to, there are a lot of people doing all of that and still not getting enough relief to make it through the day without a major, major hit to their quality of life.

Dr. Holly's drops think differently... not so much trying to alter or compensate for specific glandular conditions and misbehaviors but rather figuring out through the appropriate scientific channels the very best way to make and keep a surface as "wet" as possible even assuming chronically underperforming or irreparably damaged built-in moisture makers. (And who knows but whether having a healthier surface for longer may impact the lacrimal system itself somehow.)

If I've sorta-kinda got that right, I think it's at that level that many key scientific advances of the 1970s and 1980s were remarkable - but then came to a standstill and finally were almost completely shelved, ignored and all but forgotten by the medical community in the 90's and this decade where everything is all about trying to fight inflammation, usually from without, sometimes from within.

Interestingly, there are several signs of a renewed interest in Dr. Holly's work now.

I hope that spark can be fanned into a flame.
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