ASCRS, day two
Hypochlorous acid: It’s everywhere. As I’ve been saying, it’s well on its way to becoming the new Omega 3, in terms of ubiquity.
Sodium hyaluronate: It’s coming to more drops in the US, which is a good thing.
A “complete solution”: Most companies in the dry eye space that are doing anything at all in over-the-counter and/or consumer products is broadening their reach to cover eyelid care plus eye drops. Dry eye treatment used to be “plug & drop”. Now dry eye care is “Drop… plus clean, heat and squeeze, and wash down some Omega Threes while you’re at it”.
Plugs: 6 month dissolveables are all the rage, and everybody’s got their own partial occlusion (“flow controller”) style plug now too.
Ocular Therapeutix: Dextenza
This is not a dry eye drug, it’s a slow release tapered dose corticosteroid. It’s designed for post-surgical use. But the reason I’ve been interested in it is the potential to provide a BAK-free steroid treatment alternative for those patients who are allergic to the BAK preservative which is in almost all steroid eye drops, without them having to resort to costly compounded PF steroid drops that their insurance won’t cover.
Random observations about dry eye in the exhibit hall
A woman I met with at one company could have been Exhibit A for the Vampire on your Vanity talk.
A young man at another company that I happened to stop and chat with told me his eyes feel dry pretty regularly and asked what he should do. How to answer that? My first instinct, of course, was to suggest he see an eye doctor (oh the irony), but lest he end up in the hands of one who gives out cookie cutter treatments without any differential diagnosis, I went ahead and gave him the schpeel about how the most common form of dry eye is the oil glands, and suggested some simple questions to ask them….
Several people I spoke with are in my age range (I’m 50) and have an elderly parent with glaucoma or other ongoing eye problems. They were very aware of the level of discomfort it’s causing, but don’t necessarily know anything about some of the contributing factors, such as the glaucoma medications, or the treatment options. And this… is at an eyecare conference.
Some data were presented about Kala’s drug KPI-121 yesterday in the dry eye session. This is a low-dose steroid meant to be used for two weeks for a dry eye episode. (And yes, it is BAK preserved, but also only intended to be used for short courses, so at least it’s relatively short exposure, but important to know if you’re allergic.) In a lot of their presentations and literature, the place they are carving out for these drugs is based on the understanding that dry eye patients have “flares”. They' have another clinical trial ongoing, just measuring symptoms, and it sure sounds like there is strong reason to believe they can have this approved and on the market in 2020.
Something went wrong with a lens at some point, and I really didn’t want to deal with it there, so I had to head back to the hotel to deal with it and let my eye recover a bit that afternoon….
I talked to their folks on the phone quite a bit and I have one of the NuLids devices at home… not that I remember to use it very often. I am very much a fan of the concept though, of a device for home use that is dedicated to keeping the lid margins squeaky clean. It’s pretty easy to use, reasonably comfortable, and not that expensive. People complain about the cost of the replacement tips, but honestly, it’s still an awful lot less than a lot of things people are spending money on for dry eye these days.
Another drive-by to say hello. No particular news, but if you’re not familiar with Vital Tears, their raison d’etre is making it easy for people to get autologous serum tears. And they definitely deliver on that promise. Check ‘em out.
I often think, these days, about the anxiety driving so many dry eye or eye pain patients to churn through everything from information to doctors to treatments, sometimes many at once, always in rapid succession. What will it take, what would it take to help someone in that state to slow down and start being methodical enough to actually help themselves?
The plug wars! It seems like plugs went from vogue to not quite so much to now coming back more, at least based on how the supply chain is proliferating. Anyway, the LacriVera family looks like this:
VeraPlug (baseline version)
VeraPlug Flow - their partial occlusion version (reduces but does not eliminate tear flow)
FlexFit (complete with 45 day retention pledge)
VeraC7 (collagen 7 to 10 day plug)
Vera90 (synthetic 60 to 180 day plug)
Vera180 (synthetic absorbable 6 month plug)
Bruder were the first to popularize a bead-based microwavable warm compress and they’ve done a good job with it. There are now, of course, a ton of lookalikes on the market, so it’s harder for them to differentiate themselves, although their lovely marketing materials sure try hard to, touting their silver-infused “patented MediBeads” versus silica gel beads or other materials, and better durability and washability. All of that seems like reasonable claims to me, but the “two-pod” design that they sport is something I think could cut either way, with some preferring the one continuous compress.
Bruder have several items now specifically for dry eye:
Moist Heat Eye Compress (the classic thing)
Hygienic Eyelid Sheets (handy liners, sold in a box of 35 individually wrapped)
Cold Therapy Eye Compress (gel pad, gets colder than the other thing)
EyeLove Contact Lens Compress (am I the only one that finds this confusing? Is it meant/allowed to be used when you’re wearing contacts?
Hygienic Eyelid Solution (hypochlorous acid 0.02%, and they seem to be claiming is the only one that is pure like Avenova, but higher concentration… I’m looking into this)
Rats, I thought I got some materials, but I can’t find them now. Anyway, they have new plugs coming out, one classic, one flow controller style.
Random idea percolating
Yesterday, I was talking with the head of an intraocular lens company that had created their own software to reach out and check in on the progress of patients by email for a couple of years after their eye surgery. I really liked the concept of how it worked - and simply the act of reaching back, routinely, to all of them. With my dry eye hat on of course I’m thinking of ways they could flag and reach out to people who are unhappy with their dry eye status afterwards and might otherwise just move on to another provider if they don’t feel they’re getting enough help.
From there, the creative juices got going and… I started pondering, and started noticing all the companies in the exhibit hall whose business centers around managing communications (email, text, etc) between eye care practices and their patients. What if… those constant contact systems incorporated an OSDI dry eye survey, which would serve both to let the patient know the severity level of their dry eye AND alert the physician’s office to patients who really need some dry eye follow-up even if their surgery was otherwise successful? Hm, hm, hm.
So I started poking around and talking to additional companies. I got a lukewarm response from most of them (as I expected) except one. Thanks to a smart staffer who matched us up, I ended up talking to a head of another company who turned out to be at least as much of a data-lover and database-visionary as I am… the difference being, he actually has the technology and has access to something like 24 million patients via several systems united under the same roof, where ideas can actually come to fruition. It was so much fun learning more and drooling and fantasizing over all the software projects that I believe could help people with dry eye. The time will come!
EyeVance recently acquired FreshKote from Focus Laboratories at the same time (if I understand correctly) that it went from conventional to preservative-free multi-dose packaging. FreshKote continues to be a bit of an ‘orphan’ product - which is sad, from my standpoint, as I remember when it was one of four wonderful products, and I just wish the others could some day return to market.