Drops help prevent dry eye pain after cataract surgery

San Francisco-Just as during LASIK procedures, cataract surgery can damage the corneal nerves and cause symptoms of dry eye.

"Surgically induced dry eye syndrome is very similar to the ocular discomfort patients experience after LASIK. Cutting the corneal nerves causes loss of the ocular feedback loop and starts a cascade of events that results in dry eye symptoms," said Dr. Devgan. He is assistant clinical professor of ophthalmology, Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles.

In his practice, Dr. Devgan recently began to prescribe Soothe Emollient (Lubricant) Eye Drops (Alimera Sciences) for patients who have undergone cataract surgery, because he believes that the product restores the lipid layer and the aqueous layer, thereby resolving many of the postoperative dry eye symptoms.

"Each drop of Soothe contains water, a neutral oil, and interfacial molecules," Dr. Devgan said. "This combination of components restores the oil layer on the ocular surface, mimics the natural tear film, prevents tear film evaporation, and reduces lid friction. The effect of the drop often lasts for longer than 8 hours."

Dr. Devgan is conducting a prospective randomized trial to test the efficacy of Soothe following cataract surgery in approximately 40 patients. All patients underwent clear corneal phacoemulsification. One group of patients (n = 20) received the standard-of-care treatment postoperatively, which is an antibiotic drop four times a day for 1 week and a steroid drop four times a day for 4 weeks following surgery. The second group of patients (n = 20) also was treated with Soothe. In addition to the antibiotic drop and the steroid drop that the first group received, these patients were instructed to instill Soothe on the ocular surface four times a day beginning 1 week after the surgery. The study is still ongoing, and final data are pending, according to Dr. Devgan.

During his presentation, Dr. Devgan demonstrated the effect of the two treatments on the patients' lipid layer. In the group treated with the standard of care, the lipid layer thickness at baseline was 45 nm, and remained at that thickness 1, 5, and 15 minutes after instillation of traditional artificial tears.

In the group treatment with Soothe, the lipid layer was significantly thicker over time. The baseline value was 45 nm; this increased after instillation of the Soothe drops to 105+ nm at 1 minute and to 165 nm at 5 and 15 minutes, he reported.

Emollient eye drops seem to offer the best results for these patients, he explained. And he prefers Soothe to other commercially available emollient eye drops because he believes that their effect lasts longer and the tear film is restored.

"The difference with Soothe is the restoration of the lipid layer of the tear film, which helps to lock in moisture. It's very similar to using a lipid-based treatment for chapped lips instead of merely re-wetting your lips," Dr. Devgan said.

Dr. Devgan emphasized the importance of treating the ocular surface after cataract surgery.

"Cataract surgery cuts corneal nerves, which creates an iatrogenic tear film deficiency. This makes restoration of the tear lipid layer especially important for patient comfort and visual function," he stated, but noted that the final study data are still pending.

He also is hopeful that this level of postoperative care will replace the current standard of care for patients who have undergone cataract surgery.