Tear formulations unique in dry eye therapy, management

Key Points

In addition to dry eye, the products also are beneficial for patients who have undergone LASIK and cataract surgery and develop subsequent dry eye signs and symptoms postoperatively, said Dr. Donnenfeld, founding partner of Ophthalmic Consultants of Long Island, Rockville Centre, NY, and Connecticut, and clinical professor of ophthalmology, New York University Medical Center, New York.

He and his colleagues have used these products for more than a year because of involvement in the original FDA clinical trials. Dr. Donnenfeld described the products as unique because of their different mechanism of action.

In addition, he said that he is "very impressed with the ability of the tears to maintain a normal ocular surface, to improve the patients' quality of vision by smoothing out the higher-order aberrations, and to provide relief from dry eye signs and symptoms. We found that because of the viscoelastic capabilities, [the new tears] adhere to the ocular surface and provide long-term relief of dry eye symptoms."

Preservative-free drop

In his practice, Dr. Donnenfeld said, he uses the preservative-free drop to treat all forms of dry eye, but he finds it particularly helpful for treating patients who develop dry eye symptoms after undergoing LASIK and cataract surgery when patients expect excellent quality of vision.

"In addition to smoothly coating the ocular surface, the tear formulation does this in a way that does not cause transient blurring of vision," he said. "With [the preservative-free drop], the patient benefits from the ease and comfort of a less viscous tear and the improved quality of vision, but there are no transient visual problems or gummy vision that might develop with some thicker tear formulations that tend to disrupt the normal tear film."

Another major advantage of these tears is the absence of a preservative, especially for patients who instill drops more often than four times a day, he said.

Gel drop

The gel drop is a thicker, more viscous tear that provides patients with more prolonged periods of relief from dry eye symptoms. Interestingly, Dr. Donnenfeld said, this product does not cause as much visual distortion as other viscous gel tear formulations.

"[The gel drop] stays in the tear film for longer than any of the other gel tears and because of that characteristic, it really provides prolonged comfort and relief of dry eye symptoms," he said. The drop contains a preservative (OcuPure, AMO), but this dissipates within several seconds upon instillation in the eye.

Dr. Donnenfeld and his colleagues use these tears with most patients with dry eye and prophylactically after cataract and LASIK procedures.

"We don't use tears enough in patients who have undergone surgery," he said. "Most patients who undergo these surgeries have a relative denervation of the cornea, which may prevent them from feeling the sensation of dry eye. Nevertheless, these patients are symptomatic and the tears certainly improve their quality of vision. This is an ideal tear for anyone who complains of fluctuations in vision. The tears give them that 'Wow!' effect of high-quality vision."

Dr. Donnenfeld said he also frequently uses these products in conjunction with loteprednol etabonate (Lotemax, Bausch & Lomb) and cyclosporine (Restasis, Allergan) to improve the immune component.