Biography: White is an anterior segment surgeon and founder of SkyVision Centers in Westlake, Ohio.
Disclosures: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.
August 17, 2020
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BLOG: RIP TrueTear: Allergan pulls the plug on electrical stimulation

Biography: White is an anterior segment surgeon and founder of SkyVision Centers in Westlake, Ohio.
Disclosures: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.
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It was the easiest column I ever wrote. Seriously, it pretty much just wrote itself.

Nothing was easier than cracking wise about the new dry eye disease device that worked by stimulating the trigeminal nerve inside the nose. The evolution of TrueTear, from the grad school lab manned by Michael Ackerman, through rounds of private equity as Oculeve, on up to the purchase and renaming by Allergan — writing about the science and commercialization of TrueTear was a snap. Now comes the disappointing yet not at all surprising news announcement that Allergan will be shutting down production and discontinuing sales of both the device and its disposable tips.

So, what happened? In nutshell, TrueTear is simply too expensive to manufacture, putting it beyond the reach of all but the most desperate patients. Coming from a manufacturing background as I do (my Dad ran and eventually owned a company that manufactured spectacle frames), it’s very easy to understand the engineering, tooling and process challenges Allergan faced when bringing TrueTear to the market. Both the base unit and tips required one-off machinery. Lowering the per unit cost of manufacturing would require massive sales.

Darrell E.White, MD

Still, the darned thing just flat-out worked, especially in those with the most severe symptoms (I hypothesized in another column on neurogenic pain that a process similar to peripheral nerve stimulation for chronic pain may have played a role). You would think that a business model could have been created that would be successful. Many among us invoked the insulin pump model. Without insurance coverage for at least the base model, this would never have flown. An attempt was made to create something like the Schick razor model, letting the base unit go near cost and then sell tips (blades) through something that felt a lot like how we sell contact lenses. This was a decent plan, and frankly Allergan really did try very hard to make it successful.

In the end, the implementation was simply too hard at the point of sale (the office), and too little product was moved to justify continuing the program. To be honest, I think Allergan stuck with TrueTear way longer than anyone could justify from a business sense. It will be a bummer for that small number of patients who found relief only through the use of TrueTear (and their doctors). Perhaps someone will acquire it and try to charge it up again. In the meantime, we are left to hope that Mr. Ackerman’s next venture (Oyster Point), a nasal spray that stimulates the same nerve as TrueTear, provides a similar degree of relief in the setting of severe DED symptoms.

TrueTear shined a light on the circuitry of DED. Even off the market, what it taught us will remain current.