Panelists: Drug delivery, neuropathic therapy have exciting potential in dry eye
ATLANTA – Innovative therapeutic delivery, neurosensory treatment and lid therapies will change the management of ocular surface disease in the future, an expert panel said here at the OIS@SECO meeting.
Moderator Joseph Boorady, OD, FAAO, asked the panel what they are excited about in this area of eye care.
Panelist Walter Whitley, OD, MBA, FAAO, said he looks forward to new drug delivery devices and their potential for reducing the need for patient compliance and increasing safety and efficacy.
“We underutilize punctal occlusion, and studies are looking at drug delivery with punctal occlusion with steroids for cataract – any way we can improve the delivery of the drug for the benefit of patients is exciting,” he said.
Whitney Hauser, OD, FAAO, mentioned dry eye treatment delivery with nasal sprays.
“It opens up a huge opportunity to treat the multifactorial condition that it is in a lot of different ways,” she said.
Companies are looking into neuropathic areas as another exciting innovation, panelist Douglas K. Devries, OD, said.
“It will be tremendous for how we’ll treat our patients in the future,” he said.
“None of the current therapeutics target mite eggs,” Leslie O’Dell, OD, added. “I’m excited to see where that research goes.”
The panelists also discussed areas where gaps in investigation exist.
“Is there a better way to understand corneal nerve sensitivity and density using confocal biomicroscopy or by looking at the brain’s response to corneal stimuli through functional MRI?” Whitley asked. “We need to look at various technologies and see how we can better understand and develop treatments.”
He also pointed to neuropathic pain as a critical area of research.
Morkin and colleagues found in a small study involving nine patients that cryopreserved amniotic membranes sustained pain control in patients with neuropathic corneal pain.
“We know the signs and symptoms don’t always correlate and we have many patients suffering from neuropathic pain looking for a treatment,” Whitley said.
“The first thing we say in dry eye lectures is that signs and symptoms don’t correlate, and we just accept that,” Devries said, “but we don’t look at neurosensory abnormalities. Now that we’re starting to acknowledge this, we’ll have more information in that area.”
He noted that Oxervate (cenegermin bkbj ophthalmic solution 0.002%, Dompe) is approved for treating neurotrophic keratitis.
“When I think of the discordance between signs and symptoms,” Hauser added, “I wonder how clinicians are looking and what they’re looking at. We need to go back to the basics and do the things we need to do in the right way, in the right order.”
Whitley said he looks forward to gene therapies to provide targeted treatments for conditions such as Sjogren’s syndrome, rosacea or meibomian gland dysfunction.
“We’re seeing over 56 genetic markers in patients with increased IOP, over 286 genes that have been identified in retinal disorders, and we’re also seeing that with keratoconus and corneal dystrophies,” he said. “We’re very familiar with biomarkers in ocular surface disease, but what about genetic markers?”
Boorady J, et al. The evolution of dry eye management. Presented at: OIS@SECO; Atlanta, Ga.; March 4, 2020.
Morkin MI, et al. Ocular Surface. 2018;doi:10.1016/j.jtos.2017.10.003.