Paul M. Karpecki
NEW YORK – Clinicians should prescribe dry eye treatments based on their experience and comfort level, experts at the Ocular Surface Disease and Wellness Symposium, held during Vision Expo East, told attendees.
An audience member at the symposium, which was partially sponsored by Primary Care Optometry News, said Xiidra (lifitegrast ophthalmic solution 5%, Shire) was recently approved in Canada, and she asked the panelists to comment on how they decide on whether to prescribe Xiidra or Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan).
Panelist and PCON Editorial Board member Marc Bloomenstein, OD, said he has been using Restasis for 15 years as his primary medication choice and has had few issues with it.
“However, I do have some patients that I don’t feel I’m getting the results I want, and I’d bring in Xiidra,” he said.
“If you have a happy Restasis patient, there’s no reason to change,” panelist Paul M. Karpecki, OD, said. “If it’s a new patient, I’ve been using Xiidra to see how it works, and I’ve been pleased. It works quickly.
“I think we’re getting to the point where we’re going to know who does better with each product, but we're not there yet,” he continued. “I’ve had patients who had a lot of burning with Xiidra, switched them to Restasis, and they had no burning. I've had patients who have burning on Restasis, and then I switch them to Xiidra, and they don't experience burning. I still haven’t figured out the answer when it comes to side effects.”
Karpecki said, “Do what you’re comfortable with. Xiidra does seem to work symptomatically quicker – within 2 weeks for most patients. Restasis keeps building as it works over time, and you get good success. Both drugs are showing effects on osmolarity within a month. They’re both very effective.”
Karpecki said he used to pre-treat with a steroid before starting Restasis.
“Now I’m starting with Xiidra and adding a steroid if they’re still having symptoms,” he said.
“Now that you have Xiidra and you also have Restasis, pulling away from the steroid protocol would be in your best interest,” Bloomenstein added.
“No one knows the answer,” panelist Richard Adler, MD, FACS, said. “It has not reshaped how we treat dry eye disease in a year and a half of using it. There’s no clear preference. In my practice, if someone is not successful on Restasis, I add Xiidra.” – by Nancy Hemphill, ELS, FAAO
Schaeffer J, et al. Ocular surface disease: The diagnosis, treatment and case studies. Presented at: Vision Expo East; March 14-18, 2018; New York.
Adler reports he is a consultant for Allergan, Lumenis and Topcon. Bloomenstein is on the speakers’ panel for Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, Better Vision Institute and TearLab and a consultant for Abbott Medical Optics, Akorn, Allergan, BioTissue, Lunovus, OcuSoft and TearLab. Karpecki receives consulting fees from Aerie Pharmaceuticals, Akorn, Alcon, Allergan, AMO, Anthem, Avellino Labs, Bausch + Lomb, Beaver Visitec, BioTissue, Cambium Pharmaceuticals, Calhoun Vision, Candor Pharmaceuticals, Essilor, EyeBrain, Eyemaginations/Rendia, Eyes4Lives, Focus Labs, iCare USA, Imprimis, Johnson & Johnson Vision Care, OcuSoft, Freedom Meditech, Konan Medical, MacuLogix, Ocular Therapeutix, Reichert, Shire Pharmaceuticals, Regeneron, RySurg, Science Based Health, SightRisk, TearLab, TearScience, TLC Vision, Topcon and Vmax. He is on the speakers’ bureau for Glaukos and Oculus; has conducted research for Akorn, Allergan, Bausch + Lomb, Eleven Biotherapeutics, Fera Pharmaceuticals, Rigel Pharma and Shire and has an ownership interest in Bruder HealthCare, Eye Therapies and TearLab. Schaeffer has received honoraria, compensation or served as an advisor to: Alcon, Allergan, AMO, ArcticDx, Aton, Bausch + Lomb, Brien Holden Vision Institute, Bruder, CooperVision, ClearPath, Essilor, Ista, Hoya, MiboFlow, Nicox, Optovue, Optos, TearScience, Valeant, Vistakon and Zeiss Vision.
Editor's note: This article has been updated with an additional quote from the panel by Dr. Karpecki to more accurately reflect the context of his statement.