With the latest in basic and clinical vision science on display at this year’s meeting of the Association for Research in Vision and Ophthalmology (ARVO), a growing interest in presbyopia was apparent.
A mini-symposium on the aging eye discussed the optical and visual trade-offs of lenses and other approaches for presbyopia correction. Guiterrez-Contreras et al. (ARVO E-Abstract 1246) demonstrated the promise of IOLs for restoring accommodation levels of the crystalline lens. Work presented by de Gracia and Hartwig (ARVO E-Abstract 327) showed ways to optimize the optical design of a corneal inlay (Kamra, AcuFocus).
Pharmaceutical therapies for presbyopia were also described, including an eye drop (EV06, Encore Vision). In a phase I/II study, EV06 treatment resulted in significant improvements in distance-corrected near visual acuity when compared with placebo (Korenfeld et al. ARVO E-Abstract 331). A 7-month follow-up demonstrated that the gains in distance-corrected near visual acuity from EV06 persisted for at least an additional 210 days after final exposure to the drug (Stein et al. ARVO E-Abstract 330).
Dry eye products still an ARVO mainstay
One study described a new lubricant eye drop for patients with lipid-deficient tears (Hom et al. ARVO E-Abstract 2671). The eye drop contains lubricant polymers along with omega-3 fatty acids and trehalose. When compared with a marketed eye drop, the investigational drop proved noninferior for symptomatic dry eye relief. Further, subjects using the investigational drop saw significant improvement in corneal and conjunctival staining when compared with the control drops at all follow-up visits.
One exciting topic in the clinical dry eye community at this year’s ARVO was a novel intranasal tear neuro-stimulator (TrueTear, Allergan). This small, handheld device with two slim prongs delivers a small electrical current to sensory neurons in the nasal cavity. This stimulation induces the nasolacrimal reflex, resulting in tear formation. The device was shown to significantly increase tear production in dry eye patients when measured by Schirmer’s test and tear meniscus height measured by optical coherence tomography (OCT) (Orrick et al. ARVO E-Abstract 2692).
In the same study, it was shown that use of the device also significantly increased tear film lipid layer thickness--a finding that may have implications in tear film stability for patients with evaporative dry eye (Watson et al. ARVO E-Abstract 4387).
A separate study analyzed meibomian gland morphology before and after stimulation with the device in subjects with dry eye (Pondelis et al. ARVO E-Abstract 2235). The group used OCT to measure the size of the glands and found that the overall gland area and perimeter were significantly smaller after stimulation. The authors suggest this is due to expression of meibum from the glands--a finding that corroborates the results from the aforementioned Watson study.
Attendees also saw positive results presented from ReGenTree LLC’s ARISE-I phase IIa study evaluating RGN-259 (Thymosin β-4) ophthalmic solution for the treatment of dry eye (Ousler et al. ARVO E-Abstract 2668). This 5-week, multicenter study evaluating 317 subjects in three arms (placebo, 0.05%, and 0.10% RGN259) showed positive results for RGN-259 in ocular discomfort and ocular surface staining over placebo. The 0.05% and 0.10% solutions reduced ocular discomfort on day 28 both before and in patients more symptomatic at baseline, after exposure to a controlled adverse environment. Additionally, subjects in the 0.05% and 0.10% RGN-259 groups with worse tear-film break-up time at baseline saw improved corneal staining scores by the end of the study.
ARVO 2017 also hosted a special interest group where conclusions and recommendations from the Tear Film and Ocular Surface Society Dry Eye Workshop II were presented. The full workshop report should be published later this year.
Allergy and dry eye were also highlighted in a mini-symposium focused on the relation of these conditions to the ocular surface health. Among the presented topics, Andrea Leonardi, MD, of the University of Padua, Padua, Italy, (ARVO E-Abstract 1599) discussed how disruption of cell-cell junctions on the ocular surface is pivotal to the immune response. An analysis of patterns of tissue RNA from the conjunctival surface has provided clues to the underlying etiology of the severe allergic disorder vernal keratoconjunctivis.