Finding a match
The explosion of drop formulations has paralleled an increase in the understanding of dry causes. This raises the question of whether clinicians can now begin to ask if specific formulations can be designated for different types of dry eye. One way to dissect different formulations is by their compliment of lubricants.2 These include carboxymethyl cellulose (CMC), hydroxypropyl methylcellulose (HPMC), polyethylene glycol (PEG), propylene glycol (PG), and hyaluronic acid (HA).
Some of these are not technically designated as active drop components, but all function as lubricants. It is likely that different combinations will have different performance characteristics from patient to patient.
Most clinicians have a preferred brand. It is worth keeping in mind that even in head-to-head studies where one brand may be superior to another, another study will yield an equally convincing opposite result.
For example, in a recent study,3 Rohto Dry Aid was shown to be comparable to Systane Balance for most metrics, yet it was significantly better in the subjective, quality-of-life measures. In another study, it was Systane that was judged superior to Refresh Tears.2
It is probably more accurate to think in terms of a handful of first-line therapies (Systane, Refresh, GenTeal, Soothe, Dry-Aid, for example). It is likely that each of these products is superior for some part of the dry eye population. When it comes to finding the right artificial tear, there is no better approach than empirical trial and error.
Gail L. Torkildsen, MD
e: [email protected]
Dr. Torkildsen is in private practice in Andover, MA, and also does consulting in ophthalmic clinical research. She did not indicate any proprietary interest in the subject matter.
1. Wong J, Lan W, Ong LM, Tong L. Non-hormonal systemic medications and dry eye. Ocul Surf. 2011;9:212-226.
2. Moshirfar M, Pierson K, et al. Artificial tears potpourri: a literature review. Clin Ophthalmol. 2014;8:1419-1433.
3. Torkildsen G, Brujic M, Cooper MS, et al. Evaluation of a new artificial tear formulation for the management of tear film stability and visual function in patients with dry eye. Clin Ophthalmol. 2017;11:1883–1889.