"Patients with dry eye syndrome who use [the insert] typically will get a maximum therapeutic effect within the first 3 to 6 months," said Bruce H. Koffler MD, of Koffler Vision Group, Lexington, KY. "Interestingly, those patients who have been using [the insert] for a while have the most difficulty coming off it because they get so accustomed to the local comfort and relief that [it] can provide."
Dr. Koffler recently conducted a retrospective chart review of patients with dry eye who used the insert as part of their daily treatment regimen. Chart data from 2005 to 2007 was gathered from nine different ophthalmology practices and included 80 patients (57 female, 23 male) with moderate to severe dry eye symptoms for whom the insert was prescribed. Patient age ranged from 12 to 92 years, with a mean of 64 and a median of 66 years. The most common signs and symptoms of dry eye in the study patients included keratitis (52%), a gritty sensation (29%), burning and stinging (26%), light sensitivity (25%), and blurred vision (24%).
The median length of therapy with the insert was 5.3 years, with 52 patients (65%) using the inserts for more than 2 years. Results showed that after the addition of the insert to the daily treatment regimen, 72% of patients reported a dramatic improvement of symptoms, 8% had controlled symptoms, and only one patient reported no change. Data showed that 38 of 42 patients with keratitis (90%) still were using the inserts at the time of the chart review, of which two reported a resolution, 28 reported an improvement, and five a control of symptoms.
Although 69% of the patients were 60 years of age or older, the study also included a 12-year-old girl suffering from Wegener's granulomatosis with concomitant severe dry eye symptoms.
According to Dr. Koffler, the insert is extremely safe and there is no age limitation in prescribing it. The study population also included five contact lens wearers who still were using the insert as of the evaluation date. These patients were classified as having severe keratitis, and all five patients showed a dramatic improvement from baseline after the insert was added to their regimen, which may improve contact lens tolerance.
"Many practitioners erroneously believe that [the insert] may cause a residuum in the eye, hampering and irritating the contact lenses and vision, which is simply not the case. In reality, [the insert] can be effectively used with all types of contact lenses," Dr. Koffler said.
"A lot of people get rejected [for contact lens wear] because the practitioner thinks that their eyes are too dry to wear them," he said. "It would be good to perform a trial with [the insert] in contact lens wearers to put this false notion to rest."
According to Dr. Koffler, the insert can improve significantly the signs and symptoms of dry eye in contact lens wearers and can provide longer-lasting symptomatic relief from potential irritation of contact lenses mostly due to dry eye symptoms, more so than the other available treatments. This can improve satisfaction in contact lens wearers.