EyePod: The dry eye pipeline is more than a topical discussion

In this EyePod® podcast episode, William B. Trattler, MD, sits down with Sheryl Stevenson, Ophthalmology Times®' group editorial director, to highlight some of the novel therapies for dry eye that have recently been approved by the FDA, along with various treatment approaches that are in development.

The views and perspectives expressed are those of Dr. Trattler.

Audio transcript

Editor’s note: This transcript has been edited for clarity.

Sheryl Stevenson: Hi, everyone, and welcome to this episode of the Ophthalmology Times® EyePod® podcast series. This is Sheryl Stevenson, group editorial director with the Eye Care Group here at MJH Life Sciences. It’s been a busy first half of the year for the ophthalmology community in terms of FDA approvals and innovations within the dry eye space. Dr. William Trattler, who is a refractive, corneal and cataract eye surgeon with the Center for Excellence in Eye Care in Miami, Florida, joins me for this EyePod® podcast discussion on some of the many treatment approaches and advancements for physicians and their patients with dry eye. It’s not an exhaustive list of all that is in development, but it does speak to the depth of the pipeline. Let’s take a listen…

Stevenson: Hi, Dr. Trattler. It's so nice to have you join us today. I'm so excited to talk about dry eye and ocular surface disease. There's so much going on in this space right now. It's a delight to have a chance to chat with you about some of these developments.

William B. Trattler, MD: Thank you so much, Sheryl. I just love all the new technologies, because we need them. We have a lot of patients that really need a lot of help. While many of our patients do just fine with what we have available now, these new advances are really going to make a big difference for a lot of patients. So I'm very, very excited and optimistic that we're going to get a lot of help in the near future. So I'm very excited.

Stevenson: Yeah, for starters, there were two recent approvals in the month of June, as you well know. So we had Novaliq with their approval of CyclASol, [Vevye], which is now approved for [the treatment of the signs and symptoms of] dry eye disease.

Trattler: It's so exciting. We're really excited to work with Novaliq technology. It's a new version of a drop where it's really waterless, which it sounds strange. It's a drop that doesn't have water or oil in it. It just contains either just lubricants or actually lubricates and contains a medication like cyclosporine. The fact that we're going to have this to available to our patients...hopefully this will be helpful just to make the patients feel better, but then also give that extra treatment of an anti-inflammatory to help with their dry eye. So I'm very excited for this approval.

Stevenson: Yeah, and then right around the same time we had Miebo from Bausch + Lomb and Novaliq also approved earlier this month.

Trattler: Yes. This technology is really going to make a big difference. We have so many patients that their eyes just don't feel good. We've tried so many different things to make them feel better...anti-inflammatories, different lubrication drops, and I'm really hopeful that this will fill in the gap for a lot of these patients that just are uncomfortable. It was kind of geared towards patients with more than a Meibomian gland dysfunction type of situation where they have a rapid tear film breakup. Hopefully, this is going to help just lock in the moisture in the eye as almost an outer layer and really make these patients feel a lot better. So I'm very excited for our patients to have this available.

Stevenson: Yeah, and dry eye...there's just more and more options becoming available and different ways of looking at it. It used to be treated almost like a nuisance disorder, but now it's just becoming more understood with continuing research into the corneal surface. It's even been connected to neuro-ophthalmology disease. There's all kinds of things going on. Allgenesis [Biotherapeutics] has AG-80308, which is also in development. Any thoughts on some of these other therapies that are in the works?

Trattler: I'm really excited. Let's go back to the basics, which is, that dry eye is very complex. We have aqueous-deficient dry eye; we have the poor tear film quality version of dry eye; we have Demodex, which is also a major issue that is also associated with dry eye. We have all these different factors that are really affecting these patients. Oftentimes we focus on one area, and we need help in other areas. All these extra technologies that are getting approved, they're going to help us treat the patients. Sometimes it's going to be more helpful for one type of patient than the other. But overall, having these new technologies available will make a big difference.

For the Allgenesis technology, I'm obviously very optimistic. I don't know a lot about this technology. It's still very early on in development, but it's really I'm hoping will treat the inflammation linked with dry eye disease. I'm really hopeful that's going to be a helpful technology for us. It still has a way to go. We know inflammation, whether it's from aqueous-deficient dry eye or poor tear film quality dry eye, we know that inflammation is underneath it all. Anti-inflammatories are quite helpful for these patients.

Stevenson: Right. There's so many other things. Obviously, we know nutritional strategies have always been in place...the importance of omega-3s and so forth. There's also an oral probiotic that was recently presented at the American Society for Microbiology had a presentation about that as well. There's so many different aspects to this and even neuro-optometry and neuro-ophthalmology clinics are looking at this. What are your takeaways from some of these different approaches?

Trattler: Well, I think you're clearly right. It's not just one approach for dry eye. We need to take different approaches and every patient is unique. They have different factors impacting their overall health of their eye... again, there are different types of dry eye. We're actually utilizing a technology that's somewhat new as well, it's recently launched, called CSI Dry Eye. It actually uses artificial intelligence to help us categorize the patient into different versions of dry eye so we can more effectively provide effective treatments in first round. It's early work with this company. It looks very exciting with them. With what you just presented on the oral impact...we know that omega-3s for a while have been helpful. The concept of probiotics sounds really interesting and not something I would have expected that a probiotic can help with dry eye disease. But again, there's always room for us to learn more and more. So I'm looking forward to seeing more results on these new technologies.

Stevenson: Yeah, and that's not it. We're not done yet, right? We've got more PDUFAs coming. There's a PDUFA date of November 23. Aldeyra [Therapeutics], they have reproxalap for the treatment [of the signs and symptoms] of dry eye disease. So that's also something in the pipeline to look forward to.

Trattler: Yes. I consult with pretty much all the dry eye companies. It's just probably best for me to say it that way, including Aldeyra. I've had a chance to understand a bit more about this company, just because I've looked into company. I don't have anything confidential from them. It looks really promising. They just released their Phase 3 results from their allergic conjunctivitis study, which often goes hand in hand with dry eye disease and will prove to be quite effective in that scenario as well. Aldeyra's is like an anti-inflammatory that suppresses inflammation, but doesn't have some of the side effects of steroid drops. We're really hopeful that it'll really be an impactful treatment for patients with dry eye by suppressing inflammation and making patients feel better. The clinical trial results have been really positive, and we're hoping for approval to give our patients more opportunities for treatments in the future.

Stevenson: As a clinician in this area, I'm sure you must be super excited about all these developments and just looking forward to having these in your regimen to offer to patients with dry eye disease. Just to have as we progress forward into more and more and learning more about dry eye disease and even other approaches.

Trattler: It's so critical because, again, we often catch dry eye early. It's easy to treat patients who have early dry eye disease, and we can manage this quite nicely with what we have available today. There are patients that have more moderate to severe dry eye that we're still struggling with, and we'll come up with different treatment plans and sometimes it'll be effective and we feel really positive. But sometimes they start better and then they get worse again, and okay, now what do we use next. We're kind of running out of options sometimes. Having these new technologies become available will help not only their patients with early disease, but also patients with moderate to severe disease. We're really excited that we have more options for our patients.

Stevenson: Absolutely. Is there anything else that you'd like to add that we have not even touched upon?

Trattler: This is a great overview of some of the new things that are coming out in the near future. Another company's product, Tarsus, is hoping to get approval soon for Demodex, which is associated with poor tear film quality dry eye. I just think that 2023 is going to be really strong year for our patients. When we get into 2024, we'll have just so many more choices for our patients and more ways that we can help them, and I really am very appreciative of all the work that's being done by all the companies and researchers to help bring these technologies to our patients.

Stevenson: That's right, as you say, I mean, we're only halfway through the year and look at all that's already happened. There's so many developments and really encouraging therapies going on. Who knows what the next 6 months will bring and even beyond. We're really well positioned for growth in the coming months for sure.

Trattler: Yes, absolutely. Thank you so much for having me and I can't wait to talk again to share the next round of exciting news.

Stevenson: Yeah, absolutely. Thank you so much for your time today, Dr. Trattler.