Insert a step forward in dry eye relief

Lynda Charters

Patients with moderate to serve dry eye disease are dissatisfied with various dry eye therapies because they do not provide complete symptom relief.

Key Points

However, a hydroxypropyl cellulose ophthalmic insert (Lacrisert, Aton Pharma/Valeant Pharmaceuticals) seems to fill a void by increasing ocular comfort for these patients. Most patients who completed a study of the treatment reported overall improvement of their moderate to severe dry eye symptoms.

"Some patients are receiving maximal therapy for dry eye disease, but they are still symptomatic and miserable," said Marguerite B. McDonald, MD, clinical professor of ophthalmology, New York University School of Medicine, New York, and adjunct clinical professor of ophthalmology, Tulane University Health Sciences Center, New Orleans. "[The insert] is not intended for every patient with dry eye but for those [taking] maximal therapy who are still suffering."

In an effort to improve ocular comfort and quality of life and return the ocular surface and tear film to the normal homeostatic state, Dr. McDonald and colleagues conducted a multicenter open-label patient registry study to determine if the improvements reported by patients in dry eye symptoms, activities of daily living, and other quality-of-life measures after treatment with the hydroxypropyl cellulose ophthalmic insert were correlated with the physician assessment of the patients.

A total of 520 patients with dry eye syndrome were included in a 1-month study. At the first visit (day 0), patient information was collected and the best-corrected visual acuity was measured. Patients also underwent a full ophthalmic examination, except for dilation, and a dry eye evaluation. They also filled out a questionnaire to assess symptoms and were taught to insert the treatment correctly. On day 3, all patients were contacted by phone to determine that the inserts were being used correctly and if there were any adverse effects. On day 28, the patients were re-examined as at the first visit, and adverse effects were recorded. Patients again completed questionnaires to assess their symptoms, and physicians also completed a questionnaire.

A total of 418 patients completed the study. Dr. McDonald reported that cataract surgery and refractive surgery patients and contact lens wearers all had significant improvements in the severity of their symptoms and the activities of daily living similar to subjects who had not undergone cataract or refractive surgery and subjects who did not wear contact lenses.

The second objective of the study was to determine if the patient-reported symptom improvement correlated with the physician assessment of the clinical outcomes. Dr. McDonald reported that the reductions in symptom severity were significant predictors of physician ratings of patient compliance. Patient-reported frequency of painful or sore eyes and discomfort in areas of low humidity (p = 0.012) and windy conditions (p = 0.014) were significantly correlated with physician ratings of patient compliance. Finally, patient ability to perform housework was a significant predictor (p = 0.009) of physician-estimated patient compliance.