A hydroxypropyl cellulose ophthalmic insert (Lacrisert, Aton Pharma) is a preservative-free product recommended for once-daily insertion in the inferior cul-de-sac. Its convenience, efficacy, and safety make it a valuable option for the management of dry eye disease.
New York-A hydroxypropyl cellulose ophthalmic insert (Lacrisert, Aton Pharma) is a valuable option for the management of dry eye disease, according to Penny Asbell, MD.
Available by prescription only, the insert was approved by the FDA for use in patients with moderate to severe dry eye more than two decades ago. The current owner purchased the product in October 2006, and the company recently launched an expanded distribution program to raise clinician awareness about this modality for treating dry eye.
The insert is free of preservatives and provides sustained ocular surface lubrication, protection, and tear film stabilization. Most patients can realize symptomatic relief lasting the entire day with the convenience of once-daily insertion in the morning, said Dr. Asbell, professor of ophthalmology, Mount Sinai School of Medicine, New York.
"Patients with dry eye represent a large group with diverse needs, and our challenge as clinicians is to match individuals with the right medications that will provide them with the best results," she said. "[This insert] is an important option because it provides extended relief with once-daily insertion. Therefore, it addresses two key quality-of-care issues for patients with dry eye who suffer because of both chronic signs and symptoms and the bother of instilling artificial tears multiple times a day."
The hydroxypropyl cellulose insert is a soft, small pellet. It is intended for placement into the inferior cul-de-sac, where it gradually dissolves over the course of the day, releasing polymer that stabilizes and thickens the pre-corneal tear film.
The insert can be introduced using either the fingers or an applicator that is packaged with the product. Patients may place a drop or two of an artificial tear into the eye for initial lubrication until the insert begins to dissolve, but then usually can avoid additional use of artificial tears throughout the day, said Dr. Asbell.
"Appropriate placement is important to avoid irritation and even corneal abrasion. Although some patients may be intimidated by the need to place an object into the eye, the insertion technique is something learned very quickly and easily, even by older people," she said.
Dr. Asbell added that, as part of its expanded distribution program, the manufacturer has created patient educational tools, including a pamphlet and short online video (at http://www.lacrisert.com/) to explain and demonstrate the insertion process. The company also is providing samples of the insert to eye-care professionals and providing reimbursement assistance for patients.
Occasionally, patients find that they need to place an additional insert later in the day for optimal results. Before going to sleep, they can leave in place or remove any product that has not dissolved fully by bedtime, based on their preference, Dr. Asbell said.
Safety is another attractive feature of the hydroxypropyl cellulose ophthalmic insert, she said, because it is free of preservatives. Therefore, patients with dry eye who already have a compromised ocular surface are not exposed to the potential toxicity of the preservatives found in multidose artificial tear formulations.
"Frequent instillation of preserved artificial tears can exacerbate the ocular surface problems in patients with dry eye disease. Single-use, nonpreserved drops represent an alternative, but they are more expensive to use than the multidose vials and also somewhat of a nuisance to carry around. With the hydroxypropyl cellulose insert, patients get the benefits of the ocular lubricant ingredient without the risks of a preservative," Dr. Asbell said.
In a previous clinical study of patients with dry eye disease, the hydroxypropyl cellulose insert used once a day was demonstrated to provide better symptomatic relief and prolongation of the tear film breakup time compared with artificial tears used at least four times a day, she said. Patients using the insert also have been shown to have a thickened precorneal tear film and improvements in corneal and conjunctival staining.
"Preliminary findings from a study we've undertaken are corroborating these objective and subjective benefits," Dr. Asbell said.
She also noted that she has found the insert useful for addressing dry eye complaints in contact lens wearers.
"If the dry eye problems are very severe, we might recommend discontinuing contact lens wear. However, patients who have mild to moderate symptoms, remarkably, have been able to enjoy comfortable contact lens wear for the entire day after placing the hydroxypropyl cellulose insert in the morning followed by a drop of artificial tears or wetting drops," she said.