Cyclosporine 0.09% can quickly improve ocular surface health in dry eye patients
John Hovanesian, MD, of Harvard Eye Associates, spoke with Ophthalmology 360 about a study that found that cyclosporine 0.09% can help prepare the ocular surface ahead of cataract surgery.
John Hovanesian, MD:
I’d like to talk with you about a presentation that I gave at ASCRS on the topic of using cyclosporine 0.09%, also known as Cequa, for optimizing the ocular surface prior to cataract surgery. Now, we obviously want a nice clean ocular surface to do cataract surgery, and we’ve previously studied the use of cyclosporine 0.09% for this application, but we looked at an endpoint of 28 days when we did that previously. Indeed, the drug very effectively does prepare the ocular surface for surgery. But we really wondered whether patients need to wait that long and whether the same approach could work in a shorter timeframe as soon as one week after initiating therapy.
We set up a study in multiple centers prospectively with an open label, and patients were self-controlled, meaning we look at the pre versus post-treatment impact on the ocular surface, and we enrolled one eye in each of 60 patients for this evaluation.
Our primary outcome measure is that we consider most important when we’re thinking about premium lenses, and that’s corneal higher order aberrations. We also looked at corneal staining, best-corrected visual acuity, and symptom speed score, as well as tear breakup time, and conjunctival hyperemia. What we found, we had 46 patients who completed this study, and we found significant improvements as early as day 7 in higher order aberrations where there was improvement. We saw also artificial tears, competently used, did not meaningfully affect the outcome. Whether they’re currently taking or not, artificial tears, it still makes sense to prescribe Cequa.
Corneal staining was eliminated in about one-third of patients in a week or 2 and by two-thirds of patients by day 28 in this study. You’re going to see an improvement in corneal staining. Best-corrected visual acuity showed a trend toward improvement as early as 7 days, but that was statistically significantly different at day 28. Of course, it’s hard to measure visual outcomes in patients who have cataract as well as their dry eye.
Speed score has improved significantly by day 7 and continued to improve through day 28. Tear breakup time also improved. These patients in this study had to have a reduced tear breakup time to be included in the study, and so we saw significant improvement in that as well.
Conjunctival redness improved at day 7, really very cleanly improved by day 7, and that was about as good as it could be, so not much further improvement after day 7. For me, this study tells me that as early as 7 days after starting therapy with Cequa, patients who have dry eye who are presenting for cataract evaluation can see significant improvements in higher order aberrations, corneal staining, visual acuity, speed scores, tear breakup time, and ocular redness. This drug certainly deserves a place in the armamentarium of surgeons considering giving their patients the best visual outcome when preparing for cataract surgery. I find Cequa to be a very effective partner to use in the treatment of the patient and one that patients can tolerate very well.
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