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Exclusives
Ocular Surface Disease

Alternative Treatments for Apprehensive DED Patients

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By James Deom OD, MPH, FAAO

The year 2023 has been unusual for over the counter (OTC) eye products due to several contamination-linked recalls. The worst of these led to a multistate outbreak of extensively drug-resistant Pseudomonas aeruginosa bacterium. Tragically, of the 81 Americans infected, 4 died as a result and 18 lost their vision.1 It’s the sort of catastrophe that every drug maker, prescriber, and user worries about, but one that is so rare it comes as a true shock.

Although the contaminated products are off the shelves and production halted, experts are analyzing exactly how these things happened and how to strengthen the system to prevent recurrences. In the meantime, it’s up to eyecare professionals across the country to help manage our patients’ eye health, as well as their reasonable apprehensions sparked by these unsettling drug production breakdowns.

Step One: Get the Truth Out
“Are my drops the drops I saw on television?” When the most alarming story first broke, my staff and I heard that question from worried patients all day long. Worse, some told us they’d already stopped their prescription eyedrops for fear of going blind. With hundreds of different OTC and prescription eyedrops on the market, many of our patients didn’t wait for the details; they simply discontinued using all eyedrops. While understandable, this was not a healthy solution, and quick action was needed to turn things around.

We contacted local news outlets for help reaching the general public, and we used our email blast system and patient communication tools to inform our patients directly which brands and products were being recalled, so that they wouldn’t stop using safe, vision-saving drops such as glaucoma medication. Quickly getting ahead of the panic and misinformation with the calm truth helped us forestall major health complications for our patients, and it was key to dialing back the anxiety overall.

This situation also brought to light the complicated web of interactions among drug manufacturers and distributors. We now warn our patients that generic prescriptions and OTC products can be inconsistent from one bottle to the next because distribution companies switch suppliers in search of lower operating costs. Keeping track of these changes is daunting, but with name brands, we get a consistent product, typically from the same, reliable manufacturing facility.

Aftermath and Apprehension
Unfortunately, many of our patients still lack confidence in the safety and efficacy of drops. They tend to be more aware of expiration dates and drop contamination issues, but many have also started looking for alternative, drop-free solutions for DED. Some have drifted back to using generic, preserved rewetting drops as they had before, but even when sterile and bacteria-free, these can exacerbate the root cause of most dry eye: the twin monsters of inflammation and meibomian gland dysfunction. Unfortunately for most patients, their care regimen begins and ends with the least expensive artificial tears they can find, and these do nothing to treat DED’s underlying cause.

Drops or Dropless?
Fortunately, for those who remain apprehensive about eyedrops, we have alternative in-office treatments such as tear duct plugs, amniotic tissue transplantation, thermal pulsation, thermal massage, and intense pulsed light (IPL) therapy, which is where I’ve shifted most of my treatment emphasis. The most effective treatment we have for treating underlying inflammation is OptiLIGHT (Lumenis), which relies on the very safe and effective patented OPT technology. This treatment is also preferred by patients due to the significant improvements in signs of DED. By reducing inflammation and enhancing the morphology and function of the meibomian glands,2,3 OptiLIGHT reduces the need for OTC lubricating eyedrops and other therapies. It usually involves just four ten-minute sessions, 2-4 weeks apart, and it remains the first and only intense pulsed light technology approved for dry eye disease by the FDA.

To support our in-office treatments, we offer products for routine ocular care at home, including a hypochlorous (HOCL) lid cleansing spray; a safe, washable, reusable warm compress that provides therapeutic heat (Optase); and a highly bioavailable omega 3 supplement (PRN) to improve the quality and quantity of meibum in patients with dry eye. This regimen functions as a powerful treatment tool as well as a preventative routine to stop future outbreaks of inflammation.

Where medications remain viable, my policy is to prescribe the brand, route of administration, duration, and frequency for each treatment, ensuring my patients understand the reasons for my recommendations. I never suggest using unspecified “artificial tears as needed.”

DED Treatments Going Forward
Though rare, eyedrop and ointment contaminations represent a horrible breakdown in our system of pharmaceutical manufacturing, and the trauma they can cause is very real. Problems may be more likely with generic products from a changeable cast of unproven manufacturers. Sticking with proven products from reliable makers is the best way to ensure that your patients’ drops remain safe and consistent. And by treating the underlying inflammation—the earlier the better—we can help patients rely less on over-the-counter remedies.

James Deom, OD is Medical Director of The Scleral Lens Institute at The Dry Eye Center of Northeastern Pennsylvania, and a practicing optometrist at Hazleton and Stroudsburg Eye Specialists. Known nationwide for his expertise with scleral contact lenses-for hard to fit patients and with vision rehabilitation due to glaucoma or brain Injury, he also cohosts the podcast, Try Not To Blink, about life and work in the field of optometry. Dr. Deom is a paid consultant for Lumenis Vision.

References

  1. Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears. Centers for Disease Control and Prevention. Last Reviewed: May 18, 2023. Accessed August 28, 2023. https://www.cdc.gov/hai/outbreaks/crpa-artificial-tears.html
  2. Liu R, Rong B, Tu P, et al. Analysis of Cytokine Levels in Tears and Clinical Correlations After Intense Pulsed Light Treating Meibomian Gland Dysfunction. Am J Ophthalmol. 2017;183:81-90. doi:10.1016/j.ajo.2017.08.021
  3. Yin Y, Liu N, Gong L, Song N. Changes in the Meibomian Gland After Exposure to Intense Pulsed Light in Meibomian Gland Dysfunction (MGD) Patients. Curr Eye Res. 2018;43(3):308-313. doi:10.1080/02713683.2017.1406525
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