Management of Dry Eye Disease - Episode 6

Determining Unmet Needs and Evolutionary Opportunities In Dry Eye Disease Treatment

Dr Periman provides final thoughts exploring unmet clinical needs as well as forthcoming innovative opportunities in dry eye disease treatment.

Laura M Periman, MD: There are multiple and varied [unmet needs]. The answer to that question will translate into efficiencies for the patient, the doctor, and the third-party payer. What are those? One is ocular pain associated with dry eye. There are 2 phase 3 drugs in development that directly address this question through novel pathways. That has impacts on the whole biopsychosocial aspect of things, including less polypharmacy on psychoactive medications. There’s a ripple effect in getting it right.

There are in-office diagnostics. We’ll soon have an in-office platform that can do a multi-array analysis of the inflammatory load of the tear film. That will help us be very strategic in what we recommend, including a supersmart steroid-delivery system, like Eysuvis. That’s a brilliant innovation with minimal adverse effects. I love it. Does it mean we need to layer a second immunomodulator on IPL [intense pulsed light]? That insight into what’s happening from an inflammatory perspective will help direct care efficiently and effectively and lead to better outcomes for patients. Those things are coming.

We need better diagnostics and therapeutics. We need targeted and specific therapeutics. We need the Demodex treatment drop to be approved. We need to be able to sort out what type of MGD [meibomian gland dysfunction] the patient has. Is this seborrheic dermatitis? Is this hyperkeratinization of the meibomian glands? There’s a drug in a phase 2b trial that’s finishing up in Canada from Azura [Ophthalmics] that’s a keratinolytic for these meibomian glands’ plugs. That becomes an issue of patient selection. If the patient has a toothpaste-like plug, they’ll need that medication. It’s very effective, or at least it looks like that in their data so far. I don’t have any personal experience with it.

There are multiple unmet needs. I told you that there are about 30 circus animals in a big tent, and the lights are off. We now have a candle and a few of the animals identified. There are all these other animals running about. But that isn’t something to be fearful of. It’s just something that you know how to be an effective zookeeper for.

When we’re talking about innovations and the landscape and what I’m most excited about, it centers on things in the pipeline. All the tools that we have are wonderful and effective in the right clinical situation. There are still problems with access to some of these medications. That’s frustrating for clinicians and patients. There’s opportunity for everyone in the health care ecosystem to talk more with one another. I’d love to see more opportunities like this—as an international expert in my field—to help third-party leadership understand what this is and that, when we’re asking for a certain medication, it’s not willy-nilly. There’s a rhyme and reason to it. Maybe we can work together better to create efficient, timely, effective access for patients.

I’m excited about innovations and collaboration. The future looks bright. I appreciate the opportunity to share with you. I look forward to your questions. You can reach me any time. The best way to reach me is on Instagram or LinkedIn. My LinkedIn is Laura M. Periman, MD, and my Instagram is @dryeyemaster. Message me there. Let’s continue the conversation. Let’s put our heads together. Let’s work together to help turn this thing around.

Transcript edited for clarity.