FDA-Approved Prescription Indicated For Use In Patients with Demodex Blepharitis

Opinion
Video

A medical expert highlights a new FDA-approved medication as a key treatment in Demodex blepharitis.

Christopher Starr, MD, FACS: The lotilaner eye drops, which are the newest treatment when it comes to Demodex blepharitis, differs very substantially from all of those other things that we've been doing in the past. Probably the biggest, most important distinction is it's FDA approved. It went through the FDA process and was approved, and it is the first and only FDA-approved prescription medication for Demodex blepharitis. That's number 1 through 5 in level of importance. It's an eye drop. A lot of these other things that I had mentioned before were scrubs and ointments, procedural things, oral medication, and so on and so forth, but this is really the first eye drop. It's a twice-a-day eye drop for a 6-week course, and it's an eye drop that was, at least in the clinical trial, phase 3 clinical trial, very well tolerated, very comfortable. I think 90% of patients considered it to be a neutral or very comfortable drop. It did show, compared to the control or the placebo, a highly statistically significant improvement in the eradication of mites, reduction in collarets, and reduction in eyelid redness or erythema. Based on the strength of that clinical trial, the drop was FDA approved. Now, when we have that uncomfortable conversation about these mites living in your eyelashes and your eyelids, it's followed up with, "And by the way, we've got a brand new FDA-approved medication that is highly effective and well tolerated for this. Let's prescribe it and get you started on that." Patients are great and not cringing and horrified like they were prior.

I think that there’s a lot of education to be had around Demodex blepharitis for practitioners, for patients, health care systems, hospitals, formularies, insurance companies, etc, because this is extremely, extremely common. It might have been underreported and underdiagnosed in prior times for all the reasons that I mentioned: the lack of an FDA-approved treatment, the uncomfortable nature of discussing mites in eyelids and infestations, and so on and so forth. But now that it's FDA approved, I guarantee you that we're going to be seeing more and more of this. Not that the prevalence of it is going up, it's just that we're going to be diagnosing it more because we have effective treatments for it now.

For practitioners, I think the most important educational tip here is very simply to make the diagnosis. The simplest way to do that is to have patients look down. If you see collarets on the upper eyelid margin, you've made your diagnosis, plain and simple, takes all of 2 seconds. Now, it might require a slight change to the way we practice because a lot of doctors don't necessarily have patients always look down. You can still diagnose the collarets on the lower lid, so you don't necessarily need the patient to look down; you can sometimes see collarets on the upper lid margin when the patient's looking straight ahead, but it is much easier to make a diagnosis and to see the collarets when a patient looks down, and again, it takes all of a half a second to do that.

Then, of course, we have now the treatment, which, again, I think it's important to educate providers that there is an FDA-approved treatment. Sometimes it takes a while for people to understand that we stay abreast of all the new procedures and surgical intraocular lenses [IOLs] and lasers and this and that. There's a lot of new stuff happening in all aspects of eye care. A lot of people might not even know that we have an FDA-approved product now for Demodex. I think that's very important for people to start learning and getting comfortable with it and the prescribing of that policy and the way to use it, which is twice a day for 6 weeks, 1 eye drop. For health care systems at all, certainly, this is, I think, the cost and the burden and the recurrent visits and if when these things go untreated and you don't make the diagnosis and you start do this and try this and try that, and a patient comes back and that actually adds a lot more cost and time and waste. It will save time and money in the long run if we look for it, diagnose and treat it on visit 1 rather than visit 12, after the patient has tried a zillion other prescription medications, wipes, surgical procedures, and so on and so forth.

Transcript is AI-generated and edited for clarity and readability.

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