Taking Dry Eye Treatment in STRIDE

Millions of Americans suffer from dry eyes, and the problem has surged in the wake of increased technology use. Reduced blink frequency while looking at computers and cell phones aggravate dry eye disease (DED), which may also be worsened by environmental allergies, smoke, chlorine exposure, eyelid makeup, menopause, and aging.

“The coronavirus pandemic has led to an explosion in technology-related eye symptoms, including a marked increase in dry eye problems,” said Benjamin Ticho, MD of Ticho Eye Associates. “Most of these sufferers are not receiving adequate treatment, or often any treatment at all.”

The 20th Century approach to dry eyes was basically to lubricate the ocular surface with replacement artificial tears. Unfortunately, even in the best of circumstances, with careful pH balance, and optimum surface tension afforded by adding micro amounts of oils, the relief experienced with artificial tears alone is relatively short-lived.

Many dry eye patients actually make plenty of tears, but suffer as a result of localized inflammation on the ocular surface, making the tears less stable, and therefore less long-lasting.

Several prescription eyedrops, including Restasis (cyclosporine 0.05%, Allergan), Xiidra (lifitegrast 5%, Novartis), and Cequa (cyclosporine 0.09%, Sun Ophthalmics), attempt to address the inflammatory component of DED. These medications have an excellent safety profile, and do have a significant effect on reducing ocular surface inflammation; however, there is some delay — often up to several weeks — before this anti-inflammatory effect becomes fully evident.

The FDA has recently approved a new option to address the need for rapid inflammatory relief in DED. Eysuvis (loteprednol etabonate 0.25%, Kala Pharmaceuticals) is a low-dose topical steroid, designed for short-term use in DED patients, especially during flare-ups of greater symptoms. While the low concentration of Eysuvis reduces the risks of steroid-associated glaucoma, the potency for symptom relief is enhanced by the inclusion of a “mucus-penetrating particle” delivery technology. This permits increased drug penetration to enhance anti-inflammatory effectiveness.

FDA approval was based on the results of several clinical trials, including the STRIDE phase 3 multi center, randomized, double masked and placebo-controlled study of 901 DED patients; the STRIDE study demonstrated reduced eye redness (conjunctival hyperemia) in subjects using the corps 4 times daily for 2 weeks.

Less than 1% of study patients experienced a significant elevation of intraocular pressure, implying a much greater safety profile than traditional ocular steroid drops. The STRIDE study did not report frequent complications traditionally associated with topical steroid use, such as cataracts, predisposition to eye infections, and delayed ocular healing.

Potentially Eysuvis may prove a useful “gap-filler” for DED patients with significant symptoms, during the first two weeks while waiting for traditional cyclosporine and liftegrast treatments to fully kick in.

Learn about this and our other Dry Eye Disease treatment options by calling Ticho Eye Associates at 708-873-0088.

Benjamin H. Ticho, MD