Friday, November 6, 2009

Drug news: Inspire's Prolacria, Azasite clinicals fully enrolled

Inspire Completes Patient Enrollment in Three Late-Stage Clinical Trials in Cystic Fibrosis, Dry Eye and Blepharitis

DURHAM, N.C.--(Business Wire)--
Inspire Pharmaceuticals, Inc. (NASDAQ: ISPH) announced today patient enrollment
is complete in three of its late-stage clinical trials.

"We are pleased to be executing on our strategic plan with the achievement of
these patient enrollment milestones in the clinical development programs for
denufosol, PROLACRIA and AZASITE®,as this places us in a position to have
top-line results from all our late-stage clinical programs within 18 months. We
would like to thank the dedicated clinical investigators, study coordinators and
patients who participated in our trials as well as the Cystic Fibrosis
Foundation and its affiliates for raising awareness of the importance of
participating in clinical trials," stated Benjamin R. Yerxa, Ph.D., Executive
Vice President and Chief, Research and Development.

Abstract: H pylori infection and blepharitis?

Glaucoma and Helicobacter pylori infection: correlations and controversies.
Br J Ophthalmol. 2009 Nov;93(11):1420-7.
Izzotti A, Saccà SC, Bagnis A, Recupero SM.
Department of Health Sciences, Faculty of Medicine, University of Genoa, Genoa, Italy.
Comment in:
Br J Ophthalmol. 2009 Nov;93(11):1413-5.

A possible association between Helicobacter pylori infection and eye diseases, including Sjögren syndrome, blepharitis, central serous chorioretinopathy and uveitis, has been proposed. Glaucoma is the second leading cause of blindness in the world, after cataracts, and the leading cause of irreversible blindness, but many aspects of its pathogenesis remain unknown. H pylori infection may influence the pathophysiology of glaucoma by releasing various proinflammatory and vasoactive substances, as well as by influencing the apoptotic process, parameters that may also exert their own effects in the induction and/or progression of glaucomatous neuropathy. It is difficult to understand how H pylori infection can be linked to such varied pathologies. Systemic H pylori-induced oxidative damage may be the mechanism which links oxidative stress, H pylori infection and the damage to the trabecular meshwork and optical nerve head that results in glaucoma.

Wednesday, November 4, 2009

Abstract: How Azasite acts on the ocular surface & lids

Very, very interesting.

Wish this stuff didn't cost more than its weight in gold.

Ocular surface distribution and pharmacokinetics of a novel ophthalmic 1% azithromycin formulation.
J Ocul Pharmacol Ther. 2009 Oct;25(5):433-9.
Akpek EK, Vittitow J, Verhoeven RS, Brubaker K, Amar T, Powell KD, Boyer JL, Crean C.
The Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.

PURPOSE: To investigate the ocular distribution of 1% azithromycin ophthalmic solution and the effect of polycarbophil-based mucoadhesive formulation on ocular tissue levels of azithromycin after single and multiple topical administrations in the rabbit eye.

METHODS: Rabbits were treated with either a single administration of 1% azithromycin solution with or without polycarbophil, or with multiple administrations of 1% azithromycin solution in polycarbophil. Drug concentrations were measured using LC/MS/MS. Conjunctiva, cornea, aqueous humor, and tear samples were analyzed over a period of 144 h after a single administration of azithromycin with or without polycarbophil. Eyelid, conjunctiva, cornea, aqueous humor, and tear samples were collected over a period of 288 h during and after multiple administrations of azithromycin.

RESULTS: Azithromycin was rapidly absorbed and distributed in the ocular tissues, reaching within 5 min, concentrations of 10,539 microg/mL in tear film, 108 microg/g in conjunctiva, and 40 microg/g in the cornea. The drug demonstrated tissue-specific half-lives of 15, 63, and 67 h, respectively. Following multiple administrations, the drug gradually accumulated. The polycarbophil formulation increased the bioavailability of the drug, producing peak concentrations that were between 5- and 12-fold higher than those without polycarbophil. Azithromycin also distributed rapidly in the eyelids, reaching peak concentrations of 180 mug/g at the end of the 7-day treatment, and was eliminated with a half-life of 125 h. Six days after treatment was discontinued, eyelid levels of azithromycin were above 40 microg/g.

CONCLUSIONS: Sustained and high concentrations were encountered with 7-day approved administration of 1% azithromycin formulation (AzaSite, Inspire Pharmaceuticals, Inc., Durham, NC) within all ocular surface tissues, particularly the lids. Many ocular surface disorders involving the tear film, eyelids, and adnexal structures are associated with chronic, low-grade bacterial infection and may potentially lead to decreased vision secondary to corneal scarring. Various topical antibiotic and steroid combinations with or without oral tetracyclines are commonly used with variable clinical response and known potential side effects. The clinical relevance of this study is unknown; however, the long-lasting antibacterial and additional anti-inflammatory properties of topical azithromycin might offer an effective alternative treatment option and should be explored further in clinical studies.

Abstract: NAAGA/Naabak eyedrops

Never heard of it. But Dr. Christophe Baudouin is generally thought to be pretty much the world expert on dry eye, so I hope to learn more.

[Evaluation of NAAGA efficacy in dry eye syndrome.]
J Fr Ophtalmol. 2009 Oct 23. [Epub ahead of print]
[Article in French]
Baudouin-Brignole F, Robert PY, Creuzot-Garcher C, Olmiere C, Delval L, Baudouin C.

Centre National d'Ophtalmologie des Quinze-Vingts et UMR_S INSERM 968, Institut de la Vision, Université Paris 6, Paris; Laboratoire de Toxicologie, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris.

OBJECTIVES: The aim of this study was to assess the efficacy of Naabak(R) eyedrops in reducing inflammation in dry eye syndrome.

PATIENTS AND METHODS: This pilot, multicenter, randomized, double-blind, parallel study was carried out in adult patients suffering from moderate dry eye syndrome. Patients were treated for three months with preservative-free NAAGA (Naabak(R)) or with sodium chloride 0.9% without preservative (Larmabak(R)). They received the treatment four to six times a day during the 1(st) month and three to four times a day during the 2(nd) and 3(rd) months. At each visit (D28 and D84), clinical tests were performed as well as a biological evaluation of HLA-DR and MUC5AC expression on conjunctival imprints using flow cytometry.

RESULTS: After three months of treatment, the ocular surface symptoms and overall discomfort were improved in patients treated with Naabak(R) and in those treated with Larmabak(R) with no significant difference between the groups. Cytological impression showed a significant decrease in the expression of inflammatory markers, notably antigen HLA-DR, in the Naabak(R) group.

CONCLUSION: This study confirms the anti-inflammatory property of preservative-free NAAGA (Naabak(R)) in the context of dry eye syndrome with a similar clinical efficacy compared to sodium chloride solution (Larmabak(R)). Naabak(R) could present an additional advantage compared to artificial tears and could be indicated in the treatment of moderate inflammatory dry eye syndrome.

Abstract: Expression of CXCL9/10/11 + CXCR3 in DES' pt tear film

...Continuing in the perennial hunt for The Dry Eye Diagnostic. Quite interesting actually.

Expression of CXCL9, CXCL10, and CXCL11, and CXCR3 in the Tear Film and Ocular Surface of Patients with Dry Eye Syndrome.
Invest Ophthalmol Vis Sci. 2009 Oct 22. [Epub ahead of print]
Yoon KC, Park CS, You IC, Choi HJ, Lee KH, Im SK, Park HY, Pflugfelder SC.

Purpose: To investigate the expression of CXCL9, CXCL10, CXCL11, and CXCR3 in the tear film and ocular surface of patients with dry eye syndrome.

Methods: Thirty-three patients with dry eye (16 Sjögren's syndrome and 17 non-Sjögren's syndrome patients) and 15 control subjects were recruited. The concentrations of CXCL9, CXCL10, and CXCL11 in tears were measured using enzyme-linked immunosorbent assay. The correlation between chemokine levels and tear film and ocular surface parameters was analyzed. Expression of CXCL9, CXCL10, CXCL11, and CXCR3 in the conjunctiva was evaluated using immunohistochemistry. Flow cytometry was performed to count CXCR3+ cells and CXCR3+CD4+ cells in the conjunctiva.

Results: The concentrations of CXCL9, CXCL10, and CXCL11 were 1,148+/-1,088, 24,338+/-8,706, and 853+/-334 pg/ml in dry eye patients, and 272+/-269 (P=0.01), 18,149+/-5,266 (P=0.02), and 486+/-175 (P<0.01) pg/ml in control subjects, respectively. The concentrations significantly increased in tears of Sjögren's syndrome patients compared with those of non-Sjögren's syndrome patients (P<0.05). CXCL10 levels correlated significantly with basal tear secretion, and CXCL11 levels correlated significantly with basal tear secretion, tear clearance rate, keratoepitheliopathy score, and goblet cell density (P<0.05). Staining for CXCL9, CXCL10, CXCL11 and CXCR3 increased in dry eye patients, especially in Sjögren's syndrome patients. Flow cytometry demonstrated an increased number of CXCR3+ cells and CXCR3+CD4+ cells in dry eye patients.

Conclusions: Expression of CXCL9, CXCL10, CXCL11, and CXCR3 increases in the tear film and ocular surface of patients with dry eye syndrome, especially in those with Sjögren's syndrome. CXCL11 levels correlate significantly with various tear film and ocular surface parameters.

Drug updates: ISTA's low-dose bromfenac

In their 3Q 2009 results, ISTA stated they expect their new low-dose bromfenac for dry eye (for which positive Phase II results were announced last spring) to enter Phase III trials in the first half of 2010.

Drug/device news: EGP-437 update

I don't think I've posted about this one before although I have it on the clinical trial roster.

EyeWorld reports from this years AAO the following:

Ionized drug demonstrates rapid onset and long-lasting action in patients with dry eye

SAN FRANCISCO — A topical dexamethasone administration that is delivered to the eye by a novel drug delivery system involving ionization of drug particles by electrical current rapidly decreases clinical signs and symptoms related to dry eye, according to a poster presented here.

In a study, patients who received either a low-dose or high-dose application of EGP-437 (dexamethasone phosphate ophthalmic solution optimized for iontophoresis, EyeGate Pharma and Ora) reported a significant decrease in ocular discomfort after exposure to a controlled adverse environmental (CAE) challenge, which exacerbates dry eye signs and symptoms, compared with placebo, according to a poster presented at the joint meeting of the American Academy of Ophthalmology and Pan-American Association of Ophthalmology.

As well, study drug patients had a significant decrease in inferior region fluorescein staining at their seventh visit compared with baseline, which "demonstrates that two EGP-437 treatments over 3 weeks, which include three CAE visits, may aid healing in this region," according to the poster.

Diagnostics: TearLab trial results

Sounds like they have made some really good progress with this now:

TearLab Presents Results of Landmark Dry Eye Trial at AAO -- PAAO 2009 Joint Meeting

SAN DIEGO, Oct. 26, 2009 (GLOBE NEWSWIRE) -- OccuLogix, Inc. dba TearLab Corporation (Nasdaq:TEAR) (TSX:TLB) announced that Gary Foulks, MD, FACS, presented the poster, "Osmolarity as a Biomarker for Disease Severity in Mild to Moderate Dry Eye Disease," from the TearLab Osmolarity Core Validation Study today at the 2009 American Academy of Ophthalmology (AAO) and Pan American Ophthalmology (PAAO) joint meeting in San Francisco, California.

Dry Eye Disease and a New Severity Index

Data from this landmark study compares the results of individual clinical evaluations to Dry Eye Disease (DED) severity. Over 300 subjects were evaluated in 10 sites worldwide, and for the first time a comprehensive index has been created to classify patients into Normal, Mild/Moderate or Severe categories using an objective and quantitative analysis.

"DED has traditionally been very difficult to diagnose in early and mild stages due to compensatory mechanisms that are in effect during the early transitory phases of the disease. This difficulty to diagnose early stage disease has long been a confounding problem to clinicians and pharmaceutical companies alike. Data from this study clearly demonstrates that in earlier stages of disease, osmolarity shows a progressive increase with increasing severity," stated Dr. Foulks.

Elias Vamvakas, Chairman and Chief Executive Officer of TearLab Corporation, commented, " We are very excited about the results of this study. The demonstrated accuracy and sensitivity of our lab-on-a-chip technology is a breakthrough that will enable doctors to easily diagnose and effectively manage patients with DED. In addition we believe the test will become the catalyst to effective drug development and appropriate prescription."

The TearLab(TM) Osmolarity System

The TearLab(TM) Osmolarity System uses a novel lab-on-a-chip approach that requires less than 50 nL (nanoliters) of tear fluid in order to measure tear osmolarity. The TearLab(TM) Osmolarity System is a breakthrough test that will enable doctors to easily diagnose and effectively manage patients with Dry Eye Disease. The TearLab(TM) Osmolarity System eliminates the challenges that previously prevented point-of-care osmolarity testing. The TearLab(TM) System can produce a sample-to-answer result in less than 30 seconds and is intended to be technician administered.

Diagnostics: Auxano's new point-of-care indicator system

I have never heard of this and the article is not particularly descriptive, so I'm just flagging it as something in the works in in-office dry eye diagnostics.

Auxano Diagnostics, LLC Announces a New Point-of-Care Indicator System for Dry Eye Syndrome

Auxano Diagnostics, LLC, a subsidiary of Auxano Biomedical, LLC, has announced
the application of the company`s breakthrough wound care technology to the
treatment of dry eye syndrome (DES) with the Auxano point-of-care indicator
system. Dry eye syndrome (DES) is a condition that affects millions of people
worldwide. According to the Centers for Disease Control (CDC), DES can be a
serious condition, which, if left untreated, can damage ocular structures....

A challenge encountered in the treatment and management of ophthalmic care is
the identification between acute and chronic inflammatory diseases that lead to
visual impairment. Currently, there are no diagnostics focused on inflammatory
eye disease, and the primary way to detect inflammation is through purely
empirical methods. Misdiagnosis can lead to additional tissue damage and
potential blindness.

A solution to proper discernment between inflammatory and non-inflammatory
conditions would result in early and correct guidance towards the appropriate
therapeutic regimen, effective tracking of treatment, enhanced patient
satisfaction, and improved outcomes.

Auxano`s system is a rapid point-of-care diagnostic indicator for ophthalmic
inflammatory diseases and has the potential to provide for accurate indications
of DES within minutes.

Abstract: Cyclosporine A not effective in thyroid orbitopathy

Here's a surprising one. If you look at the Results section, in several respects the patients with only artificial tears actually did better than those taking both cyclosporine A (Restasis) and artificial tears. Hm. Makes you wonder what artificial tear that was... among other things.

Topical cyclosporine A for the dry eye findings of thyroid orbitopathy patients.
Eye. 2009 Oct 16. [Epub ahead of print]
Altiparmak UE, Acar DE, Ozer PA, Emec SD, Kasim R, Ustun H, Duman S.

PURPOSE: To determine the beneficial effect of topically administered Cyclosporine A (CsA) for the dry eye findings of thyroid orbitopathy patients.

PATIENTS AND METHODS: This prospective pilot study included 73 eyes of 42 patients with thyroid orbitopathy who had documented dry eye findings. Patients were randomly assigned into two groups: in group 1 (48 eyes), patients received topical artificial tear-drop treatment. In group 2 (25 eyes), patients received topical CsA and artificial tear-drop treatment. During a mean follow-up of 6 months, change in Schirmer's test with aneasthesia, tear break-up-time (BUT) and impression cytology results were analyzed and were compared between groups.

RESULTS: The two groups were age (P=0.449) and gender (P=0.942) matched. The Schirmer's test (P=0.441), tear BUT (P=0.718) and impression score (P=0.103) were also similar before the treatment in both groups. In group 1, all three parameters improved significantly with treatment (P<0.001 for all). In group 2, Schirmer's test (P=0.001) and tear BUT (P<0.001) improved, but the impression score (P=0.175) did not change significantly after treatment. The percentage of patients with improved tear BUT (P=0.04) and improved impression score (P<0.001) were higher in group 1. At the end of follow-up, group 1 patients had better Schirmer's test (P=0.004), tear BUT (P=0.021) and impression scores (P<0.001), than group 2 patients.

CONCLUSIONS: The combined CsA use with artificial tear drops is not more advantageous than the use of artificial tear drops alone, for the dry eye findings of thyroid orbitopathy patients.

Tuesday, November 3, 2009

Allergan's lawsuit

Allergan Files Federal Lawsuit to Allow It to Share Relevant Information with the Medical Community on the Safe Use of BOTOX(R) for Common Therapeutic Off-Label Treatments

Did I ever do a double-take when I saw THAT headline. It sounds just too delectably, archetypically appropriate to our times.

First, allow me to translate: Allergan (the company that sells Restasis as well as Botox) is suing the US government for the right to market Botox for uses for which it has not been approved but which doctors use it for anyway.

Now, for those of you who aren't familiar with the concept of "off-label": Drugs and devices are approved by the FDA for specific indications - that is, for a very carefully defined use in treating a disease or other condition. The company can only market it for the specified indication(s) - however, doctors are not restricted in what they can choose to prescribe or use it for. Once approved, the product gradually gets used more and more by doctors and as they gather more clinical experience with it often it gets used for different purposes than that for which it was approved. Some of these remain relatively rare, and some become commonplace. Some companies seek a new approval for the new use that it's showing good results in, if they're able to prove those results objectively. Some don't. And now, apparently, some sue the FDA instead.

An example of how 'off-label' works is excimer lasers, used to perform LASIK and PRK. Individual companies' excimer lasers were originally approved for PRK, but when LASIK was developed, they began using it for that, as far back as 1995 - while the very earliest laser to actually be approved for LASIK received its approval in 2000. (Or was it 99? Anyway, at least a 4-year gap.) Likewise, though excimer lasers are approved for LASIK and have been used for repeat LASIK procedures for more than a decade (procedures typically called 'enhancements' or 'touch-ups', the lasers themselves were never approved for anything but a primary treatment. What this means in practice for those using the lasers is that (among other things) they cannot advertise these 'off-label' procedures and they must inform the patients that the procedure is an off-label procedure. So if you've ever had a LASIK 'enhancement', and are scratching your head over the idea that it was not an approved procedure, if you go back and look at your paperwork you'll probably find the phrase "off-label" tucked away in there somewhere.

Anyway, the same holds true for drugs. Azasite, for example - the new bleph wonderdrug du jour. It was approved for treating bacterial conjunctivitis. Lo and behold, it's been found to be so helpful in many cases of meibomian gland dysfunction that it's being Rx'd left and right. On the other hand, Inspire, instead of suing the government, are simply applying for FDA approval to sell Azasite for more uses than the originally approved use (indication).

Now I'll try my best to stop pontificating and just report the news straight from the horse's mouth.

IRVINE, Calif., Oct 01, 2009 (BUSINESS WIRE) -- Allergan, Inc. (NYSE: AGN) today filed a declaratory relief action in the United States District Court for the District of Columbia seeking a ruling that would allow Allergan to proactively share truthful and relevant information with the medical community to assist physicians in evaluating the risks and benefits of BOTOX(R) (onabotulinumtoxinA) for certain "off-label" therapeutic uses. Some of these off-label uses are medically accepted and commonly prescribed but currently unapproved by the United States Food and Drug Administration (FDA). In the lawsuit, Allergan contends that the Government's legal position that it is a crime for a pharmaceutical company to proactively communicate truthful information to physicians about off-label uses of its products violates the First Amendment and is inconsistent with the Federal Food, Drug & Cosmetic Act. The lawsuit does not involve BOTOX(R) Cosmetic.

My heart bleeds for all the innocent sales reps anxious to proactively share truthful and relevant information - or even conscientiously sharing said truthful and relevant information and causing their company to be wrongfully investigated by the FTC or FDA....

I shudder at the thought of a pharma being deprived by our very own government of its first amendment rights and the potential to turn a ten digit annual revenue into an eleven digit annual revenue without a two-year delay to definitively establish safety and efficacy for an additional indication. Surely someone somewhere has written a folk song about that....

After all, what reasonable individual would expect a multinational pharmaceutical company to put their drug through clinical trials and the FDA approval process a second time, when we all know it's probably more or less safe and effective for the additional indication anyway? I mean honestly. There is just something too utterly twentieth-century about that whole process.

Oops. Well, I said I'd try.

So, by now you think I'm way too far gone in anti-pharma prejudice and cynicism to have any reasonable opinion to share on the subject. I do have some understanding of the counter arguments. And here's an op-ed piece in the Washington Examiner which presents a decent case for lifting the ban on offlabel marketing. I know off-label usages are the norm these days, and I know there are benefits. But there are also tradeoffs - which will increase if Allergan win this thing.

Drug news: Macusight receives fast track status for Perceiva

MacuSight(R) Receives Fast Track Designation From FDA for Perceiva(TM) in Treatment of Diabetic Macular Edema

As reported previously, Macusight has Perceiva (ocular sirolimus) in four different Phase II trials, one of which is for dry eye. Perhaps with their new fast track designation in one indication, the other indications will enjoy some benefit along the way....

..."By granting Fast Track status to Perceiva for the treatment of DME, the leading cause of vision loss among working-age adults, FDA is providing an accelerated pathway for delivering this potentially important therapeutic to patients in need of effective treatment options," stated Joel Naor, M.D., chief medical officer of MacuSight. "Based on our clinical research to date with Perceiva in DME patients, we believe that this drug candidate may offer those patients a safe and effective treatment. We remain focused on advancing the clinical development of Perceiva for DME and other ocular diseases in as expeditious a manner as possible and look forward to announcing data from our Phase 2 clinical program in the first half of 2010."

Latest FDA follow-up to 2008 hearing: New study being launched

FDA to study negative effects of Lasik eye surgery

WASHINGTON — The Food and Drug Administration announced plans Thursday to study the scope of problems connected with laser eye-correcting surgery, which include blurred vision and dry eyes.

The FDA says it will work with the National Eye Institute and the Department of Defense to determine the percentage of patients who experience negative side effects following surgery.

The first phase of the project is already under way, with plans for an online questionnaire to help patients gauge their quality of life following surgery, according to an FDA statement.

The project will also include a clinical trial tracking patients who undergo the procedure, which is expected to conclude by 2012.

Turning around a sour Restasis experience

Some of you may have read earlier coverage like this old post about financial disputes emanating from Restasis' troubled past.

I was interested to read recently that Restasis inventor Renee Kaswan has started a nonprofit website, IP Advocate. She's using her experience of getting the short end of the Restasis stick to work to help other researchers navigate the complex world of intellectual property rights. I love seeing negative experiences be put to work for good.

Dr. Kaswan has quite an ambitious agenda for her new nonprofit:

To SERVE as a repository of Intellectual Property (IP) Best Practices.
To PROMOTE ethical commercialization of innovations on behalf of the public welfare.
To ENCOURAGE mutually beneficial relationships between institutions of higher learning and their researchers.
To CULTIVATE innovation in American universities as a valuable national resource.
To ESTABLISH a forum for open dialogue and information exchange among faculty, students, researchers and other interested parties.

General press coverage of dry eye: What they're reporting

I get a daily google news alert on dry eye.

Usually the vast majority of news reports that it flags are descriptions of some kind of event or ceremony where the journalist says "There was not a dry eye in the house." Gotta love the originality. Every now and then there are actually truly relevant links - pharmaceutical company updates for the most part. And then there's the slow news day health reports relating to dry eye. I've seen the quality and frequency of such reports ebb and flow quite a bit in the years since launching DEZ, from the ubiquitous Restasis infomercials to the computer-vision-syndrome warnings. Wish I had a nickel for every one of them that's been titled "Not a dry eye in the house".

But as a general trend, this year I'm seeing a far greater proportion of these alerts actually having substantive business and treatment content, reflecting the much increased attention to the need for better dry eye treatments. A very hopeful sign.

Meantime, in 'general press', infomercials, Dry Eye 101 newspaper writeups, dog owner tips, and local service- or product pushing press releases, here's a flavor of what's being reported about dry eye these days:

Smaller Screens Mean Bigger Eye Health Issues (Health News Digest)
“While these small and highly productive devices may make us more efficient work-wise, they are causing unprecedented levels of CVS symptoms in patients of all ages — we’ve seen a dramatic increase in the number of patients we see monthly for CVS,” said Dr. Harvey Moscot, a renowned Optometrist in New York City and a CVS specialist who is presently conducting a CVS study to evaluate the effectiveness of specialized lenses for the reduction of CVS symptoms.

Zapping Dry Eye (ABC)
Dry eye is a condition that affects tear production and/or drainage. Patients may complain of eye stinging, burning, irritation or discomfort. Vision may be blurred, causing difficulty viewing a computer monitor, watching television or seeing clearly while driving....
Christopher Coad, M.D., Ophthalmologist at Chelsea Eye & Cosmetic Surgery Associates in New York City, is using a technique for some dry eye patients called intense pulsed light therapy (IPL). IPL is sometimes used to reduce facial skin redness caused by growth of abnormal blood vessels in patients with rosacea. Doctors noticed that some rosacea patients reported easing of dry eye symptoms after getting IPL. That finding led physicians to try it for patients with dry eye.

Worn at night, ortho k lenses are taken out in the day, meaning that the eye is open to elements and less likely to become oxygen starved - and consequently dry.

Orthokeratology lenses also mean that a wearer can avoid having the annoyance of getting things stuck to lenses during the day or having them fall out at awkward moments.

Lack of tears in animals can lead to blindness (
Keratoconjunctivitis sicca, or KCS, is a condition that occurs in dogs and cats, and often called dry eye.

Animals with KCS can't make enough tears. While this might seem like a desirable situation if you routinely deal with tear-staining on the fur of your fluffy white dog, uncontrolled KCS can cause pain, corneal ulcers and even blindness.

Dry Eye in Dogs (The Nassau Guardian)
Numerous breeds of dogs are at risk for developing KCS including the West Highland White Terrier, English Bulldog, Pug, Shih Tzu, American Cocker Spaniel, Lhasa Apso and Pekingese.

Tips to winterize your eyes (
Dr. Marguerite McDonald, a cornea/refractive/anterior segment specialist with the Ophthalmic Consultants of Long Island and a clinical professor of ophthalmology at NYU School of Medicine in New York, says that during winter months, men and women can guard against dry eye symptoms at home, at work and when traveling by following these simple tips:

Tip No. 1: Keep moisture in and smoke out of your home....
Tip No. 2: Take blinking breaks at work....
Tip No. 3: Keep hydrated inside and out when traveling....
Tip No. 4: Relief over the counter and at your doctor's office....

Why are your eyes dry? (
Our eyes are naturally kept moist by a thin layer of tears which are necessary for good vision. These tears consist of three parts: an oily or lipid layer, a watery layer, and a mucus layer. The ratio between these parts is critical to maintaining the best consistency in our tears. Your eyes may feel dry if you are not producing enough tears, or if your tears are the wrong consistency and evaporate too quickly. A variety of other factors can contribute to the feeling that your eyes are dry....

New treatments for dry eye (
Higher concentration Cyclosporine A – If the dry eyes are not responding to Restasis, a stronger concentration of Cyclosporine A, such as 1% for example, can be formulated at special compounding pharmacies and used to treat dry eyes resistant to other treatments
Other steroids – dexamethasone eye drops can be formulated at special compounding pharmacies as well to treat dry eyes
Hormone eye drops – DHEA is an androgen that can be formulated into an eye drop and used to treat dry eyes, especially in peri- or pos-menopausal women
Intense Pulsed Light (IPL) – is commonly used as a treatment for skin rejuvenation. New evidence suggests that Intense Pulsed Light can also be used to treat improper functioning of the oil glands in the lids and improve the lipid layer of the tear film.

Fish Oil May Fight Dry Eye Syndrome (
Dry eye syndrome in women may be linked to their intake of dietary fat. But consuming foods rich in omega-3 -- such as tuna -- may reduce dry eye risk by 68 percent, according to a new U.S. study....
"We found that a high intake of omega 3 fatty acids, often referred to as a ’good’ fat, commonly found in fish and walnuts, is associated with a protective effect. Conversely, a higher ratio of omega 6, a fat found in many cooking and salad oils and animal meats, compared to omega 3 in the diet, may increase the risk of dry eye syndrome," Miljanovic said.

Say Goodbye to Gamer's Dry Eye ( Also see my previous post with a pic of the Wink Glasses.
The Japanese company that designed Sarah Palin's thin-rimmed specs has released a new set of glasses to fight "dry eye." The condition affects gamers, readers and others who stare at screens or pages for long stretches of time, causing a lower than average blinking rate.

Masunaga Optical Manufacturing Co.'s new Wink Glasses feature a tiny sensor that monitors the wearer's eye-blink activity. If the users' eyes go more than five seconds without blinking, tiny liquid crystals cause the lenses to become opaque, fogging vision. The wearer is forced to blink, after which the lenses immediately de-frost.

The high-tech glasses protect customers' eyes from fatigue and dehydration. But, they're not cheap, be ready to shell out $430.

Monday, November 2, 2009

Study: Calcineurin inhibitors for bleph

There is only a tiny summary of this available on PubMed but it looks extremely interesting. Hopefully I will be able to get more information from the authors and if so I will post it separately.

Treatment of chronic blepharokeratoconjunctivitis with local calcineurin inhibitors

Ophthalmologe. 2009 Jul;106(7):635-8.
Auw-Hädrich C, Reinhard T.

Topical calcineurin inhibitors (cyclosporin A 1%, FK506, pimecrolimus) can be useful for treating chronic blepharokeratoconjunctivitis in addition to lid hygiene and lubricants. This treatment leads to an improvement of dry eye symptoms and reduces inflammation.