Improving Tolerance and Compliance with Topical Immunomodulators Using Micro-Emulsion Lipid Layer Artificial Tears

• Main Authors: Epitropoulos AT, Therattil A, Periman LM, Rosenberg ED
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-07-01
• Series: Clinical Ophthalmology
• Subjects: dry eye disease; cyclosporine; lifitegrast; artificial tears
• Online Access: https://www.dovepress.com/improving-tolerance-and-compliance-with-topical-immunomodulators-using-peer-reviewed-article-OPTH
• ISSN: 1177-5483

Alice T Epitropoulos,1 Anthony Therattil,2 Laura M Periman,3 Eric D Rosenberg4 1Ophthalmic Surgeons & Consultants of Ohio, The Eye Center of Columbus, Department of Ophthalmology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; 2New York Medical College, School of Medicine, Valhalla, NY, USA; 3Periman Eye Institute, Seattle, WA, USA; 4Weill-Cornell Medical College, Department of Ophthalmology, New York, NY, USACorrespondence: Alice T EpitropoulosOphthalmic Surgeons & Consultants of Ohio at the Eye Center of Columbus, 262 Neil Ave #430, Columbus, Ohio 43215 Tel [phone]Email [e-mail]: To investigate the efficacy of a micro-emulsion (ME) lipid layer artificial tear in improving tolerance of immunomodulator eye drops for the treatment of dry eye disease.Patients and Methods: A total of 33 patients with previously diagnosed dry eye disease were given the micro-emulsion lipid layer artificial tear in conjunction with either lifitegrast or cyclosporine. Patients were queried on their tolerance of the regimen by reporting VAS scores before starting the adjunctive eye drop, immediately after starting, and 2– 3 weeks later. Tolerance was statistically compared over time and with respect to previous medication compliance, timing of the adjunctive eye drop, age, gender, and ethnicity.Results: Across all patients, the VAS pre-treatment score (6.8 ± 0.6) was significantly higher than both the VAS 1-day post ME lipid tear instillation time point (3.0 ± 0.7) (post hoc Bonferroni, p < 0.001) and the VAS 2– 3-week post instillation time point (1.7 ± 0.7) (post hoc Bonferroni, p < 0.001), with the mean VAS score improving over time (post hoc Bonferroni, p < 0.028). Average VAS scores did not vary with respect to specific medical therapy or the timing of instillation of this artificial tear. Both the “at-risk” and “conversion” groups independently had significant improvements at both 1-day and 2– 3-week time points compared to baseline.Conclusion: The micro-emulsion lipid layer artificial tear was effective as an adjunctive eye drop to improve tolerance of lifitegrast and cyclosporine for patients with dry eye disease who were at risk of failing or had previously failed immunomodulatory therapy.Keywords: dry eye disease, cyclosporine, lifitegrast, artificial tears