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Drake TN, Sheppard JD. Impact of Neurostimulation, Immunomodulation, Topical Medication Application, and Surgical Reconstruction on Corneal Nerve Function and Regeneration. Eye Contact Lens 2024:00140068-990000000-00235. [PMID: 39392164 DOI: 10.1097/icl.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 10/12/2024]
Abstract
ABSTRACT The corneal epithelium, supplied by thousands of nerve endings, plays a substantial role in absorbing and distributing nutrients along the ocular surface. Many studies have explored the influence of various modalities in regulating tear production to manage corneal disorders and dry eye disease. These findings have highlighted the advantages of enhancing corneal nerve function and regeneration through neurostimulation, neural signaling, immunomodulation, topical medication application, and surgical reconstruction. The purpose of this narrative review article was to provide an overview of the current state of knowledge on this topic based on a PubMed database literature search for relevant animal and human studies investigating the modification of the trigeminal pathway to restore corneal nerve function and improve overall ocular health. Further investigation into this area of research is important to help guide new therapeutic targets for the prevention and development of treatments of corneal degeneration.
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Affiliation(s)
- Taylor N Drake
- Eastern Virginia Medical School (T.N.D., J.D.S.), Department of Ophthalmology, Norfolk, VA; and Virginia Eye Consultants/EyeCare Partners (J.D.S.), Norfolk, VA
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Gupta PK, Toyos R, Sheppard JD, Toyos M, Mah FS, Bird B, Theriot PE, Higgins D. Tolerability of Current Treatments for Dry Eye Disease: A Review of Approved and Investigational Therapies. Clin Ophthalmol 2024; 18:2283-2302. [PMID: 39165367 PMCID: PMC11334916 DOI: 10.2147/opth.s465143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/06/2024] [Indexed: 08/22/2024] Open
Abstract
Dry eye disease (DED) is a common, multifactorial ocular disease impacting 5% to 20% of people in Western countries and 45% to 70% in Asian countries. Despite the prevalence of DED and the number of treatment approaches available, signs and symptoms of the disease continue to limit the quality of life for many patients. Standard over-the-counter treatment approaches and behavior/environmental modifications may help some cases but more persistent forms often require pharmacological interventions. Approved and investigational pharmaceutical approaches attempt to treat the signs and symptoms of DED in different ways and tend to have varying tolerability among patients. While several pharmacological approaches are the standard for persistent and severe disease, mechanical options provide alternate treatment modalities that attempt to balance efficacy and comfort. Newer approaches target the causes of DED, utilizing novel delivery methods to minimize irritation and adverse events. Here, we review approved and investigational approaches to treating DED and compare patient tolerability.
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Affiliation(s)
- Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA
- Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | | | | | | | | | - Brian Bird
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Don Higgins
- Dry Eye Treatment Center of Connecticut, Plainville, CT, USA
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Hu J, Ju M, Shi Y, Liu X, Zhu Y. Efficacy and safety of trigeminal parasympathetic pathway stimulation for dry eye: A systematic review and meta-analysis. Indian J Ophthalmol 2024; 72:S381-S392. [PMID: 38454841 PMCID: PMC467035 DOI: 10.4103/ijo.ijo_2147_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/04/2023] [Accepted: 11/28/2023] [Indexed: 03/09/2024] Open
Abstract
This study aimed to investigate the efficacy and safety of trigeminal parasympathetic pathway (TPP) stimulation in the treatment of dry eye. A comprehensive search for randomized clinical trials was performed in seven databases (MEDLINE, Embase, CENTRAL, etc.) up to 28 February 2023. After screening the suitable studies, the data were extracted and transformed as necessary. Data synthesis and analysis were performed using Review Manager 5.4, and the risk of bias and quality of evidence were evaluated with the recommended tools. Fourteen studies enrolling 1714 patients with two methods (electrical and chemical) of TPP stimulation were included. Overall findings indicate that TPP stimulation was effective in reducing subjective symptom score (standardized mean difference [SMD], -0.45; 95% confidence interval [CI], -0.63 to -0.28), corneal fluorescence staining (mean difference [MD], -0.78; 95% CI, -1.39 to -0.18), goblet cell area (MD, -32.10; 95% CI, -54.58 to -9.62) and perimeter (MD, -5.90; 95% CI, -10.27 to -1.53), and increasing Schirmer's test score (SMD, 0.98; 95% CI, 0.65 to 1.31) and tear film break-up time (SMD, 0.57; 95% CI, 0.19 to 0.95). Compared to inactive or low-activity stimulation controls, it has a higher incidence of adverse events. Therefore, TPP stimulation may be an effective treatment for dry eye, whether electrical or chemical. Adverse events are relatively mild and tolerable. Due to the high heterogeneity and low level of evidence, the current conclusions require to be further verified.
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Affiliation(s)
- Jindong Hu
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Department of Integrative Medicine, Baoshan Campus of Huashan Hospital, Fudan University, Shanghai, China
| | - Mohan Ju
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Yongjun Shi
- Department of Anesthesiology, Yichun Hospital of Traditional Chinese Medicine, Yichun, Jiangxi, China
| | - Xinquan Liu
- Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongbao Zhu
- Department of Oncology, Shanghai Baoshan Luodian Hospital, Shanghai University, Shanghai, China
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Ballesteros-Sánchez A, Borroni D, De-Hita-Cantalejo C, Sánchez-González MC, Sanchez-Gomez S, Rocha-de-Lossada C, Sánchez-González JM. Efficacy of bilateral OC-01 (varenicline solution) nasal spray in alleviating signs and symptoms of dry eye disease: A systematic review. Cont Lens Anterior Eye 2024; 47:102097. [PMID: 38065797 DOI: 10.1016/j.clae.2023.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE To comprehensively review the efficacy and safety of OC-01 varenicline nasal spray versus vehicle nasal spray (VNS) in the treatment in dry eye disease (DED). METHODS A systematic review that included full-length randomized controlled studies (RCTs), as well as post hoc analyses of RCTs reporting new findings on OC-01 VNS treatment in three databases, PubMed, Scopus and Web of Science, was performed according to the PRISMA statement. The search period included studies published between December 2021 and September 2023. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. RESULTS A total of 8 studies were included in this systematic review. OC-01 VNS treatment achieved higher improvement than vehicle in all reported variables. The mean differences between both groups were in favor of OC-01 VNS treatment and were as follow: eye dryness score base on a visual analogue scale (EDS-VAS) of -7.5 ± 2.2 points [-11.6 to -5.6], Schirmer test (ST) with anesthesia of 6.6 ± 2.3 mm [4.9 to 11.8] and total corneal fluorescein staining (tCFS) of -1.2 ± 0.01 points [-1.2 to -1.1]. Similar improvements were reported with OC-01 VNS 0.03 mg and 0.06 mg. Adverse events (AEs) were 15.5 ± 19.4 % [-13 to 80.5] higher in the OC-01 VNS group with an overall adherence > 93 %. CONCLUSIONS OC-01 VNS improves dry eye symptoms and signs with a satisfactory tolerability. Therefore, OC-01 VNS seems to be a safe and effective treatment that could be recommended in patients with DED. This new treatment could be particularly useful in those patients who have difficulties with the administration of traditional topical therapies.
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Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Seville, Spain; Department of Ophthalmology, Clínica Novovisión, Murcia, Spain.
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia; Advalia Vision, Cornea Research Unit, 20145 Milan, Italy
| | | | | | - Serafin Sanchez-Gomez
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Carlos Rocha-de-Lossada
- Ophthalmology Department, VITHAS Malaga, 29016 Malaga, Spain; Regional University Hospital of Malaga, Hospital Civil Square, 29009 Malaga, Spain; Qvision, Ophthalmology Department, VITHAS Almeria Hospital, 04120 Almeria, Spain; Surgery Department, Ophthalmology Area, University of Seville, Doctor Fedriani, 41009 Seville, Spain
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Manohar D, Shtein RM. Update on pharmacotherapy for dry eye. Curr Opin Ophthalmol 2023; 34:550-554. [PMID: 37326227 DOI: 10.1097/icu.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE OF REVIEW This review provides an overview of pharmacologic treatments for dry eye disease (DED), with a focus on newer developments. RECENT FINDINGS Along with the existing treatments, there are several new pharmacologic treatments available and being developed for DED. SUMMARY There are many currently available options for treatment of DED, and ongoing research and development to expand potential treatments for patients with DED.
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Affiliation(s)
- Divya Manohar
- University of Michigan, Kellogg Eye Center, Ann Arbor, Michigan, USA
- Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Roni M Shtein
- University of Michigan, Kellogg Eye Center, Ann Arbor, Michigan, USA
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Nijm LM, Zhu D, Hemphill M, Blemker GL, Hendrix LH, Kabat AG, Gibson AA. Does Menopausal Status Affect Dry Eye Disease Treatment Outcomes with OC-01 (Varenicline Solution) Nasal Spray? A Post Hoc Analysis of ONSET-1 and ONSET-2 Clinical Trials. Ophthalmol Ther 2023; 12:355-364. [PMID: 36401081 PMCID: PMC9834459 DOI: 10.1007/s40123-022-00607-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This study sought to compare the efficacy of OC-01 (varenicline solution) nasal spray for treatment of dry eye disease (DED) in postmenopausal women (PM+) versus women who were not postmenopausal (PM-). METHODS This was a post hoc subgroup analysis of data integrated from two prior randomized controlled clinical trials, ONSET-1 and ONSET-2. Women randomized to treatment with OC-01 (varenicline solution) nasal spray 0.03 mg or vehicle control (VC) whose self-reported menopausal status (PM+ versus PM-) was known were included. Outcomes included the treatment difference (the OC-01 [varenicline solution] nasal spray change from baseline [CFB] minus VC CFB) in Schirmer test score (STS, mm) with anesthesia and the eye dryness score (EDS) measured on a 100-mm visual analog scale (0 = no discomfort, 100 = maximal discomfort). Least-squares mean treatment differences were derived from analysis of covariance (ANCOVA) models. RESULTS Overall, 449 female participants in the ONSET-1 and ONSET-2 trials randomized to the OC-01 (varenicline solution) nasal spray 0.03 mg or VC groups were included in this analysis. The treatment-menopausal status interaction terms in the STS and EDS ANCOVA and logistic regression models were not statistically significant (p > 0.05), indicating consistency of treatment effect between the PM- and PM+ groups. The treatment difference in STS was similar in the PM- and PM+ groups (6.7 and 5.5 mm, respectively). The treatment difference in EDS was similar in the PM- and PM+ groups (- 5.5 and - 4.1, respectively). CONCLUSIONS OC-01 (varenicline solution) nasal spray demonstrated similar efficacy in promoting natural tear production and improving symptoms in both PM- and PM+ groups. As menopausal-related hormonal changes may be associated with more severe DED, these results may support OC-01 (varenicline solution) nasal spray as an effective treatment for DED in women regardless of presenting menopausal status. TRIAL REGISTRATION Post hoc subgroup analysis of data integrated from ONSET-1 (ClinicalTrials.gov identifier NCT03636061) and ONSET-2 (ClinicalTrials.gov identifier NCT04036292).
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Affiliation(s)
- Lisa M. Nijm
- Warrenville Eyecare & LASIK, Warrenville, IL USA ,Illinois Eye and Ear Infirmary, Chicago, IL USA
| | - Dagny Zhu
- NVISION Eye Centers, Rowland Heights, CA USA
| | - Mandy Hemphill
- Oyster Point Pharma, 202 Carnegie Center, Suite 106, Princeton, NJ 08540 USA
| | - Gretchen L. Blemker
- Oyster Point Pharma, 202 Carnegie Center, Suite 106, Princeton, NJ 08540 USA
| | - Laura H. Hendrix
- Oyster Point Pharma, 202 Carnegie Center, Suite 106, Princeton, NJ 08540 USA
| | - Alan G. Kabat
- Oyster Point Pharma, 202 Carnegie Center, Suite 106, Princeton, NJ 08540 USA ,Salus University, Elkins Park, PA USA
| | - Andrea A. Gibson
- Oyster Point Pharma, 202 Carnegie Center, Suite 106, Princeton, NJ 08540 USA
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Giannaccare G, Vaccaro S, Pellegrini M, Borselli M, Carnovale Scalzo G, Taloni A, Pietropaolo R, Odadi AS, Carnevali A. Serial Sessions of a Novel Low-Level Light Therapy Device for Home Treatment of Dry Eye Disease. Ophthalmol Ther 2023; 12:459-468. [PMID: 36484948 PMCID: PMC9834479 DOI: 10.1007/s40123-022-00619-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate the changes that a recently developed at-home device using low-level light therapy (LLLT) produced in signs and symptoms of patients with dry eye disease (DED) owing to meibomian gland dysfunction (MGD). METHODS In this prospective study, patients with DED owing to MGD not successfully responding to first-line therapy (tear substitutes and eye lid hygiene) were treated with four serial sessions (every other day) of mask based on LLLT technology and dedicated for home use (my-mask®, Espansione Marketing S.p.A., Bologna, Italy). Non-invasive ocular surface examination was carried out by means of Keratograph 5M (Oculus, Wetzlar, Germany) before and after four mask sessions for the evaluation of (i) tear meniscus height (TMH); (ii) first and average non-invasive Keratograph breakup time (NIKBUT); (iii) meibomian gland loss (MGL). Ocular Surface Disease Index (OSDI) questionnaire was used to assess ocular discomfort symptoms. RESULTS Overall, 17 patients (3 male, 14 female; mean age 61.47 ± 11.93 years) were enrolled and all of them regularly completed the entire cycle of four sessions without reporting any adverse event. The mean values of NIKBUT first and NIKBUT average increased significantly after treatment (from 5.29 ± 2.60 at T0 to 9.04 ± 3.49 s at T1 [P = 0.001] and from 9.40 ± 3.81 to 11.28 ± 2.81 s [P = 0.017]); in parallel, the mean value of TMH increased significantly from 0.27 ± 0.06 to 0.32 ± 0.09 mm (P = 0.029). Conversely, there were not statistically significant differences for MGL (P = 0.346). In addition, the mean value of OSDI score decreased after treatment (from 32.00 ± 7.96 at T0 to 20.71 ± 8.03 at T1; P < 0.001). CONCLUSIONS One week of serial sessions of a newly developed LLLT device for home use significantly improved tear film production and stability along with ocular discomfort symptoms in patients with DED owing to MGD. These findings open up a new scenario for patients with MGD who can enjoy the unique benefits of LLLT at home.
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Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Sabrina Vaccaro
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy ,Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy ,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy
| | - Massimiliano Borselli
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Giovanna Carnovale Scalzo
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Rocco Pietropaolo
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | | | - Adriano Carnevali
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
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Abstract
Increasing endogenous tear film production via pharmacological neuroactivation of the nasolacrimal reflex [NLR; also known as the trigeminal parasympathetic pathway (TPP)] is a novel therapeutic approach to treating dry eye disease (DED). An intranasal formulation of the water-soluble, small-molecule, nicotinic acetylcholine receptor (nAChR) agonist varenicline (Tyrvaya™) has been approved in the USA for the treatment of DED. Twice-daily administration of varenicline solution nasal spray resulted in rapid, statistically significant and clinically meaningful improvements in the signs and symptoms of DED over a period of 4 weeks in two pivotal studies (ONSET-1 and -2). The efficacy of varenicline solution was maintained over a longer-term period of 12 weeks in a third study (MYSTIC). Consistent with the nasal route of delivery, the most common adverse events reported by varenicline solution recipients were non-ocular in nature (mild and transient sneezing and cough). Thus, varenicline solution nasal spray is a rapidly-acting, effective and generally well tolerated treatment for DED that offers several potentially useful advantages over existing topical ocular therapies in terms of increasing endogenous tear secretion and reducing ophthalmic treatment burden. Dry eye disease (DED) is a common, often chronic, condition characterized by symptoms, such as irritation and blurred vision, that can negatively impact on quality of life. DED occurs due to the production of insufficient or unstable tear films and is typically treated with topically applied artificial tears and medications that reduce accompanying inflammation of the ocular surface. Using an intranasal formulation of the nicotinic acetylcholine receptor (nAChR) agonist varenicline (Tyrvaya™) to enhance natural tear production represents a novel approach to DED treatment. Varenicline solution nasal spray led to fast and sustained improvements in the signs and symptoms of DED in clinical trials of up to 12 weeks’ duration. Varenicline solution was also generally well tolerated, with the most common adverse events being mild and transient sneezing and cough. Varenicline solution nasal spray is a new type of treatment for DED that may increase natural tear production, have better ocular tolerability and, for some patients, be easier and/or more convenient to use compared with traditional topical therapies.
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Affiliation(s)
- James E Frampton
- Springer Nature, Mairangi Bay, Private Bag 65901, Auckland, 0754, New Zealand.
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