New treatment for dry eye disease now PBS listed

Australians living with persistent dry eye disease (DED) can now access a new, preservative-free, hydrating and lubricating emulsion — Cationorm — available on the Pharmaceutical Benefits Scheme (PBS).

Delivered in a 10 mL multidose bottle, the treatment uses cationic nanoemulsion technology to protect the ocular surface, reducing discomfort and irritation due to persistent dry eye caused by prolonged use of contact lenses or environmental conditions.

Dry eye is a common ophthalmic disease, characterised by a loss of homeostasis of the tear film, accompanied by symptoms such as irritation, pain, dryness, foreign body sensation and fluctuations in visual disturbance.

According to In2Eyes Optometrist and Director of Dry Eye Group Jason Teh, the availability of an additional, preservative-free treatment option for DED is a welcome step for clinicians and patients.

“It’s estimated that tens of millions of people worldwide are affected by DED, with the prevalence, involving symptoms with or without clinical signs, ranging from approximately 5 to 50%.

“Importantly, patients often present with a lack of correlation between signs and symptoms. In fact, several studies have demonstrated less than 60% of those showing objective evidence of DED are symptomatic,” Teh said.

“While the full impact of DED on a patient’s quality of life (QoL) is not easily quantifiable, the economic burden and impact of DED on vision, QoL and work productivity is considerable.”

The management of DED is highly complicated due to its multifactorial aetiology.¹ In severe cases, and in the latter stages of DED, conjunctival scarring, filamentary keratitis, epithelial defects and corneal ulceration may also occur.^2,3 If managed inappropriately, or left untreated, DED can lead to keratitis (inflammation of the cornea) and, ultimately, loss of vision.^4,5

Contact lens wearers have been found to be more than twice (2.38) as likely to have a diagnosis of DED, compared with non-contact lens wearers.^6,7 Due to the COVID-19 pandemic, a marked increase in dry eye symptoms among regular mask users has been reported, including among those who had never previously experienced dry eye.⁸ Moreover, the surge in virtual remote learning and working from home, coupled with governmental measures to encourage stay-at-home practices to help minimise the spread of the virus, has driven a substantial increase in the use of digital media, such as desktops, laptops, tablet computers and mobile devices.⁹

“Decreased blinking during extended visual tasks, such as computer use, watching television and prolonged reading, are some external factors known to precipitate and exacerbate dry eye,” Teh explained.

“Furthermore, in the younger population, DED is growing more common due to the surge in digital screen time.

“Indoor environmental factors, including air conditioning, ceiling fans and forced air heating systems, can all lower humidity and exacerbate tear evaporation, causing dry eye symptoms.”

Dr Jonathan Anderson, Seqirus Head of Medical Affairs Asia Pacific, said the company is committed to pursuing innovative treatment options for eye care.

“DED represents the most common reason for seeking medical eye care, with one in four patients who visit ophthalmic clinics reporting symptoms of the disease.

“The reimbursement of an additional treatment option for DED represents a significant milestone for Seqirus in addressing a common and chronic disease afflicting many Australians,” Dr Anderson said.

Increased osmolarity associated with DED activates an inflammatory cascade at the ocular surface that initiates epithelial damage, apoptosis of the cells of the conjunctiva and cornea, and altered mucin production.^4,10 This exacerbates instability of the tear film, thereby increasing hyperosmolarity and contributing to a vicious cycle of chronic ocular dryness, further ocular surface damage and self-perpetuating symptoms.^4,10-12

Although a mainstay of therapy, ocular lubricants (eg, artificial tears) mainly provide palliative relief.¹³ Treatment strategies for DED involving topical instillation of artificial tears or lubricating gels do not adequately address the pathophysiology.^4,10

“Due to the chronic and often self-perpetuating nature of this disease, an additional treatment option should, therefore, be appreciated, by those living with DED,” Teh said.

References

1. Şimşek, C., et al., Current Management and Treatment of Dry Eye Disease. Turkish journal of ophthalmology, 2018. 48(6): p. 309-313.

2. Messmer, E.M., The pathophysiology, diagnosis, and treatment of dry eye disease. Deutsches Arzteblatt international, 2015. 112(5): p. 71-82.

3. Pisella, P.-J., et al., Topical ocular 0.1% cyclosporine A cationic emulsion in dry eye disease patients with severe keratitis: experience through the French early-access program. Clinical ophthalmology (Auckland, N.Z.), 2018. 12: p. 289-299.

4. Baudouin, C., et al., A randomized study of the efficacy and safety of 0.1% cyclosporine A cationic emulsion in treatment of moderate to severe dry eye. Eur J Ophthalmol, 2017. 27(5): p. 520-530.

5. Leonardi, A., B. Flamion, and C. Baudouin, Keratitis in Dry Eye Disease and Topical Ciclosporin A. Ocular Immunology and Inflammation, 2017. 25(4): p. 577-586.

6. Stapleton, F., et al., TFOS DEWS II Epidemiology Report. The Ocular Surface, 2017. 15(3): p. 334-365.

7. Kojima, T., Contact Lens-Associated Dry Eye Disease: Recent Advances Worldwide and in Japan. Investigative Ophthalmology & Visual Science, 2018. 59(14): p. DES102-DES108.

8. Moshirfar, M., W.B. West, Jr., and D.P. Marx, Face Mask-Associated Ocular Irritation and Dryness. OphthalmolTher, 2020. 9(3): p. 397-400.

9. Sultana, A., et al., Digital screen time during COVID-19 pandemic: A public health concern. 2020.

10. Leonardi, A., et al., Efficacy and safety of 0.1% cyclosporine A cationic emulsion in the treatment of severe dry eye disease: a multicenter randomized trial. Eur J Ophthalmol, 2016. 26(4): p. 287-96.

11. Amrane, M., et al., Ocular tolerability and efficacy of a cationic emulsion in patients with mild to moderate dry eye disease - a randomised comparative study. J Fr Ophtalmol, 2014. 37(8): p. 589-98.

12. Craig, J.P., et al., TFOS DEWS II Introduction. The Ocular Surface, 2017. 15(3): p. 276-283.

13. Lin, H. and S.C. Yiu, Dry eye disease: A review of diagnostic approaches and treatments. Saudi journal of ophthalmology: official journal of the Saudi Ophthalmological Society, 2014. 28(3): p. 173-181.

Image credit: ©stock.adobe.com/au/fizkes