Dry eye disease (DED) and glaucoma are two of the most challenging conditions that ophthalmologists face. In recent months, the U.S. Food and Drug Administration (FDA) approved several new treatments, providing new options for managing these conditions. Learn about advancements, current treatments, and future directions in managing DED and glaucoma.*

Innovations in Dry Eye Treatment

Dry eye disease affects approximately 27 million Americans, leading to symptoms like grittiness and itchiness. Treatment options have long been limited, but recent advancements have brought new hope.

In the past year, the FDA approved three new treatments for DED:

• Lotilaner 0.25% solution. Targets Demodex mites, which can cause blepharitis, a trigger for DED.
• Perfluorohexyloctane solution. Acts as a shield to prevent tear evaporation.
• Cyclosporine solution 0.1%. Uses perfluorobutyl pentane to enhance drop penetration and effectiveness in reducing inflammation.

Several promising treatments on the horizon include:

• Selenium sulfide 0.5% ointment. Moves into phase 3 trials, showing potential in improving secretions of the meibomian glands (tiny oil glands in the eyelid).
• Reproxalap. A treatment to reduce inflammation, expected to resubmit for FDA approval.
• AR-15512. A topical treatment to increase tear production.

Advances in Glaucoma Management

More than 3 million Americans suffer from glaucoma. Despite the effectiveness of daily eye drops to lower intraocular pressure (IOP), an estimated 67% of patients don’t adhere to their prescribed glaucoma eye drop regimens.

To address adherence and effectiveness, several new treatments have emerged:

• Laser treatments. Techniques like selective laser trabeculoplasty (SLT) improve eye fluid drainage.
• Minimally-invasive glaucoma surgery (MIGS). MIGS creates small tunnels or inserts shunts to create new outflow pathways.
• Implantable drug depots. Tiny devices release IOP-lowering drugs over the course of months, reducing the need for daily drops.

Recent FDA Approvals

• Belkin Eagle Nd Laser. Having received FDA clearance in December 2023, this laser offers a new approach to SLT without the need for a diagnostic lens.
• iDose TR. An implant loaded with travoprost, iDose TR was released for commercial use in early 2024, with trials showing significant reduction in IOP without the need for additional medications.

Future Directions

Emerging Technologies 

Several innovative technologies are under development:

• ViaLase. A femtosecond laser image-guided high-precision trabeculotomy, currently in clinical trials.
• Microshunts. New-generation minimally-invasive shunts that can be adjusted post-implantation to control fluid drainage.

Topical and Preservative-Free Treatments

• Cannabinoid-based drops. Trials are ongoing for SBI-100 ophthalmic emulsion, a synthetic prodrug of tetrahydrocannabinol, showing promising results in reducing IOP.
• Preservative-free solutions. Efforts to develop preservative-free formulations of existing IOP-lowering drops are advancing, with the first preservative-free latanoprost ophthalmic solution launched in late 2023.

The landscape of treatments for dry eye disease and glaucoma is rapidly evolving, offering new hope for better management and improved patient outcomes. Ophthalmologists now have a wider array of tools at their disposal, with ongoing research promising even more breakthroughs in the near future.

 *Kirkner, R. M. (2024, February 8). 2024 Will See Major Advances in Glaucoma Care. Medscape. https://www.medscape.com/viewarticle/2024-will-see-major-advances-glaucoma-care-2024a10002tw

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