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The LipiFlow device (Johnson & Johnson Vision Care) does this best, but cost of acquisition is still a relative barrier. • It is well understood that “inflammation” of the ocular surface is commonly present in the setting of dry eye disease. So, the next question is fundamental: which drug class best addresses the “inflammatory” component? It should be profoundly obvious that the answer is a topical corticosteroid. Objectively, the “pick of the litter” is loteprednol because of its efficacy, enhanced safety profile and lower cost. Just as in glaucoma patient care, cost is a major deterrent to patient compliance. The cost of prescription drugs such as Restasis (Allergan) and Xiidra (Novartis), and even OTC artificial tears, can put an undue burden on the patient. Now, let’s put this into clinically relevant, patient-centric perspective. The vast majority of dry eye patients develop symptoms before the age of 65, i.e., while of working age. Lotemax SM (Bausch + Lomb) can be purchased (with a coupon) for $25 to $35. In our experience, nothing out there to treat dry eye symptoms is more efficacious and less expensive. Studies have shown that after one month of corticosteroid suppression, the inflammation is subdued.1 Once this major ANTERIOR SEGMENT CARE CORTICOSTEROIDS FOR DRY EYE DISEASE • Study: PF Refresh Optive vs. PF 0.1% dexamethasone, each QID • No difference between untreated and AT-treated at two-week mark • After two weeks of steroid treatment, both signs and symptoms were “significantly” improved • “Our study shows that corticosteroids can mitigate the adverse effects of low-humidity environmental stress on the ocular surface in individuals with DED.” • “The increased irritation and ocular surface epithelial disease [...] is attributable to inflammation that can be modulated by a corticosteroid.” —AJO, July 2015 (see ref. 8) TWO WEEKS TWO WEEKS INDEFINITELY Lipid-Based Artificial Tear Four to six times a day as needed Lotemax SM Gel 0.38%* Four times a day Lipid-Based Artificial Tear Three to four times a day as needed Lotemax SM Gel 0.38% Two times a day (Consider punctal plugs if needed) The risk of increased IOP with loteprednol is uncommon at high dosage and rare at low dosage. Our experience has been that if an increase in IOP is going to occur, it will do so at the initial one-month follow up, and not later. *Alternatively, instill loteprednol ointment daily at bedtime for three weeks, then M-W-F for two weeks.
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