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As with the 0.05% formulation, about 25% of patients using the 0.09% drop experienced instillation-site pain vs. 4.3% with vehicle.3 As we have asserted for over 20 years, if the goal is to reduce ocular surface inflammation, a month-long course of loteprednol is optimally effective and vastly less expensive than other brand-name products. SECTION II: ANTERIOR SEGMENT CARE 0.09% CYCLOSPORINE OPHTHALMIC SOLUTION • As opposed to cyclosporine 0.05% emulsion, this nanomicelle formulation is a clear solution • Like the 0.05% emulsion, dosage is BID • Significant improvement within 12 weeks; as early as four in some • “Lubrication of the ocular surface can alleviate symptoms; as such, the lubricating effect of the polymeric vehicle also may have contributed to the improvement of symptoms.” • 24% experienced mild stinging or burning (4% in vehicle group) • Marketed as Cequa by Sun Pharmaceuticals —Ophthalmology, September 2019 (see ref. 3) OMEGA-3 FATTY ACIDS, ROSACEA AND MGD • “A major focus of treatment of ocular rosacea is the management of DED caused by MGD.” • “Two well-designed studies have demonstrated improvements in the subjective symptoms and objective signs of MGD with the use of oral omega-3 fatty acids.” Wladis EJ, Adam AP. Treatment of ocular rosacea. Surv Ophthalmol. 2018 MayJun;63(3):340-6. MG ORIFICE SCRAPING IN TREATING DED Legendary dry eye scientist, educator Donald Korb, OD, had this to say a number of years ago: “In the future, the health and maintenance of the mucocutaneous junction (MCJ) and keratinized lid margin may be considered integral to routine eye care. This shift in our culture will involve improvements in our observation skills and also the willingness to incorporate novel techniques such as debridement-scaling of the MCJ and keratinized lid margin in our clinical practice.” Korb DR, Blackie CA. Debridement-scaling: a new procedure that increases Meibomian gland function and reduces dry eye symptoms. Cornea. 2013 Dec;32(12):1554-7. 0.09% CYCLOSPORINE OPHTHALMIC SOLUTION Significant improvement within 12 weeks; as early as four in some “Lubrication of the ocular surface can alleviate symptoms; as REVIEW OF OPTOMETRY JUNE 15, 2020 23 The Medical Letter is a highly prestigious publication and is similar to Consumer Reports, in its exhaustive and objective analysis. The December 2, 2019 issue of The Medical Letter stated that Cequa “appears to be similar in efficacy” to Restasis.4 It goes on to say that the “addition of topical corticosteroids in the first month [of treatment] may be helpful.” In our opinion, that is because our experience and the peer-reviewed literature have confirmed that a one-month course of loteprednol suppresses the ocular surface inflammation!1
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