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All kinds of loteprednol should see a bump in prescriptions written because of this.” —OSN, September 25, 2019 (see ref. 10) PERSPECTIVE ON CYCLOSPORINE AND LIFITEGRAST • Frequent side effects could make Restasis and Xiidra hard to take.1,2 For example, “burning and stinging associated with initial use of topical cyclosporine were reported as the common reasons for early discontinuation.”2 For Xiidra, dysgeusia is a unique side effect reported by patients.1 • “Over 60% of DED patients discontinued treatment within 12 months of initiation.”1 The median time to discontinuation was three months for Restasis and one month for Xiidra.1 • “During the first 12 months following [Restasis or Xiidra] initiation among patients with DED, the overall adherence was low at 30%.”1 • “Side effects, as well as delayed onset of effect, have been reported with these two anti-inflammatory treatments.”1 • Cyclosporine “may take weeks of administration before an effect occurs.”3 1. White DE, Zhao Y, Ogundele A, et al. Real-world treatment patterns of cyclosporine ophthalmic emulsion and lifitegrast ophthalmic solution among patients with dry eye. Clin Ophthalmol. 2019:13:2285-92. 2. Mah F, Milner M, Yiu S, Donnenfeld E, Conway TM, Hollander DA. PERSIST: physician’s evaluation of restasis satisfaction in second trial of topical cyclosporine ophthalmic emulsion 0.05% for dry eye: a retrospective review. Clin Ophthalmol. 2012;6:1971. doi:10.2147/OPTH.S30261 3. Bjordal O, Norheim KB, Rødahl E, et al. Primary Sjögren’s syndrome and the eye. Surv Ophthalmol. 2020;65(2):119-132. 24 REVIEW OF OPTOMETRY JUNE 15, 2020 approach). Now consider punctal plugs and a lipid-based artificial tear. We start all patients on a premium-quality fish oil at 2000mg per day from the outset. For the most part, treating dry eye disease is straightforward; don’t make complex what is simple. • Regener-Eyes may have a role as an additive therapy in patients recalcitrant to steroid therapy. We have some early and limited experience with this nonmedical (biologic) eyedrop. It is in the same universe as autologous serum tears, but contains numerous biological cytokines and growth factors. We have seen no conclusive studies, but anecdotally at this time, we feel Regener-Eyes may have merit. It is very expensive (about $200 a bottle), but there are patients out there for which you have tried everything without success. This new product may be helpful to some of these more severely afflicted patients. For now, we simply suggest you explore the Regener-Eyes website (mydryeyes.com) and then use your best judgment. By next year, we will have a much more definitive understanding of its role in patient care. 1. Lee H, Chung B, Kim KS, et al. Effects of topical loteprednol etabonate on tear cytokines and clinical outcomes in moderate and severe meibomian gland dysfunction: randomized clinical trial. Am J Ophthalmol. 2014 Dec;158(6):1172-1183.e1. 2. Seitzman GD, Lietman TM. Dry Eye Research—Still Regressing? Ophthalmology. 2019;126(2):192-94. 3. Goldberg DF, Malhotra RP, Schechter BA, et al.
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