Giving you a quick rundown on the top news and research From the past month. Consider this the most productive five minutes of your day. Ready?

Now that 2018 is here, it’s only natural to do the obligatory recap of advances in eyecare in 2017. A lot happened actually. Here’s the rundown.

The U.S. Food and Drug Administration approved Restasis Multidose (cyclosporine 0.05%) in March. The new bottle design offers an alternative to single-use vials.Then in April, the FDA approved TrueTear, a handheld intranasal neurostimulator that provides a temporary increase in tear production for up to four hours.

How do you use TrueTear?
TrueTear emits micro-electric pulses to stimulate the lacrimal gland and trigeminal nerve. The intensity can be adjusted, but the desired effect is a “tingling sensation” in the nose. The neurostimulation should be no longer than three minutes at a time and no more than 10 times a day.

In May, the FDA approved Zerviate (ceterizine 0.24%), a second-generation antihistamine drop from Nicox Vision Science. Cetirizine is the active ingredient in Zyrtec. Dosing is b.i.d.

Right before the ball dropped on 2017, the FDA approved two new glaucoma drops: VYZULTA (latanoprostene bunod 0.024%) and Rhopressa (netarsudil 0.02%).

How does VYZULTA work?
According to Bausch + Lomb, it is “a nitric oxide-donating prostaglandin F2-alpha analog.” I can feel your attention fading so let me say that a different way. VYZULTA has two mechanisms of action. It’s a prostaglandin analogue that increases aqueous outflow via the uveoscleral pathway. It also acts as a nitric oxide donor, which increases outflow throughout the trabecular meshwork and Schlemm’s canal.

What is the dosing?
One drop once a day.

What are the side effects?
The most common are conjunctival hyperemia, eye irritation, eye pain, and instillation site pain. Increased pigmentation of the iris and periorbital tissue and growth of eyelashes also may occur.

How much IOP reduction are we talking?
In the APOLLO and LUNAR studies, there was an average of 32% diurnal IOP reduction.

When can I prescribe it?
Now! Go forth and prescribe.

What is Rhopressa?
A once daily eyedrop from Aerie Pharmaceuticals to lower IOP for patients with open-angle glaucoma or ocular hypertension.

How does it work?
The main buzzword you will hear is that it’s a ROCK inhibitor. It increases outflow through the trabecular meshwork by inhibiting Rho Kinase (ROCK). Rhopressa is also presumed to work via two other mechanisms. It reduces fluid production in the eye by inhibiting the norepinephrine transporter, and it lowers episcleral venous pressure.

What are the side effects?
The biggest one was conjunctival hyperemia, reported in 53% of patients. Others were vortex keratopathy, instillation site pain, and conjunctival hemorrhage.

When can I prescribe it?
Likely by the second quarter of 2018, but you’ll start seeing reps soon.

In December, the FDA approved Lumify (brimonidine tartrate, 0.025%), an over-the-counter eye drop to help treat red eyes.

Brimonidine tartrate (brand name Alphagan) was approved in 1996 to lower IOP. It does so by reducing aqueous production and increasing uveoscleral outflow.

What is the difference between Alphagan and Lumify?
Lumify contains a lower concentration of brimonidine compared to Alphagan, which is available in 0.2%, 0.15%, and 0.1%. In other words, Alphagan 2% is eight times stronger than Lumify.

Why is this better than Visine?
Visine use can lead to loss of efficacy and rebound redness when stopped. Brimonidine specifically targets, namely the alpha receptors on blood vessels, which reduces the other side effects.

When will I see this on the shelves?
Second quarter of 2018.

The FDA approved Luxterna (voretigene neparvovec), a one-time gene therapy treatment for patients with vision loss due to biallelic RPE65-mediated inherited retinal disease (Leber’s congenital amaurosis as well as autosomal-recessive retinitis pigmentosa).The estimated cost for this one time treatment is nearly $1 million.

That’s your short and sweet recap of 2017. Here’s to hoping you have a productive and successful 2018!


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