By The Wall Street Journal
Dry eye, a common malady of aging, is getting more attention from the medical community and drug makers, who see a growing and largely untapped market for new treatments.
For some people, dry eye is more than a small irritation -- it can be a debilitating condition that causes painful scratchiness, light sensitivity and stinging in the eyes. But dry-eye patients say they often get perfunctory care from ophthalmologists and optometrists, who simply advise them to blink more and use over-the-counter lubricating drops. Such products may offer temporary relief, but they can be expensive, and many patients complain that they aren't very effective.
Perhaps 25% of eye-doctor visits are for dry-eye complaints, according to a study a decade ago, and some doctors are seeing rising complaints today. Most patients are women over 40, a bulging demographic group. And many complaints are linked to the popularity of vision-correction surgery. There are about 1.4 million surgeries a year in the U.S., according to industry research firm Market Scope. Ophthalmologists say that dry eye is a common side effect that can become chronic in some patients.
In addition, symptoms are mounting among patients who have had cosmetic eyelid surgery and find they can't fully close their eyes. Even a sliver of an opening that isn't readily noticeable can allow the eye to dry out, say eye doctors.
Over all, increased demand for dry-eye treatment has led a handful of physicians to specialize in the field. "My typical patient has seen 10 different eye doctors and says they've tried everything and nothing works," says Robert Latkany , an ophthalmologist who is founder of the Dry Eye
Center in New York City.
Now, specialty pharmaceutical companies are targeting this niche market. Five years ago, the Food and Drug Administration approved the first prescription drug for dry eye -- Restasis, marketed by Allergan Inc. of Irvine, Calif. Consumer advocates have said that aggressive marketing surrounding Restasis has led patients to clamor for a drug that won't necessarily help them. Doctors say the treatment doesn't work for everyone and more options are needed.
"It is truly a wonder drug for a good number of dry-eye people; some others fail miserably with it," Dr. Latkany says. There are some 20 experimental drugs in the pipeline, he estimates, although only one has advanced through human tests.
Prolacria, developed by Inspire Pharmaceuticals Inc. of Durham, N.C., is under review at the FDA. Inspire said recently that the agency is asking for more proof of effectiveness, however, so the drug won't be commercially available for some time.
which says it sees the entire dry-eye sector producing potential annual sales of $1.5 billion within five to 10 years -- is developing a low-dose steroid as a dry-eye treatment, which the company hopes will reach the FDA in 2009. Doug MacHatton , a vice president, says the company has several earlier-stage products in the pipeline. Advanced Medical Optics Inc. of Santa Ana, Calif., also has a dry-eye development program under way, but it isn't talking about specific products.
Creating drugs for dry eye is difficult because "it's a syndrome with a collection of signs and symptoms, and isn't identified by a single pathologic mechanism," says Deborah S. Jacobs , medical director of the Boston Foundation for Sight, a nonprofit organization in Boston. For instance, patients whose dry eye is caused by an underlying autoimmune disease tend to do well on Restasis, she says.
In 2003, an international panel of cornea specialists convened to discuss step-by-step diagnosis and treatment. The attendees even proposed changing the condition's name to "dysfunctional tear syndrome," reflecting findings that many sufferers experience poor tear production or retention.
Dry eye affects more women than men because of hormonal changes as women age, but can also be caused by environmental conditions such as wind, dust and air conditioning.
Lioudmila Prichoutova, a 47-year-old private chef in Manhattan who recently emigrated from Ukraine, says she developed problems last fall after the heat came on and the windows were shut in the Upper East Side apartment where she worked. Her eyes started burning, and she couldn't sleep at night. Her vision blurred. "The pain was worse than tooth pain, I had never experienced anything like it before," she says.
Ms. Prichoutova says she went to seven doctors before seeing Dr. Latkany, who has devised a treatment regimen including Restasis and other drugs that is helping. She quit her job and found a new one in a home without pets or smokers. Cat dander and nicotine aggravate her condition, she says.
Some patients' complaints are caused by soft contact lenses, which absorb fluid on the eye surface. A number of contact-lens manufacturers have developed lenses meant to alleviate dry-eye complaints, including CooperVision Inc., with its Proclear line, and Johnson & Johnson , with Acuvue Oasys.
Ironically, chronic dry eye can also be caused by patients' efforts to relieve contact-lens discomfort. Some patients who find they can't wear contacts turn to laser surgery. But such intolerance is a warning sign of a possibly higher risk of dry eye, ophthalmologists say. The condition is common after Lasik surgery, and usually goes away within a few months. But doctors say that for a small percentage of patients -- perhaps 5% -- dry eye can be a lasting and debilitating outcome.
There are many over-the-counter remedies, ranging from about $5 to $25, depending on the product. When people go without a doctor's advice to the drugstore, they may buy a redness reliever like ones by Visine, but these products aren't lubricants, and are designed to constrict blood vessels. Among products aimed at dry eye are Alcon's Systane and Allergan's Refresh -- in addition to one by Visine called Visine Tears. Eye doctors warn, however, that some patients may be sensitive to the preservatives in some eye drops.
"There is such an enormous need out there for consumer awareness," says Rebecca Petris , who runs dryeyezone.com, a patient information site and dryeyeshop.com, a seller of artificial tears, sleep masks and other aids.
Ms. Petris is one of a growing number of dry-eye patients who find relief from a large, custom-made contact lens that sits over the front surface of the eye to create a fluid reservoir. The lenses, which cost $7,600 a pair including fittings, are available by prescription from the Boston Foundation for Sight, which provides free or subsidized care to qualified patients.
Some patients find relief from tiny devices known as punctal plugs, which are inserted into the tear ducts to slow the drainage of eye moisture. Others use lubricating ointments applied under the lids. Diet modification, including eating more tuna and other foods rich in omega-3 fatty acids, helps some people, ophthalmologists say.
Cathy Bishop-Clark, a professor of computer and information technology at Miami University's Middletown, Ohio, campus, says she tried "a boatload of treatments, including Restasis, which didn't help me." She says she gets help from special goggles meant to create a moisture chamber around the eyes. "I came across the goggles at a motorcycle shop," she says. She has five pairs,
costing between $125 and $150 each.
Panoptx Eyewear, a closely held Pleasanton, Calif., company, developed the eyewear for skiers and other outdoor sports enthusiasts. A few years ago, the company started marketing to dry-eye patients.
Dr. Bishop-Clark, 43 years old, says her dry eye was caused by Lasik surgery seven years ago. She says she was told by her surgeon that dry eye was a risk, but a very low one. Because she can't stand to have her eyes open all the time, she has had to curtail her leisure reading and hire people to assist her at work. "Dry eye just sounds so trivial, but it's a disability," she says.
