The Most Commonly Prescribed Treatments – Part 1

A recent study published on BioMed Central may explain why Dry Eye sufferers often receive treatments that are ineffective or inadequate.Not A Dry Eye Blog

For the study, authors surveyed ophthalmologists to “identify the most common treatments used among specialists” for Dry Eye.

Not surprisingly, one of the most commonly prescribed treatments for Dry Eye was topical cyclosporine A (CSA), the active ingredient in Restasis. According to the study, of the 104 specialists surveyed 71, or a full 68%, said they prescribe CSA.

The reliance on Restasis, a topical drop that benefits only about 10% of users, may alone explain why so many Dry Eye sufferers continue to complain of symptoms after starting treatment.

A clue to understanding why a medication that is effective only 10% of the time is among the most commonly prescribed treatments for Dry Eye lies in understanding the mechanisms of disease management in populations. For example, if a drug that benefits 10% of those who use it is given to 100 million people, 10 million might benefit from it. That’s a lot of people. And so Restasis now enjoys the number one position in commonly prescribed Dry Eye treatments despite its limited efficacy, while profits to the drug maker accrue.

Other Commonly Prescribed Treatments for Dry Eye

Next on the list is fluorometholone, a steroid marketed under many brand names that is most often prescribed after laser refractive surgery. Which then begs the question — is this result simply an indication of the frequency of laser refractive surgery, a common cause of both transient and chronic Dry Eye?

Loteprednol etabonate, brand name Lotemax, is another steroid. Although effective in treating inflammation, long-term steroid use is usually not recommended.

Surprisingly autologous serum tears made it to the number 4 slot, a ranking the authors suggest may be due to the number of responders from large university centers. Although serum tears too have limited efficacy, even if they were more effective, they are still virtually unavailable in most ophthalmology and optometry practices.

Lubricating drops universally prescribed for Dry Eye were excluded from the survey.

The authors suggest that this study will help to inform future studies.

We hope that these future studies will examine not only which treatments address symptoms and signs of Dry Eye but also the effectiveness of these treatments for specific co-morbidities e.g. obstructive meibomian gland dysfunction (o-MGD), non-Sjogren’s aqueous deficiency, or many others, rather than the less specific Dry Eye Syndrome or blepharitis.

To be continued….


Expert Opinion in the Management of Aqueous Deficient Dry Eye Disease (DED)
A. Sy; K. S. O’Brien; M. P. Liu; P. A. Cuddapah; N. R. Acharya; T. M. Lietman; J. Rose-Nussbaumer
BMC Ophthalmology
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