What’s new in 2024? Let’s focus on the nerves!
Dompé corneal nerve graphic for Oxervate
Another pipeline first!
Stuart Therapeutics has started a study for dry eye treatment using a novel approach. As you recall from my earlier posting - tears are made of water, salts, proteins and oils (I use the salad dressing analogy here – but it is perhaps more correct to see tears are a form of “clear blood” to nourish, support and protect the surface of the eyes). Most current treatments aim to reduce inflammation by interfering with inflammatory pathways (steroids, cyclosporine, lifitigrast and the like). This supports tear production, but has its most profound effects on tear volume (reducing the damaging effects of inflammation on the water-producing cells). Most include moisturizers and some include oils (Castor oil for Restasis, or the novel, solely artificial oil in Miebo). Cyclosporine also has been found to promote protein production from the mucin-making goblet cells. Salt production is well regulated but becomes unbalanced through evaporative loss of water and resulting toxically-high salt concentration, so adding moisture in artificial tears is a standard strategy.
Stuart Therapeutics new product is a “polypeptide.” Polypeptides are made from strings of amino acids called peptides – which are the building blocks of proteins found throughout nature. Diverse as a group, they are known to help with the many functions required for a healthy life. This new, synthetic group of amino acids they call “PolyCol,” appears to assist in building up or repairing damaged cells within the ocular surface. This includes the nerves beneath the epithelial surface as well as helping restore surface cells. Corneal nerves are the “maestro” that helps coordinate the “symphonic” production of tears from the “orchestra” of cells and glands that make those tears. These nerves are also responsible for the constant upkeep or repair of corneal surface cells – so it is no surprise that other approaches to dry eye includes the repair of those damaged nerves (see my post on related neurostimulation https://www.eyethera.com/blog/what-is-neurostimulation-for-dry-eye-treatment-and-do-i-need-it ).
Dompé is a company marketing a recombinant form of human nerve growth factor (NGF) they call Oxervate, which has been a staple of eyedrop therapy for patients with damaged nerves leading to a condition called “Neurotrophic Keratitis” (or NK). When the maestro is lacking, the tear quality and volume suffer, as do the surface cells maintained by those tears. Chronic “open sores” (ulcers) can form, and corneas deteriorate. Since the nerves are “broken” there can be chronic pain from the remaining swollen “stumps” of those nerves – or the corneas can become “numb” as feeling is lost. Sadly, the higher pain centers can become so overburdened that a chronic pain can exist independent of the state of the surface nerves and cells. See my link to this topic here: https://www.eyethera.com/blog/why-do-my-eyes-hurt-even-though-my-eye-doctor-says-they-look-fine
Current treatments that align with this new product include Autologous Serum Tears, Platelet Rich Plasma drops, Oxervate (as noted above), amnion products and any other forms of “Neuro-Stimulation” as I noted in the earlier post (including Tyrvaya nasal spray and iTear). Adding a new angle that doesn’t require blood draws and frozen storage, or hyper-expensive and often hard-to-dispense drops (Oxervate, with its syringe to meter the drops), blurry “contact lenses” made of human-derived membranes (amnion) or frequent sneezing (Tyrvaya) will be most welcome! It is also true that it sometimes requires a number of these products to turn around these difficult problems - so adding another “arrow to our quiver” of useful therapies is always good news! For a full physician-level discussion of the new product, see this link:
To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:
(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020
(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463