RESTASIS: Not Just for Severe Dry Eye
Patients with mild and moderate symptoms are obtaining much needed relief.
BY LAURIE BARBER, M.D.

Since the April 2003 launch of Restasis (cyclosporine ophthalmic emulsion 0.05%), physicians have been debating which patients are best suited for Restasis therapy. In my experience, the ideal Restasis patient isn't necessarily the patient with severe symptoms and a barely functioning lacrimal gland, such as a patient suffering from Sjögren's Syndrome or another autoimmune disease. I find that Restasis is an excellent treatment for relatively healthy men and women who simply have chronic symptoms that aren't relieved by frequent use of artificial tears.

To illustrate my point, I'd like to share case studies of two of my patients. These cases aren't very dramatic, but they're important illustrations of how Restasis can help relieve the disruptive mild or moderate symptoms experienced by dry eye patients. Resolving this kind of complaint will help you build a practice population of satisfied, happy patients.

Case One: Increasing Artificial Tear Use

A 61-year old-Caucasian male ophthalmologist presented after attending the UAMS Department of Ophthalmology Grand Rounds lecture on the Scientific Basis and Treatment for Dry Eye. He'd been using artificial tears as often as four times a day for about 10 years, but they only provided temporary relief. He reported some discomfort when reading, a slight foreign body sensation, conjunctival chemosis and rare, intermittent visual blurring. He'd been diagnosed with Acne Rosacea 20 years earlier.

I conducted a dry-eye exam and found:

► VA 20/20 OU with myopic and presbyopic correction

► Schirmer's was 7 mm OD, 8 mm OS, with anesthesia

► minimal corneal staining, 1+ injection conjunctiva

► telangectatic lid margins with inspissated tear glands and rapid tear break up.

I diagnosed mild dry eye with meibomian gland dysfunction. I prescribed Restasis OU b.i.d. on a Friday, encouraging the patient to continue using preservative-free artificial tears as needed.

A week and a half later (just 10 days after beginning treatment), the patient reported that his dry-eye symptoms felt "considerably better." His eyes were more comfortable; he was able to read for longer periods of time without blurring; and he was not as often "aware" of his eyes.

Today, after 3 months of Restasis treatment, he reports that his use of artificial tears has decreased significantly and he's considerably more comfortable. "I think Restasis has made me much better," he says. "The gritty, dry sensation when I blink is much improved."

Restasis clearly had a positive impact on this patient's quality of life.

Case Two: Contact Lens Discomfort

A 51-year-old female clinical research coordinator -- who spent her "downtime" working as an opera singer and choir director -- presented with symptoms of itchy, dry, red, burning eyes with photophobia. She'd been experiencing these symptoms for at least 10 years. Another physician had diagnosed her condition as dry eye about 9 years earlier, but she had no history or symptoms of Sjögren's Syndrome or other autoimmune disease.

Her job involved extensive computer use, so she'd been increasing her artificial tear use to tolerate longer visual tasks. At the same time, she liked to wear contact lenses while directing the choir or singing (in order to see the music) and had been using frequent artificial tear replacement to help her tolerate the lenses. In spite of this, she was only able to wear the contacts for short periods (despite trying different types of lenses) because of the discomfort and visual blurring caused by dryness.

When she came to my office for help, she complained that her symptoms were forcing her to alter her lifestyle. Contact lenses were more of a problem than ever, she said, and she was having an increasingly difficult time reading. She also experienced occasional visual blurring.

My clinical exam found that her Schirmer's was 2 mm OU without anesthesia; her visual acuity was 20/20 OD and 20/25 OS. She had some (1-2+) PEK, with 1+ conjunctival injection. Tear break-up time was decreased, as was her tear meniscus.

Given the results of her clinical exam and her personal reports, I diagnosed moderate dry eye. I initiated Restasis treatment OU b.i.d.

The results were impressive:

► After 2 weeks on Restasis she noticed symptom improvement, with longer periods between artificial tear replacement and no more visual blurring when reading.

► After 2 months of Restasis use, she reported that her ability to work at the computer had improved; she used artificial tears less frequently and didn't need to rest her eyes as often. Her artificial tear use dropped from every 4 hours (or even more frequently) to just one or two times per day.

Best of all, I have a much happier patient. "Restasis has been a big help," she says. "I've been very happy since starting it." She also found the drops easy to use. "I knew the drug could burn from talking to patients in Restasis studies, but I didn't experience any burning at all."

She's now looking forward to wearing contact lenses comfortably while taking part in her favorite musical activities.

Dr. Barber is professor of ophthalmology at the University of Arkansas Medical School (UAMS).