Efficacy of Nonpreserved Sodium Hyaluronate Artificial Tears in Dry Eye Disease Patients Treated with Prostaglandin Analogs for Primary Open-Angle Glaucoma: A Prospective, Nonrandomized, Open-Label Pilot Study

Abstract

Purpose. Dry eye disease (DED) can be triggered using preserved ophthalmic formulations or prostaglandin analogs. In this prospective, nonrandomized, open-label pilot study, we evaluated the efficacy of a 0.15% hyaluronic acid (HA) nonpreserved ophthalmic formulation in decreasing DED symptoms in patients with open-angle glaucoma treated with prostaglandin analogs. Methods. 30 patients with DED receiving chronic treatment with prostaglandin analogs for primary open-angle glaucoma or ocular hypertension were administered ophthalmic formulations 3 times daily for 12 weeks. Foreign body sensation, burning, stinging, dryness, pain, frequency of symptoms, Ocular Surface Disease Index (OSDI), conjunctival hyperaemia, corneal fluorescein staining (CFS), tear film break-up time (TBUT), best-corrected visual acuity, Schirmer test results, and 25-item National Eye Institute Visual Function Questionnaire score between the baseline and 4 and 12 weeks were evaluated. Results. The analysis shows that all primary endpoints improved; in particular, burning sensation and the frequency of symptoms after 4 and 12 weeks of treatment ( p < 0.001 ) and dryness and pain after 12 weeks of treatment ( p < 0.001 and p = 0.03 , respectively) were reduced significantly. Secondary outcomes confirmed the positive results, with a statistically significant change in the OSDI score and CFS between the baseline and 4 ( p = 0.02 and p < 0.001 , respectively) or 12 weeks (both p < 0.001 ) and TBUT after 4 weeks ( p = 0.01 ). Conjunctival hyperaemia improved in both eyes in >90% of cases at 12 weeks of treatment. Conclusion. The present study shows that the ophthalmic formulation containing 0.15% HA has a promising beneficial effect on reducing the signs and symptoms of DED in patients treated with prostaglandin analogs.

Management of Dry Eye Disease in Asia: A Review

“…Because of these advantages, it was widely adopted and is continuing to be used by many patients. Although a large range of artificial tears have been researched and advanced [8,11], their effectiveness is, regrettably, transient. Moreover, the physical properties of eye drops, which affect comfort of use and blurred vision, are becoming increasingly important, but unlike prescription drugs, the physical properties of artificial tears are not always available from the manufacturer [12].…”

“…Thus, a drug that is more effective than artificial tears and does not have the severe side effects observed with corticosteroids and non-steroidal anti-inflammatory drugs was long awaited, and sodium hyaluronate ophthalmic solution was developed. Sodium hyaluronate bound to fibronectin in tear fluid accelerates the adhesion and extension of corneal conjunctival epithelial cells, thereby ameliorating epithelial damage [8], and its conjugates retain water, thereby resulting in greater water retention [8]. However, the stabilizing effect of the all-important tear fluid layer was weak, and the therapeutic effect of DED was often not observed.…”

Treatment of Dry Eye Disease (DED) in Asia: Strategies for Short Tear Film Breakup Time-Type DED

“…Because of these advantages, it was widely adopted and is continuing to be used by many patients. Although a large range of artificial tears have been researched and advanced [16,20], their effectiveness is, regrettably, transient. Moreover, the physical properties of eye drops, which affect comfort of use and blurred vision, are becoming increasingly important, but unlike prescription drugs, the physical properties of artificial tears (the content of viscosity-enhancing agents, electrolytes, osmo-protectants, oily agents, antioxidants and preservatives, etc., and their mechanical and pharmacological effects) are not always available from the manufacturer [21].…”

“…Thus, a drug that is more effective than artificial tears and does not have the severe side-effects observed with corticosteroids and nonsteroidal anti-inflammatory drugs were long awaited, and sodium hyaluronate ophthalmic solution was developed. Sodium hyaluronate bound to fibronectin in tear fluid accelerates the adhesion and extension of corneal conjunctival epithelial cells, thereby ameliorating epithelial damage [16], and its conjugates retain water, thereby resulting in greater water retention [16]. However, the stabilizing effect of the all-important tear fluid layer was weak, and the therapeutic effect of DED was often not observed [17].…”