With an estimated 16 million adults suffering from dry eye disease (DED) in the US alone, there is huge appetite for more effective and easy-to-use therapeutic options. The news of the OC-01 nasal spray being released by Oyster Point Pharma was welcome news to me, as I feel it will have a real impact on my patients’ outcomes. The spray promises to overcome a number of challenges in ocular surface disease (OSD) management, namely by offering both physicians and patients a unique delivery system.
One of the key factors that contributes to OSD is the tear film. It is crucial that both the quality of the tear film and the architectural health of the ocular surface are improved in dry eye patients to help maintain a normal baseline of ocular surface. It is here where the neurostimulation pathway comes into play – enabling meibum egress and helping to create a more complete tear film. The primary cause of meibomian gland dysfunction (MGD) is the fact that we just aren’t very good at blinking in today’s society – whether this is because we’re staring at visual devices for extended periods of time or because of contact lens wear. This poor-quality blink leads to pressure build up in the meibomian gland because the meibum is not being expressed properly, leading to pressure atrophy and destruction of the ocular surface architecture.
Neurostimulation that enables the release of meibum is therefore an extremely helpful tool to combat dry eye. Medical devices, such as the TrueTear from Allergan, have enabled neurostimulation of the glands in the past and can be useful as an adjunctive therapy for those suffering from DED. However, there have been challenges with the reimbursement pathway for such devices and the TrueTear is currently not covered by insurance in the USA. In my opinion, durable medical devices in ophthalmology are also just not that common. In addition to these issues, there are ergonomic challenges in getting the device into the proper position, especially for our older patients who already have digital arthritis and proprioception difficulties. Taking all of these factors into account, there is clearly a need for more therapeutic options that can benefit a broader population of patients with dry eye.
Earlier this year, Oyster Point Pharma announced the enrollment of their first subject in a Phase III clinical trial of the OC-01 nasal spray for dry eye disease. OC-01 is a highly selective nicotinic acetylcholine receptor (nAChR) agonist that re-establishes tear film homeostasis by stimulating the Lacrimal Function Unit – the glands and cells responsible for natural tear film production. So far, the OC-01 nasal spray is a really promising product. The phase two data demonstrate that it shows no negative side effects or adverse events as related to the eye. There is also no burning or foreign body sensation or any of the other concerns that can happen with some other known pharmaceuticals. In my opinion, this nasal spray can be used in many ways as both a primary therapy as well as an adjunctive therapy.
The beautiful thing about using a nasal spray is that the delivery system spares the ocular surface. If someone is having an acute flare with significant itching or discomfort, adding a drop can actually be more uncomfortable. Nasal sprays are already commonly used by patients who, in my experience, tend to be much more receptive to using a nasal spray over eye drops. Eye drops are also less favorable for women as an approach because it causes makeup to “run.” As silly as that may sound, it can affect compliance with treatment for a huge target population that is affected by dry eye.
Personally, I would use this nasal spray for any patient, but especially those using artificial lubrication more than twice a day. It does not mean that we won’t use other interventions, nor does it mean we’re not going to use adjunctive anti-inflammatories to help quell the T cells and take care of acute flares, but I believe this spray could be a truly effective primary or adjunctive therapy.
Considering less than 10 percent of my own patients are completely under control with prescription therapy alone, being able to offer this therapy option will only help to improve patient satisfaction with their treatment. I think the use of this nasal spray means we’re finally going to enter an exciting era where a single panacea therapy could help address the different challenges of dry eye more effectively.
Disclosure: Elizabeth Yeu is a member of Oyster Point Pharma’s medical advisory board.
Elizabeth Yeu is Assistant Professor at Eastern Virginia Medical School and Cornea, Cataract and Refractive Surgeon with Virginia Eye Consultants, VA, USA
