What’s the deal with all these artificial tears?

Jerry Robben, O.D.
Chief Optometric Physician-Bowden Eye & Associates
Dry Eye University

When is the last time that you visited the eye care aisle at your local pharmacy or grocery store? What a mess it is…Even as eye care providers, we could get overwhelmed in finding a specific eye drop that we want in that hodge-podge of choices. Think how your patients feel when they are sent there to find the artificial tear that you have suggested for them. Some may get side tracked by sale signs or price tags and go for the cheaper options. Some may go off of brand recognition and choose Visine. And, some may get frustrated in trying to find the exact one that you recommended and just grab a random one or give up all together.

It has been commonly discussed that it is better for us to make specific artificial tear recommendations for our patients instead of just giving them whatever samples we have that day. We all have also been encouraged on to give a mixture of various brand samples to confuse them even more. As physicians, how does that look when we give the patient that mixture of various tears and say, “Try some of these and see if any help.” We can and should do better.

In clinics, our administrator, Patti Barkey, COE, has mandated that we do not have any of the OTC artificial tear samples available anymore. Our Allergan, Alcon and B & L reps have all been told to shut down the auto-ship on their artificial tear samples. This isn’t because we don’t want to partner with these companies. We depend greatly on their medical resources and treatment options for our patients, and we promote them and their benefits at length. But when it comes to artificial tears, the available options have become even more sophisticated than the OTC options, and we owe it to our patients to recommend the best!

I just left Vision Expo West in Las Vegas. In fact, I am writing this on the plane ride back. If you were there, or at any recent large eye related convention, and if you visited the exhibit hall; you were treated to a mind blowing amount of eye related technologies and break troughs. It seems like everything in eyes is becoming more and more sophisticated and artificial tears is the same way. Clearly, artificial tears aren’t as interesting as most of the technology on the exhibit floor, but we likely recommend some type of ocular lubrication to almost every patient you see, we at Bowden Eye do. So artificial tears should not be overlooked.

In this specialty artificial tear and ocular lubrication arena, we have selected our favorite types that we recommend as follows.

Oasis Tears (OASIS Medical) is our go to brand for most “every day” artificial tear patients. This is a Glycerin (0.22%) based, preservative free tear that is available only in doctor’s offices. They work great with contact lenses too. We usually recommend them to be used QID in an average patient (more if needed or for post-operative patients). This is our “entry level” artificial tear. We recommend these to every patient, even if they do not truly have a medical Dry Eye Disease diagnosis. We feel that most people are at risk of Ocular Surface issues and preventative care is a good practice, just as brushing our teeth is good dental hygiene. (We also recommend warm compresses (DERM or Bruder Mask), Lid Scrubs (Avenova or OCuSoft Lid Scrub) and even nutraceuticals (Hydroeye Vitamins) on nearly every adult patient we see for preventative purposes.)

Retain MGD (OCuSoft) is our go to tear if a patient shows significant reduction of meibomian gland function due to it’s Mineral Oil (0.05%) base. We can exam for reduced meibomian gland function with meibomian gland evaluation (MGE) at the slit lamp, or with Lipiview II diagnostic testing for Lipid Layer Thickness and DMI Meibography. If the patient shows significant reduction in these areas, we feel that the Lipid based ingredient in the Retain MGD, which is also preservative free, is the most beneficial in the tear supplementation. We also recommend it QID to start but could use it more if need be. It also can be used over a contact lens, but due to the oily consistency, we have has some patients complain that it doesn’t work well with contacts, other do just fine with it. We usually educate the patient that it could cause some blurring of the vision with contact lens wear and to have the patient let us know if it bothers them, and then we would switch them to the Oasis Tears brand.

Oasis Tears Plus (OASIS Medical) is the same main ingredient (Glycerin 0.22%) as the Oasis tears with twice the viscosity. This is essentially our “Gel” tear that we use to gain better coverage on a patient with Exposure or Lag Ophthalmos contributing to their condition. I also like to use it when we have a Prokera ring in place or for any other special situations where more lubrication is needed.

Retain PM (OCuSoft) is our choice for night time coverage or for those patients with significant surface breakdown. We find that it is tolerated better than other similar options that are offered OTC as it is not as thick and sticky as those options. The active ingredients are Mineral Oil 200mg in 1g, Petrolatum 800mg in 1g. We use it in some patients just at night or can even recommend it to be the predominant lubricant that they use multiple times during the day in a severe case. We also will use this with Prokera treatments in cases where the patient has more awareness of the ring.

We find that having these select few lubrication options has helped in reducing patient and technician confusion; and has improved patient compliance. With this method, all of our physicians are recommending the same lubricants so, no matter which physician a patient sees, they get the same message on their lubrication drops. They can purchase the drops at our office, so we can be sure that the patients are using the recommended tears, and then they don’t have to visit that confusing eye drop aisle at the pharmacy. We, as physicians, can be confident that we are recommended the best quality and options for our patients. This all improves the patient’s confidence and compliance in the whole process. With Dry Eye Disease being a multifactorial, chronic and progressive condition; something as simple as artificial tears can make an impact on the patient’s success. This should not be ignored or overlooked.