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Sustain Ocular Health

Emulsion technology restores lipid layer and natural tear film.

Paul A. Williams, O.D., F.A.A.O.

As common as Dry Eye Syndrome is, one of its leading causes, meibomian gland dysfunction (MGD), is frequently overlooked. The meibomian glands in MGD patients secrete inadequate amounts of quality oils, or lipids, causing tear film instability. Systane Balance Lubricant Eye Drops, from Alcon, provide for restoration of the lipid layer, protecting the tear film from evaporative loss, and, therefore, the ocular surface. This treatment option essentially “rebalances” the components of the tear film. The advantages of the product: It provides lasting comfort, a prolonged duration of effect and minimal blur upon instillation.

Systane Balance Lubricant Eye Drops are designed for meibomian gland dysfunction patients. The drops provide for restoration of the lipid layer, protecting the tear film from evaporative loss, and, therefore, the ocular surface. The lubricant eye drops essentially “rebalance” the components of the tear film.

Here, I provide some background on the drop, a description of its mechanism of action and a summary of data from clinical trials, so you can see why you should consider recommending it to your MGD patients.

Background

Systane Balance Lubricant Eye Drops, which come in a 10 ml bottle and can be instilled as needed, became available this past October, joining Alcon's existing line of Systane products.

The product contains a blend of HP Guar, borate, sorbitol, propylene glycol (0.6%) and the company's LipiTech System, which is an emulsion technology that consists of mineral oil and an anionic phospholipid. As a result, Systane Balance Lubricant Eye Drops work to simultaneously restore the lipid layer and natural tear film to relieve MGD-caused dry eye symptoms. These symptoms can include foreign body sensation, burning, a feeling of grittiness and itching.

In addition, the drops don't contain benzalkonium chloride — a preservative that can exacerbate dry eye symptoms.

Mechanism of action

The product appears to provide a sustained release of its emulsion-based artificial tear, increasing tear film breakup time (TBUT) so patients experience extended relief from their MGD-induced dry eye symptoms.

Specifically, the artificial tear's lipids loosely bind to the HP Guar, which adheres to the ocular surface. When the HP Guar is released, the oil from the artificial tear migrates to the natural oils of the lipid layer, supplementing the natural oils and providing a sustained release. This process also allows the polar phospholipid surfactant dimyristoylphosphatidylglycerol to migrate to and stabilize the aqueous/lipid interface of the tear film.¹

Clinical trials

Systane Balance Lubricant Eye Drops have been shown in clinical trials to improve lipid layer thickness, TBUT and minimize post-instillation blur.

In one randomized clinical study of 40 patients who had a baseline lipid layer thickness of less than 75 nm in both eyes — with less than 15 nm in variation through the course of a 10-minute observation period — the artificial tear improved the thickening of the lipid layer five, 15, 60 and 120 minutes following instillation. Lipid layer thickness, in nanometers, was, respectively, 132, 114.4, 103.5 and 88.9.^2,3

Also, in a randomized clinical trial of 38 MGD patients with TBUTs of five seconds or less, Systane Balance Lubricant Eye Drops demonstrated improvements in TBUT up to two hours post-instillation, minimal blur and enhanced comfort.⁴

In addition, in a study of 49 MGD patients, 86% of the subjects reported that Systane Balance Lubricant Eye Drops provided fast symptomatic relief, and 79% reported satisfaction with drop comfort. Further, after 28 days of using the artificial tear, TBUT decreased 33%, corneal staining decreased 26%, MG expression increased 17%, and drop usage decreased 24%.⁵

Systane Balance Lubricant Eye Drops simultaneously stabilize the tear film and protect the ocular surface, rebalancing the tear film. Its sustained release provides lasting comfort and a pro longed duration of effect, while offering minimal blur upon instillation. Based on these attributes as well as direct patient feedback on their satisfaction in having a treatment specific to their needs, I find that this product is ideal for our MGD patients. OM

1. Ketelson HA, Davis J, Meadows D. Characterization of an anionic lipid stabilized ocular emulsion containing HP-Guar. Presented at ARVO meeting; May 2010; Fort Lauderdale, Fla.
2. Korb D, Blackie C, Meadows D, et al. Evaluation of extended tear stability by two emulsion-based artificial tears. Presented at the Tear Film and Ocular Surface Society meeting; September 2010; Florence, Italy.
3. Korb DR, Scaffidi RC, Greiner JV, et al. The effect of two novel lubricant eye drops on tear film lipid layer thickness in subjects with dry eye symptoms. Optom Vis Sci. 2005 Jul;82(7): 594-601.
4. Korb D, Blackie C, Meadows D, Christensen M, Tudor M. Evaluation of extended tear stability by two emulsion based artificial tears. Presented at the Tear Film and Ocular Surface Society meeting; September 2010; Florence, Italy.
5. Foulks G, Sindt C, Griffin J. Efficacy evaluation of a novel emulsion based, anionic phospholipid containing artificial tear in meibomian gland dysfunction (MGD) subjects. Presented at the Tear Film and Ocular Surface Society meeting; September 2010; Florence, Italy.

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Dr Williams is in private practice at Parkland Eye & Vision in Tacoma, Wash., where he treats “a lot” of dry eye patients, among others. E-mail him at drpaul@eyehealth.org, or send comments to optometricmanagement@gmail.com.