A device uses neurostimulation to encourage tear production

This “Focus” column presents the perspectives of several optometrists regarding their firsthand experiences with a new product.

A post-PRK patient, a lupus patient, a drop-intolerant patient and a patient who did not desire a pharmaceutical solution all have something in common: They reported relief from ocular dryness after Selina McGee, O.D., provided treatment plans that included a neurostimulation device (TrueTear, Allergan).

OVERVIEW

TrueTear is an FDA-cleared device indicated to provide a temporary increase of tear production during neurostimulation in adult patients. The prescription-only handheld device features two disposable tips, inserted into the nose, that give off pulses of energy to stimulate the trigeminal nerve. This results in a temporary increase in tear production.

Josh Johnston, O.D., F.A.A.O., of Georgia Eye Partners uses the device in patients who have moderate to severe dry eye disease and in those already using an anti-inflammatory or an immunoregulator, and in those using artificial tears frequently, but who still have some lacrimal gland function.

Dr. James Deom, O.D., M.P.H., F.A.A.O., of Hazleton and Stroudsburg Eye Specialists in Pennsylvania, adds to this list patients who are purely symptomatic, or those who have “pain without the stain.”

Dr. McGee, of Precision Vision, Edmund, Okla., offers it as a first-line therapy.

Contraindications include patients who have cardiac pacemakers, implanted or wearable defibrillators or other implanted metallic or electronic devices in the head or neck, chronic or recurrent nosebleeds, a bleeding disorder or a condition that can lead to increased bleeding or a known allergy to hydrogel material that comes into contact with the inside of the nose.

IN THE OFFICE

Dr. Deom says he demonstrates the device in-office. Patients will begin to feel their eyes tear within seconds, he says.

Dr. McGee’s dry eye coordinator assists in communicating with the patient by acting as the TrueTear “designated trier” — that is, the staff member who is knowledgeable about the device and can demonstrate it when the doctor is unavailable.

All three doctors dispense TrueTear in office. “I want that momentum to continue,” Dr. McGee says. “When they have a good response with it, I want them to have access to it immediately.” Doctors also can write a prescription that Allergan will fill.

The follow-up period is within weeks of prescribing. At this appointment, the doctors measure the effectiveness via osmolarity, inflammatory-marker detection, corneal staining, Schirmer’s Test and the Ocular Surface Disease Index questionnaire, among others. The doctor also may see the patient back at three and/or six months, depending on the doctor’s preference, their practice’s protocol and severity of dry eye.

Most patients will use TrueTear twice a day, says Dr. McGee, but it can be used multiple times per day. At follow-up, Dr. Johnston says he assesses how often the patient is using the device and adjusts its use as necessary.

PRESCRIBE SOLUTIONS

Dr. McGee says: “Now that we have all of these amazing things, I want people to fully engage and recognize these patients are sitting in our chairs, and they are trying things OTC that don’t work. Really dig. Ask the right questions, identify the disease, and prescribe solutions.” OM

Drs. Johnston and Deom are consultants/speakers for Allergan. Dr. McGee also reports receiving fees from Allergan.