Explaining the Explosion in the Dry Eye Space

At OIS@AAO 2018, strong attendance at the breakfast breakout session “Evolution of the Dry Eye Market” made a statement about the current level of interest in this topic. As session moderator Preeya Gupta, MD, of Duke University Eye Center said, 10 years ago there wasn’t much of a market for dry eye or much innovation in the space, but there has been an explosion in the last five to seven years.

Quinton Oswald, CEO of Notal Vision, agreed, saying that in 2010 (when he started at SARcode Bioscience), four or five people would have attended a session on dry eye. “I think it’s a truism that success has many parents and failure has few,” he noted.

A Simple-Looking Equation That’s Not

What’s changed in that time? Oswald said that the dry eye space seems simple, but it’s actually quite complex because of the need to achieve duplicate endpoints, both signs and symptoms. Clinical trial populations tend to be heterogeneous, making it difficult to determine which patients would respond to treatment. Therefore, he asserted, it’s important to consider endpoints and populations carefully.

Oswald added that another important decision a company must make early in its development plan is how to play in the market. Determine if it’s going to be better to find a partner or continue alone, and if a combination therapy approach or monotherapy is best.

Michael Ackermann, PhD, chairman of Oyster Point Pharmaceuticals and former CEO of Oculeve, acknowledged the clinician innovators in the room who did a lot to educate both patients and physicians to take dry eye seriously as a disease rather than a symptom.

He noted that one thing that hasn’t changed yet is that the unmet need is still very real, with millions of patients in the US alone either not on therapy or having tried something that didn’t work. “It’s incumbent upon us to develop things that are truly differentiated in terms of the value that it provides to patients and to the payers,” he said.

A More Proactive Approach

Caroline Blackie, OD, PhD, has seen the shift in the dry eye space as medical director, ocular surface disease at Johnson & Johnson Vision, and previously as director of medical affairs for TearScience. She said today’s understanding of meibomian gland function on the ocular surface is unrecognizable compared with 2005, when TearScience was founded. Today’s approach to ocular surface health and how that might impact patients’ lives is more proactive, whereas before it was more reactive, she added.

From her medical and scientific perspective, she said the challenges in the dry eye space have expanded the understanding of what it means to listen to the patient. “What I’m excited about as we move from where we are today to the next decade, is how we transition from here to a highly proactive space,” Dr. Blackie said. “We have a very well-educated medical and patient community.” She also advocated a shift in thinking away from monotherapy for dry eye and toward combination therapy and comprehensive options.

In the past, discussions about dry eye were all about comfort; now, they focus on the science of dry eye as a disease, said Christian Roesky, MD, PhD, managing director and CEO at Novaliq. “We’re learning every day, so it’s very important for companies like us not to focus only on our technologies, but we need to have an academic view of dry eye disease,” he stressed. Emerging literature about how dry eye disease impacts vision is getting attention from investors and driving hope from patients, which drives smart companies, Dr. Roesky added. While therapeutic companies are very active in the space, he called for more work to be done on the diagnostic side.

Oswald pointed out that another important element in the evolution of our understanding of dry eye disease is gaining an appreciation of the patient journey in dry eye. Get as close to the patients as possible, he suggested to drug developers. He recommended obtaining informed consent for access to clinical trial patients once a trial is complete as part of a company’s drug development program, because their experience will be critical in later stages.

Dr. Gupta pointed out that industry representatives have a hard time connecting with patients because they don’t have direct access, but they can partner with key opinion leaders and clinicians to gain that access.

For questions about this article, please contact Steve Lenier at Steve@healthegy.com.