As the dry eye market continues to expand with novel technology and products, a recent study brings back a new idea and makes it better, according to Dr. Ayres.
In a prospective, multicenter, controlled, double-masked, randomized clinical trial, investigators compared the safety and effectiveness of a crosslinked hyaluronate (HA) canalicular filler (Lacrifill Canalicular Gel; Nordic Pharma) and a hydrogel canalicular plug (Form Fit; Oasis). The study met its primary endpoint in demonstrating that the HA canalicular filler was statistically noninferior to traditional hydrogel plugs in the mean Schirmer score change from baseline (Figure 1).1 Safety data indicated both study cohorts had a similar rate of patients with ≥1 ocular device-related adverse events (Figure 2), and no patients discontinued the study due to an adverse event.1
Figure 1. Primary endpoint (left) and key secondary endpoint (right) noninferiority at 3 months following treatment with either crosslinked HA filler or hydrogel plug.
Figure 2. Recorded adverse events among patients using the crosslinked HA filler versus patients using the hydrogel plug.
“[The HA canalicular filler] brings back the interest in interventional dry eye treatments, which we've kind of lost,” explained Dr. Ayres. “This is a much easier concept for patients to understand. It's not as scary and it brings interest back for punctal occlusion.”
One of the key advantages of the HA canalicular gel, according to Dr. Ayres, is that it obviates the need for measuring the punctum and selecting the appropriately sized device—a frequent source of consternation associated with traditional punctal plug devices that may be a deterrent to their use. “With the cross-linked hyaluronic acid gel plug, it's one size fits all,” he said. “It's also one size fits better, because this form fits into the canaliculus. It doesn't just plug; it fills with that soft gel.”
Dr. Ayres said that while the crosslinked HA canalicular filler is a new product, it’s not a new procedure. “Punctal occlusion is probably one of the most beneficial procedures for patients and probably one of the most beneficial procedures for the office,” he said. “It reimburses pretty well [and] it’s really an underutilized procedure.”
Dr. Singh concluded this treatment can be utilized as an additive treatment. “We have all these technologies for ocular surface disease, and it's not this versus that,” he said. “Do your immunomodulators, do your steroids, treat your Demodex, whatever it is. But you can also use this with them. I think they all have a place.”
1. Packer M, Lindstrom R, Thompson V, et al. Effectiveness and safety of a novel crosslinked hyaluronate canalicular gel occlusive device for dry eye. J Cataract Refract Surg. 2024;50(10):1051-1057.
