Eye-care practitioners have added another option to their dry eye algorithm with the U.S. launch of Lacrifill Canalicular Gel, from Nordic Pharma, Inc. The cross-linked hyaluronic acid derivative that temporarily blocks tear drainage by the occlusion of the canalicular system is administered through an in-office procedure.

According to a study by Packer M. et al, “The Effectiveness and Safety of a Novel Crosslinked Hyaluronate Canalicular Gel Occlusive Device for Dry Eye,” (https://tinyurl.com/mtzk8ycf), the dry eye therapy was shown to be safe and effective. Patients who were administered Lacrifill showed clinically and statistically significant improvements in signs and symptoms of dry eye, specifically Schirmer score and ocular surface disease index, sustained through 6 months. The therapy has received 510(k) clearance from the FDA.

Here, Selina McGee, OD, FAAO, Jonathan Solomon, MD, MPH, and Gagan Sawhney, MD, share their experiences prescribing Lacrifill.

Reduces Patient Burden

Lacrifill, the practitioners indicate, addresses patient comfort and ocular surface health without adding to concerns of medication adherence and compliance.

“Anything that I can take away from the patient having to do on their own in their already long day, is very helpful,” says Dr. McGee, indicating she will frequently reach for interventional dry eye therapies to reduce patient burden outside of the office.

For Dr. McGee, Lacrifill enters her treatment algorithm after first-line therapy, such as medication and artificial tears, have failed. Administration for her includes lower canaliculi occlusion only. In instances where the patient just needs “their own real tears to stay on the front surface longer,” she says she reaches for this therapy.

Whereas Dr. Solomon has introduced Lacrifill as a first-line therapy to improve tear quality and enhance tear volume of his patients. Administration for him includes occlusion of the upper as well as the lower canaliculi, though this can vary by patient.

Easily Integrated Into Practice

Dr. Solomon says he appreciates “not having to make sweeping modifications to your practice in order to offer the treatment.”

In terms of onboarding, Dr. McGee says operational adjustments were minimal given the small footprint. She uses a Bailey lacrimal cannula or bent tip cannula behind the slit lamp, therefore the set-up fits into the existing infrastructure in her office. Additionally, the treatment is a one-size-fits-all product, reducing the need to hold large amounts of inventory. And one syringe will fill all four canaliculi, Dr. McGee adds.

Finally, the therapy utilizes an existing billing code for punctal plug insertion, CPT code (68761), easing the burden on billing and coding staff. (Optometrists should ensure punctal plug insertion is within their scope of practice.)

Improves Surgical Outcomes

As a cataract and glaucoma specialist, Dr. Sawhney says having glaucoma does not preclude patients from refractive cataract surgery. To deliver excellent visual outcomes, treating ocular surface disease (OSD) prior to combined cataract and minimally invasive surgery is critical. To illustrate this approach, Dr. Sawhney offered the following case study: A highly myopic man with preperimetric glaucoma, on two glaucoma agents, suffered from OSD and had developed a visually significant cataract. The patient said he wanted premium vision with less dependence on glasses and drops.

The treatment goals were to provide him with distance and some intermediate vision and decrease drop dependence, Dr. Sawhney continues. The plan was to perform femtosecond laser-assisted cataract surgery with an extended depth of focus (EDOF) IOL and a minimally invasive glaucoma surgery procedure. Initial biometry suggested a toric EDOF IOL.

However, before surgical intervention, Dr. Sawhney says he addressed the patient’s OSD with Lacrifill, after which biometry was repeated to ensure accurate IOL measurements prior to cataract surgery.

Best Possible Measurements

This system, explains Dr. Sawhney, gives practitioners the best possible measurements to inform the treatment plan. Repeat biometry indicated to Dr. Sawhney that the patient would benefit more from arcuate incisions instead of a toric IOL. (See “Creating Arcuate Incisions to Reduce Astigmatism,” at https://tinyurl.com/mrxdrcuy.)

This combination of surgical and therapeutic interventions resulted in this patient’s having distance visual acuity of 20/20 and intermediate of J1 at 1 month postoperative. The patient was also able to stop one of his glaucoma medications. What’s more, the patient was more comfortable. CP