Our focus this month is on Contamac's HyClear, a hypochlorous acid 0.01% solution that the company says is the next generation of hypochlorous acid for essential daily eyelid health management. With a broad spectrum of antimicrobial activity from the pure hypochlorous acid 0.01%, HyClear kills most ocular pathogens in 15 seconds, according to Contamac. In addition, the company says that HyClear’s manufacturing process produces a balanced formulation with up to 18 months of shelf life in an easy-to-use pump spray bottle.

HyClear is a cost-effective, prescription-strength daily regimen that provides a safe treatment for eyelid hygiene without the high cost or hassle of being a prescription product, according to Contamac. HyClear is an exclusive brand for optometrists and ophthalmologists for sale directly to their patients; Contamac says that HyClear will never be a prescription product or an over-the-counter product.

I recently talked with practitioners who are actively prescribing HyClear in their practices. Here we share their clinical experiences.

Please tell us about your general experience with Contamac’s HyClear.

Arthur B. Epstein, OD, of Phoenix notes that hypochlorous acid in general is very beneficial in managing blepharitis and meibomian gland dysfunction (MGD), which is the primary driver of tear film instability and dry eye symptoms in the population that he sees. “The microbiome of the eye shifts in patients who have MGD as part of the disease process; Staph and other bacterial species overpopulate the lid margins,” he says.

Dr. Epstein explains that the byproducts of this bacteria break down the lipids in the tear film and lead to the production of soaps, which further break down the lipid layer and result in a very unstable tear film. “This cycle can only be stopped by reducing the Staph on the eyelids and lid margins,” explains Dr. Epstein. The body’s white blood cells naturally produce hypochlorous acid and use it in the body to kill bacteria, so it’s well suited and efficacious for this purpose.

With respect to HyClear, Dr. Epstein says that similar products that were not stabilized would break down into essentially water and chlorine before the bottle was even half empty in some cases. “What I like about HyClear is that it is intrinsically stable, so a bottle can be opened and will last for six to 12 months or longer. This allows me to prescribe it for different regimens and still be assured that the product will remain stable,” he says.

Jeffrey Sonsino, OD, of Nashville, TN, has had similar experiences. “A hypochlorous acid product that we used to recommend had a very short shelf life. So our patients would purchase it, but it would become nonviable after only about 60 days. HyClear has a much longer shelf life of 18 months,” he says.

Dr. Epstein notes that HyClear is also more comfortable compared to some other hypochlorous acid products that contain a significant amount of sodium hypochlorite.

Two other benefits of HyClear that all of the practitioners mentioned are its cost effectiveness and its in-office availability. Arlene Schwartz, OD, of Hartsdale, NY, says, “Some of the other products were good but expensive.” She would provide samples, and there were coupons available, but she says that “it was just too difficult. Patients weren’t following up with it. But HyClear’s cost is much reduced, and I can provide it here in my office, which is much more convenient.”

Dr. Epstein notes that “To me, point of care is the key to making sure that patients leave with everything that you want them to use, whether it’s a sample or an actual product. It helps control the patient experience, and patients understand and appreciate that. They’re also often relieved that they don’t have to go shopping for what they need.”

Dr. Sonsino says that with HyClear, “Now, we can offer right in our office what I feel is the best product for a competitive price. Our patients have been very happy with it.”

Who are the best candidates for this product and why?

While hypochlorous acid is traditionally considered a product for managing blepharitis, all three practitioners are prescribing it for a broader range of patients. “It was traditional, conventional blepharitis that first turned my attention to hypochlorous acid, but it became rapidly apparent that it was at least as functional if not more so for patients who had MGD,” says Dr. Epstein. He explains that most dry eye results from the tears not working properly rather than from not enough tears, and reducing the bacteria helps stabilize the tear film.

Dr. Schwartz states that anyone who complains of dry eye is a great candidate. “When you manage dry eye, you want to get to the underlying cause. Most often that is MGD, so when patients mention dry eye symptoms, I am most likely to go to HyClear because I want them cleaning the bacterial buildup off of their lids. There’s no reason to wait,” she says.

“We have a robust contact lens practice; an astronomical number of contact lens patients have some form of dry eye. You simply cannot have a contact lens practice today without also having a robust dry eye practice,” says Dr. Sonsino. In his practice, HyClear is part of the standard dry eye regimen, so all of their dry eye patients are exposed to it.

Tell us about the prescribing process and what has worked best for you.

Dr. Schwartz evaluates the eyelids of all of her patients, and when she notes a problem with buildup, she takes a picture. “When patients see what their eyelids look like, they are more likely to follow my recommendations,” she says. For mild cases, she prescribes warm compresses and lid hygiene, and she will prescribe something with tea tree oil if the problem is Demodex. But if there is buildup on the lids, HyClear is her go-to. She instructs patients to spray it on a pad and wipe their lids with it so that they are naturally doing some debridement. For cases of significant buildup, she will have patients return for microblepharoexfoliation, but she usually tries HyClear first.

Dr. Sonsino begins the conversation with hot compresses. “Once they do that for 15 minutes, I tell patients to spray HyClear on their eyelids and to rub it in with clean fingers. That way, the HyClear makes its way into the meibomian glands, where it can knock down the bacterial load. This combination should be universal, there’s great evidence that the spray alone is not going to do as much as a complete regimen will for dry eye patients,” he says.

For Dr. Epstein, HyClear and a triglyceride-based omega-3 with a high EPA-to-DHA ratio are the two most important elements in his basic dry eye regimen. “This combination is game changing for many patients,” he says. “For some, this and a few other things are sufficient to get them back on track and do really well. For others, it’s a foundation for other treatments.” He has patients spray HyClear directly on their closed eyelids, look up, flutter their lids to spread it onto the eyelid margin, then close their eyes for 10 seconds. Then they can let it evaporate or wipe their lids with a clean tissue. Dr. Epstein has patients do this twice a day at first; if patients are doing well, he scales it back to once a day or once every other day.

How has HyClear helped with troubleshooting for particular patients? Tell us about any success stories in that regard.

Dr. Epstein says that many practitioners wonder how bad dry eye can really be. Because he focuses on dry eye only, he knows that “Dry eye is miserable; it can be disabling and so disruptive to normal life.”

He said that many of his patients do life-changingly well on a regimen with HyClear. “Many patients cry or ask for permission to give me a hug,” he says. “Hypochlorous acid is one of those often-overlooked tools that really works; it’s a tremendous opportunity to do a lot of good for a lot of people,” he says.

Dr. Schwartz reiterates that most meibomitis and blepharitis stems from bacterial buildup on the lids, leading to clogged glands. “HyClear reduces the bacterial buildup, so you’re getting to the underlying cause. It’s antimicrobial, naturally occurring in the body, cost effective, and convenient. My patients love it.”

“I had a patient just this morning tell me that the regimen we put her on has changed her life. HyClear is an important part of that regimen,” said Dr. Sonsino. “If you are an eyecare practitioner in 2020 and you are not treating dry eye, you are missing the boat,” he adds. CLS