RECENTLY, Bausch + Lomb announced the U.S. commercial launch of Miebo for the treatment of the signs and symptoms of dry eye disease (DED). Formerly known as NOV03, the water- and preservative-free perfluorohexyloctane ophthalmic solution is the first U.S. Food and Drug Administration (FDA)-approved treatment for DED that directly targets tear evaporation, according to Bausch + Lomb. The FDA approved Miebo in May 2023.
A leading cause of DED, tear evaporation due to an altered tear lipid layer is often associated with the clinical signs of meibomian gland dysfunction (MGD). An unstable tear film can result in increased ocular surface desiccation, inflammation, and damage to the ocular surface, and Bausch + Lomb notes that Miebo is designed to reduce tear evaporation at the ocular surface.
Here, CLS shares the clinical experiences of four practitioners who are using Bausch + Lomb’s Miebo in their practices.
PLEASE TELL US ABOUT YOUR GENERAL EXPERIENCE WITH MIEBO.
Both Walter Whitley, OD, MBA, and Selina McGee, OD, marked patients as potential Miebo users as soon as the product was on the horizon.
“I’ve been so excited to have Miebo available for my patients who are suffering from the signs and symptoms of DED. Prior to approval and availability, I was flagging patients who have been on or tried previously available therapies to make sure I offered Miebo to them at their next visit,” notes Dr. Whitley, who practices in Virginia.
“I knew this medication was coming to market, so I had actually built a list of all my patients who have evaporative dry eye issues with whom I thought this medication would work well,” says Dr. McGee, who has a dry eye practice in Oklahoma.
“They love how it feels, which is honestly pretty rare in any kind of drop,” she continues. “I have patients tell me it feels like silk, which is an interesting term…we finally have a medication that feels good going in.”
For Denver-based practitioner Cecelia Koetting, OD, her experience has also been positive so far. “I had my first round of patients prescribed Miebo coming back into the office for follow-ups,” she says. “Patients have been returning with both improvement in signs and symptoms, wanting to continue the medication.”
“The results across the board have been extremely good compared to any other drug in the ocular surface space. We are excited about the way in which it has changed treatment patterns and about the way patients are receiving it,” says J. James Thimons, OD, who practices in Fairfield, CT. “We’ve had a number of individuals who have recommended patients because of their results.”
WHO ARE THE BEST CANDIDATES FOR THIS PRODUCT AND WHY?
Dr. Koetting finds that the best patients are those who have mild to moderate MGD and DED. “Because the molecule is both lipophilic and aerophilic, the patients have to have some amount of lipid in the tear film to adhere to,” she explains.
Dr. Whitley agrees that anyone who has DED is a potential candidate. “With most dry eye having an evaporative component [Sheppard and Nichols, 2023], Miebo is now my go-to Rx for patients who are suffering,” he says. “Everyone is a candidate for Miebo—either as a first-line Rx for patients who have already tried artificial tears or as a complimentary medication to current chronic therapy or procedures.”
Dr. Thimons concurs that patients who are distributed toward the evaporative side of the ocular surface equation are the best. “Patients who have aqueous insufficiency syndrome are possible patients, but I think the real strength of the product is its ability to extend the tear film presence and decrease evaporative desiccative stress, and in doing so, allow the patients to have a much more comfortable and healthier ocular surface,” he says. “So, post-serolid disease patients are obvious. Patients with mixed disease states such as posterior lid issues and aqueous deficiency are excellent candidates. I don’t think at this point I have a place for it in that pure aqueous deficiency space, but that will remain to be discovered at a later point.”
TELL US ABOUT THE PRESCRIBING PROCESS AND WHAT HAS WORKED BEST FOR YOU.
Dr. Whitley notes that the key with prescribing is making sure your staff is aware of the prescription process—from the front desk to technicians to scribes. “It is important for our teams to know how and why [Miebo] is different from other dry eye medications and artificial tears,” he says. “I let patients know why I’m prescribing Miebo, how to use it, any side effects, and how to get it. I use one of the four specialty pharmacies and let the patient know they will be receiving a text (most commonly) or call from the pharmacy. I give patients a handout to help them understand the process. Right now, there is no reason not to prescribe it for a new or existing dry eye patient with commercial insurance due to the current saving/discount programs. I typically see my patients back in about four to six weeks to assess their condition.”
Dr. Thimons performs a structured protocol. “We take a very intensive look at the lids, both anterior and posterior lid position. We grade the oil gland productivity or lack thereof. They receive lissamine stain to identify inflammatory cellular activity on the conjunctiva, which is not visible with any other process. We look at [tear break-up times], and then we go over environmental issues, screen time, medications, work environments—all of those enter into it. Additionally, we also use [tear osmolarity and MMP-9 testing] for all dry eye evaluations,” he explains.
PLEASE TELL US ABOUT A PARTICULAR SUCCESS STORY WITH THIS PRODUCT FOR A GIVEN PATIENT.
Dr. McGee tells of a patient who had gone through a series of intense pulsed light treatments and a heat treatment successfully. “After six months, she was having some breakthrough in signs and symptoms. Yet, even with all of that, she still wasn’t quite where I wanted her to be [therapeutically]. So, we added [Miebo] to her regimen,” she says.
“She came back four weeks later, and she said ‘Whatever you have to do, I can’t not have this drop.’ Her osmolarity normalized as well as her non-invasive tear break-up time,” Dr. McGee continued.
“She had suffered for over a decade. So, we considered her a huge success stort becaue she had been managed with maximum therapy and was still having breakthrough signs and symptoms,” she adds. “[Miebo] was the last like piece of that puzzle that she needed to get her fully therapeutically managed and treated.”
Finally, Dr. Koetting recounts her own experience with using Miebo. “With a lot of travel lately, my consistency with MGD treatment and environmental changes have made my eyes very angry,” she says. “I started using Miebo myself and am truly enjoying how my eyes are feeling better, and my vision has stabilized throughout the day.” CLS
- Sheppard JD, Nichols KK. Dry Eye Disease Associated with Meibomian Gland Dysfunction: Focus on Tear Film Characteristics and the Therapeutic Landscape. Opthalmol Ther. 2023 Jun;12:1397-1418.