A new product from Alcon is shaking up the eye lubricant category and piquing the interest of clinical optometrists and tear film researchers in Australia.
In Australia’s Top End, patients have many reasons to visit optometrist Ms Helen Summers’ with a dry eye complaint. Bushfires, a long dry season and heightened allergy responses are among the contributing factors, along with long periods of exposure to air conditioning and fans.
With a younger demographic, there’s also a high number of post-refractive surgery patients seeking relief, as well as older patients recovering from cataract surgery or treating chronic conditions like glaucoma with eye drops.
For most optometrists, lubricating eye drops are a first-line defence in such instances. It’s a market that has matured significantly over the years, with a greater emphasis on preservative-free products.
Alcon Vision Care is one company considered an innovator in the preservative-free lubricant eye drop category, resulting in its latest product: Systane Hydration Lubricant Eye Drops 10mL.
Summers and other Australian optometrists gained access to the over-the-counter (OTC) product earlier this year, which has become a go-to solution for many of her patients seeking dry eye relief.
According to Alcon, the lubricant adopts Systane’s Intelligent Delivery system of HP-Guar and borate in combination with 0.15% hyaluronic acid (HA)* for long-lasting dry eye relief. 1-3 Upon instillation, the HP-Guar and borate crosslink to form a viscoelastic meshwork,4 forming a mucomimetic bandage over the ocular surface and therefore increasing the retention of demulcents.5 Additionally, HP-Guar preferentially binds to damaged areas of the cornea, therefore protecting damaged cells to allow for repair and renewal,5 Alcon states.
All in all, the combination of HP-Guar and borate with HA has been shown to have an additive effect providing two times greater moisture retention compared to drops with HA alone in a laboratory study.1
Summers has welcomed the addition of Systane Hydration to her dry eye tool kit, with the therapy designed to address the symptoms of moderate to severe^ dry eye – and can be used for dry eye patients before and after ocular surgery.6 Approximately 82% of patients experience moderate to severe dry eye symptoms following cataract surgery.7 And peri-operative management of existing dry eye can reduce post-operative dry eye symptoms and may influence post-operative outcomes.6 The product is also suitable to use with soft contact lenses.
“By listening to what the research is telling us, Alcon has innovated to come up with Systane Hydration,” says Summers, who practises in Darwin.
“The innovation lies in the formulation, with the product being ideal for patients I see with aqueous deficient dry eye, and also those having post-refractive and cataract procedures. By retaining the moisture on the ocular surface for longer, there is an improved tear film osmolarity. We are able to create a better outcome, not only in comfort, but for recovery too. It’s important we see the clinical difference, but what’s the point if the patient doesn’t feel the soothing effect as well? Systane Hydration is offering an improved tear film, more comfort for the patient and better outcomes from the procedures.”
Summers has also prescribed Systane Hydration in patients taking glaucoma eye drops to help counteract the chronic dry eye effects of preservatives like benzalkonium chloride (BAK).
“I see a lot of ocular surface toxicity (medicomentosa) due to chronic exposure of BAK from long term use of glaucoma drops, allergy drops and ‘misuse’ of OTC antibiotic drops, and ‘red-eye’ drops. Even some of the so-called ‘safe preservatives’ cause reactions in some patients. To recover after the use of medicated drops during surgery and post-surgery, (anti-inflammatories, antibiotics) a preservative-free option for dry eye relief is so important,” she says.
“For my post cataract or refractive surgery patients, Systane Hydration has played an important role. You might say it fills the uneven surface or compromised areas of the cornea which helps improve patient comfort levels.
“We need to remember people with dry eye can be quite desperate by the time they visit the optometrist. Dry eyes are tired eyes, and impacts their quality of life. So, it’s great to have a product like Systane Hydration as a starting point where I can be confident patients are likely to notice a difference.”
Alcon has innovated beyond the formulation too. The multidose bottle features Alcon’s patented PureFlow technology, helping the company eliminate the need for preservatives. It is designed with a one-way valve to ensure no contaminated liquid can be re-introduced into the container and a fine silicone membrane to filter returned air.8 The bottle also has a low squeeze force and features a blue tip to aid targeting of the eye for ease of instillation.”8
Summers expects this will be of benefit to elderly patients who may have dexterity issues. But there’s environmental benefits as well, with multi-dose bottles considered friendlier to the planet than single-use ampoules.
Performance in UNSW studies
Systane Hydration is also of interest to the ophthalmic research community in Australia, with studies under way to investigate its effectiveness in dry eye patients also dealing with diabetes or migraines.
Associate Professor Maria Markoulli is from the School of Optometry and Vision Science at UNSW whose research interests lie within tear film biochemistry and the ocular surface.
She first became aware of Systane Hydration through Alcon when UNSW started looking into possible treatments for study patients with diabetes. In particular, UNSW researchers sought an eye drop that was preservative-free, given the often-delicate corneas of patients with diabetes.
Of interest to Markoulli is that Systane Hydration is well-tolerated by patients, with her unpublished preliminary data indicating it provides symptomatic relief to patients with diabetes and dry eye disease.
“We have been working with Alcon, specifically on Systane Hydration, on two studies. The first looked at patients with diabetes and showed they were four times more likely to have dry eye disease if they had co-existent neuropathy,” she says. “When we treated those with dry eye disease with either Systane Hydration or saline as a placebo, we saw an improvement in symptoms with Systane Hydration when used four times a day for one month.”
“The second study is still a work in progress and involves us treating patients who have both migraine and dry eye disease, our aim being to evaluate whether managing dry eye disease helps alleviate the severity and possibly the frequency of migraine. This work will be presented in 2024.”
When looking at the lubricants landscape, Markoulli says the industry is in a much better position than years gone by, with more options, and many of these being preservative-free – but there was still some way to go.
“Going preservative-free in the management of dry eye disease is a ‘no-brainer’ now. We know that the use of preservatives can contribute to iatrogenic dry eye disease. The more options we have that are preservative-free, the better for our patients” she says.
“One challenge that we have now is that in many cases there is a lack of studies evaluating the clinical efficacy of these lubricants in certain patient cohorts. For example, we don’t have many head-to-head comparisons, or studies showing lubricant efficacy in those who have lost corneal nerves due to various conditions. We also don’t know a lot about when we should be implementing therapy post-operatively, e.g., post cataract surgery, or post refractive surgery.”
1.Ranagarajan et al. Effects of a Hyaluronic Acid/Hydroxypropyl Guar Artificial Tear Solution on Protection, Recover and Lubricity in Models of Corneal Epithelium. J Ocul Pharmacol Ther 2015; 31(8): 491-497
2.Davitt et al. Efficacy in Patients with Dry Eye After Treatment with a New Lubricant Eye Drop Formulation. J Ocul Pharmacol Ther 2010; 26(4): 347-353
3.Rolando et al. Protecting the Ocular Surface and Improving the Quality of Life of Dry Eye Patients. J Ocul Pharmacol Ther 2009; 25(3): 271-277
4.Springs, C. Novel Ocular Lubricant Containing an Intelligent Delivery System: Details of Its Mechanism of Action. Dev Ophthalmol 2010; 45: 139-147
5.Labetoulle et al. Efficacy and safety of a dual-polymer hydroxypropyl guar- and hyaluronic acid-containing lubricant eyedrops for the management od dry-eye disease: a randomized double-masked clinical study. Clin Ophthalmol 2018; 12: 2499-2508
6.Favuzza et al. Protecting the Ocular Surface in Cataract Surgery: The Efficacy of the Perioperative Use of a Hydroxypropyl Guar and Hyaluronic Acid Ophthalmic Solution. Clin Ophthalmol 2020; 14: 1769-1775
7.Jayshree et al. A Prospective Study of Dry Eye after manual Small Incision Cataract Surgery in a rural population of Bagalkot. J Clin Res Ophthalmol 2017; 4(2): 25-29
8.Nemera Novelia Product Leaflet
*contains sodum hyaluronate, the salt form of hyaluronic acid
^recommendation based upon expected on-eye viscosity