for the Price of 2 1

Glaucoma ain’t the only sign of aging

Given that the theme of this edition of CAKE magazine is focused on two of the most common conditions that ophthalmologists come across — namely, cataract and glaucoma — we want to start this article with a warning: You will get old.

Yes, eventually you will become old… a coffin dodger, a Florida enthusiast, and the type of person that enjoys

by Andrew Sweeney

shouting at children to “get off their lawn.” You can forestall this fate as much as you want — but eventually, it will hit you like your shock at your first social security check. So get ready for the twilight and the ocular conditions that often come along with it: cataracts, glaucoma, dry eye disease (DED) and presbyopia.

While glaucoma doesn’t directly cause DED, both conditions are

“The most common conditions I see at my clinic are blepharitis and DED, and both of these conditions do the same thing. They impact the health of the ocular surface and the tear film, so when they’re not normal, they’re going to impact preoperative measurements and the patient’s postoperative vision as well, that’s why it’s so important to treat them,” Dr. Trattler said.

Azura and Tarsus … not resort towns in Greece

Dr. Trattler has consistently been at the forefront of utilizing highquality new treatments for DED, blepharitis and other conditions. And at the moment, there are two products he’s keen to see deployed in the near future. The first is the AZR-BL-007 (surely shaken, not stirred…) by Azura Ophthalmics (Tel Aviv, Israel), which uses keratolytics to treat ocular surface conditions. The second is Tarsus, specifically the TP-03, again manufactured by an eponymous company but this time based in Irvine, California — and if approved, would be the first US Food and Drug Administration (FDA)approved treatment for Demodex blepharitis. forward to it getting approved by the FDA,” he added.

“Azura is developing a therapy that’s going to hopefully get the oil glands to function better. It’s based on keratolytics treatment for dry skin warts, etc., and oil glands of the eyelid produce relatively the same substance. So what Azura does is get the meibomian glands to work better, which is ideal for blepharitis and is really exciting,” Dr. Trattler continued.

Aging eyes? Glaucoma isn’t the only thing to consider…

As people get older (yes, I’m afraid we’re driving this point home), they also become more vulnerable to conditions like presbyopia, which is bad enough when a patient has relatively normal vision, but can seriously decrease quality of life when they also have conditions like cataract and glaucoma. Eye drops to treat this condition were something of a holy grail in ophthalmology for some time, and now they are becoming a practical reality. This development is something that Dr. Trattler welcomes on behalf of his patients.

“One thing that is interesting with presbyopia eye drops is that they may cause pupillary miosis. In some cases, having a smaller pupil might be the answer because sometimes there’s little astigmatism and a smaller refractive error. In that situation, if you make their pupil even smaller, that actually might improve their vision,” Dr. Trattler said.

have presbyopia in addition to other problems like cataracts or glaucoma, all of which require their own treatment regimen.

“As these presbyopia eye drops last for four to six hours, they might really help these patients. We’ll need to see how they work out once they become approved and available across the country. Right now there’s no evidence of their losing efficacy,” concluded Dr. Trattler.

Reference

* Williams RD. Dry Eye and Glaucoma: Double Trouble. Glaucoma Research Foundation Posted on September 15, 2019; Last reviewed on March 16, 2022. Available at https://glaucoma.org/dry-eyes-and-glaucomadouble-trouble/. Accessed on January 19, 2023.

Contributing Doctor

“Tarsus is similarly very interesting. The company is developing a medication called TP-03, which is targeted at the Demodex that lives on the eyelashes, it’s going to wipe it out. That will result in a dramatic improvement in blepharitis, and the product has already undergone phase three studies. I’m looking

Dr. Trattler pointed to a number of presbyopia-specific eye drops that should be available to clinicians in the near future, including the CSF-1 by Orasis Pharmaceuticals (Herzliya, Israel) and BRIMOCHOL PF by Visus Therapeutics (Seattle, Washington). He said that the appeal of these products is how easily they can be used by patients, especially those in demographic groups that are traditionally less compliant. Perfect for the young at heart who wtrattler@gmail.com

Dr. William B. Trattler , MD, is a refractive, corneal and cataract eye surgeon at the Center For Excellence In Eye Care in Miami, Florida, USA. He performs a wide variety of cataract and refractive surgeries — including PRK, all-laser LASIK, no injection sutureless cataract surgery, as well as laser cataract surgery. He has been an investigator for next-generation technologies (like the Tetraflex accommodating intraocular lens) and procedures like corneal collagen crosslinking (CXL). His involvement in the FDA-approval study for CXL led to its approval in 2016. In addition to his private practice, Dr. Trattler is on the Volunteer Faculty at the Florida International University Wertheim College of Medicine, as well as the University of Miami’s Bascom Palmer Eye Institute. He is boardcertified by the American Board of Ophthalmology and has been an author of several articles and abstracts. In 2016, Dr. Trattler received the Catalyst Award in Advancing Diversity in Leadership from the Ophthalmic World Leaders (OWL), an association of interdisciplinary ophthalmic professionals dedicated to driving innovation and patient care by advancing diversity in leadership.