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Dry Eye Disease: August 2026 Phase II/III Results for Novel Mechanisms · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Dry eye disease.
• 0:01
  SPEAKER_00: August 2026 phase 2-3 results for novel mechanisms.
• 0:06
  SPEAKER_00: Evidence cutoff, August 22nd, 2026.
• 0:10
  SPEAKER_00: Introduction.
• 0:11
  SPEAKER_00: Dry eye disease treatment is moving beyond replace the tears with artificial tears.
• 0:15
  SPEAKER_00: Newer therapies are attempting to stimulate the eye's own tear flex, restore the mucin layer, slow tear evaporation, improve mybomian gland function, or target inflammation in genetically selected patients.
• 0:27
  SPEAKER_00: A date clarification is important.
• 0:29
  SPEAKER_00: There was not one single August 2026 wave of completed phase 2 or phase 3 dry eye readouts covering all of these mechanisms.
• 0:38
  SPEAKER_00: The most important recent human data available by August 22, 2026, include the May 2026 publication of phase 3 results for a coultramon, now marketed in the United States as triptyre.
• 0:52
  SPEAKER_00: A 2026 randomized study of the mucin secretagogues Dequifazole and Rebimipid, showing effects within 30 minutes.
• 0:59
  SPEAKER_00: A July 2026 randomized study of lipid-containing artificial tears in people with a thin tear film lipid layer.
• 1:07
  SPEAKER_00: Continuing phase 2-3 programs for AZR MD001, Licumin LIMAB, PL9643, and Platelet Lysate Biologics, for which definitive August 2026 efficacy results were not publicly posted.
• 1:20
  SPEAKER_00: An August 8, 2026 publication involving troxipide nanoparticles applied through the eyelid was preclinical animal research, not a human phase 2 or phase 3 trial.
• 1:31
  SPEAKER_00: It should not be interpreted as proof of clinical benefit in patients.
• 1:35
  SPEAKER_00: Troxipide Nanoparticle Study How to Interpret Dry Eye Trial Results.
• 1:40
  SPEAKER_00: Clinical trials usually measure both symptoms and signs.
• 1:43
  SPEAKER_00: Symptoms assessment and dry eye, or SANDE, measures the frequency and severity of symptoms on a 0 to 100 scale.
• 1:51
  SPEAKER_00: Higher scores indicate worse symptoms.
• 1:54
  SPEAKER_00: Ocular Surface Disease Index, or OSDI, measures symptoms and their effect on daily activities.
• 2:00
  SPEAKER_00: Higher scores indicate worse disease.
• 2:03
  SPEAKER_00: Tear breakup time, often called TBU, measures how long the tear film remains stable after a blink.
• 2:08
  SPEAKER_00: A longer time is generally better.
• 2:11
  SPEAKER_00: Corneal fluorescence staining measures damage to the surface cells of the cornea.
• 2:15
  SPEAKER_00: A lower score is better.
• 2:17
  SPEAKER_00: Schirmer testing estimates tear production using a paper strip.
• 2:21
  SPEAKER_00: A larger increase suggests more aqueous tear production.
• 2:25
  SPEAKER_00: These measures do not always improve together.
• 2:28
  SPEAKER_00: A patient may have less burning but little change in staining, or may produce more tears without feeling much better.
• 2:35
  SPEAKER_00: This symptom sign mismatch is one of the major difficulties in dry eye research.
• 2:40
  SPEAKER_00: Results also cannot be compared directly across studies unless the trial populations, control groups, dosing schedules, and measurement methods are similar.
• 2:48
  SPEAKER_00: Summary of the most relevant 2026 evidence.
• 2:52
  SPEAKER_00: For the full table, please open this article on VisualFieldTest.com.
• 2:57
  SPEAKER_00: Neurosensory modulation, a Kultramon or tryptar mechanism and treatment concept.
• 3:02
  SPEAKER_00: Triptar contains a Kultramon, a transient receptor potential melastatinate agonist.
• 3:08
  SPEAKER_00: Transient receptor potential melastatin 8 channels are found on cold-sensitive sensory nerves in the cornea and eyelids.
• 3:15
  SPEAKER_00: Activating these nerves can stimulate a reflex pathway involving the lacrimal gland and increase tear production.
• 3:22
  SPEAKER_00: The mechanism is different from anti-inflammatory drugs such as cyclosporine and lymphytograst.
• 3:28
  SPEAKER_00: It also differs from MiBO, which is designed primarily to reduce evaporation.
• 3:33
  SPEAKER_00: The Food and Drug Administration review noted that a cultraman's tear-producing effect is greatly reduced under topical anesthesia, supporting the importance of an intact sensory nerve pathway.
• 3:44
  SPEAKER_00: Food and Drug Administration integrated review.
• 3:47
  SPEAKER_00: Triptyre was approved by the Food and Drug Administration on May 28, 2025, at a dose of one drop in each eye twice daily.
• 3:57
  SPEAKER_00: Food and Drug Administration Drug Trial Snapshot for Triptyr.
• 4:01
  SPEAKER_00: TIR production.
• 4:03
  SPEAKER_00: The two pivotal phase 3 studies, Comet II and Comet 3, enrolled a combined 931 patients.
• 4:10
  SPEAKER_00: The primary endpoint was the percentage of patients achieving at least a 10mm increase in unanesthetized Shermer testing on day 14.
• 4:17
  SPEAKER_00: Comet 2, 42.6% with a caultraman versus 8.2% with vehicle.
• 4:23
  SPEAKER_00: Comet 3, 53.2% with a Kaltramon versus 14.4% with vehicle.
• 4:29
  SPEAKER_00: Both differences were statistically significant.
• 4:32
  SPEAKER_00: Increased tear production was also observed after the first dose and remained detectable through day 90 when the test was performed after dosing.
• 4:40
  SPEAKER_00: A Kaltraman phase 3 publication, trip tire prescribing information, symptoms.
• 4:46
  SPEAKER_00: In Comet 2, the key secondary endpoint, change in the global Sandy score at day 28, favored a Cultraman, least squares mean change of minor 19.7 points.
• 4:57
  SPEAKER_00: Vehicle, least squares mean change of minus 14.7 points.
• 5:01
  SPEAKER_00: Difference, minor 5.1 points.
• 5:04
  SPEAKER_00: However, the same Sandy endpoint was not statistically significant in Comet 3, the replication study.
• 5:11
  SPEAKER_00: The Food and Drug Administration also noted that day 90 symptom endpoints were not met and that the evidence for replicated symptom relief was weaker than the evidence for increased tear production.
• 5:21
  SPEAKER_00: Food and Drug Administration Review.
• 5:24
  SPEAKER_00: Clinical Interpretation.
• 5:26
  SPEAKER_00: Triptier clearly stimulates tear production, but the size and consistency of symptom improvement may vary.
• 5:32
  SPEAKER_00: It should not be presented as a guaranteed rapid pain relief treatment for every patient.
• 5:37
  SPEAKER_00: Corneal staining and tear film stability.
• 5:41
  SPEAKER_00: The published phase 3 report found greater reductions in total corneal fluorescence staining on days 28 and 90 and greater reductions in conjunctival staining across study visits.
• 5:52
  SPEAKER_00: However, the regulatory approval was primarily based on the tear production endpoint rather than a replicated symptom endpoint.
• 6:00
  SPEAKER_00: Tear breakup time was measured in the trial program, but a replicated, clinically persuasive tear breakup time benefit was not the central basis for approval.
• 6:10
  SPEAKER_00: The Food and Drug Administration review also raised uncertainty about how long the tear stimulation effect lasts between the post-dose measurement and the next dose 12 hours later.
• 6:22
  SPEAKER_00: Onset of Action.
• 6:23
  SPEAKER_00: Tripter appears to act very quickly on tear production.
• 6:26
  SPEAKER_00: A significant effect was observed on day one.
• 6:29
  SPEAKER_00: The post-dose Schirmer test was started only a few minutes after installation.
• 6:35
  SPEAKER_00: The study does not prove that patients experience meaningful symptom relief within a few minutes.
• 6:41
  SPEAKER_00: The duration of effect throughout the entire 12-hour dosing interval has not been clearly established.
• 6:47
  SPEAKER_00: The practical expectation is therefore rapid stimulation of tearing, with symptom and surface improvements potentially requiring continued use.
• 6:57
  SPEAKER_00: Safety and tolerability.
• 6:58
  SPEAKER_00: The main tolerability problem is burning or stinging immediately after use.
• 7:03
  SPEAKER_00: Installation site pain occurred in approximately 50% of patients.
• 7:07
  SPEAKER_00: Most events were mild.
• 7:09
  SPEAKER_00: Less than 1% of patients discontinued treatment because of burning or stinging.
• 7:14
  SPEAKER_00: No major drug-related safety signal was identified in the pivotal trials.
• 7:18
  SPEAKER_00: Triptyre is packaged in single-dose vials.
• 7:22
  SPEAKER_00: One vial can be used for both eyes, but it must be discarded after use.
• 7:26
  SPEAKER_00: Contact lenses should be removed before dosing and may be reinserted after 15 minutes.
• 7:31
  SPEAKER_00: Triptyre prescribing information.
• 7:34
  SPEAKER_00: Likely responder phenotype.
• 7:36
  SPEAKER_00: The best mechanistic fit may be patients with low tear production, preserved corneal sensory nerve function, a functioning reflex tear pathway, mixed disease with an aqueous deficient component.
• 7:48
  SPEAKER_00: This is a mechanism-based inference, not a validated clinical responder rule.
• 7:52
  SPEAKER_00: The comet trials did not establish that triptyre is superior in a clearly defined aqueous deficient subgroup or inferior in evaporative disease.
• 8:01
  SPEAKER_00: Patients with severe corneal nerve dysfunction, prominent neuropathic pain, or symptoms that are very poorly matched to clinical signs, may respond unpredictably.
• 8:11
  SPEAKER_00: Mucin secretagogues, dequafosol, and rebamipide, why mucin matters.
• 8:16
  SPEAKER_00: The tear film is not simply water, it includes an aqueous component, a lipid component that reduces evaporation, a mucin component that helps tears spread across the ocular surface.
• 8:27
  SPEAKER_00: The gel-forming mucin, mucin 5AC, produced mainly by conjunctival goblet cells, helps lubricate the eye and maintain tear film stability.
• 8:36
  SPEAKER_00: 2026 Randomized Study A.
• 8:38
  SPEAKER_00: 2026 prospective paired eye study compared 3% dequafosol with 2% rebimepide.
• 8:45
  SPEAKER_00: This was not a large registration phase 3 trial, but it provides unusually useful information about early pharmacologic effects.
• 8:53
  SPEAKER_00: 30 minutes after installation, both agents significantly increased tear mucin 5AC, both improved symptoms and tear breakup time.
• 9:01
  SPEAKER_00: The difference in tear breakup time between the two agents was not statistically significant.
• 9:06
  SPEAKER_00: Dequafosol produced a greater improvement in the visual analog symptom score than rebamipide.
• 9:13
  SPEAKER_00: Mucin-1, a membrane-associated mucin, did not change significantly during this short observation period.
• 9:20
  SPEAKER_00: The study therefore supports a rapid tear film and mucin effect, especially for patients with short tear breakup time or suspected mucin dysfunction.
• 9:29
  SPEAKER_00: 2026 Decoffisol and Rebamipide study.
• 9:32
  SPEAKER_00: Safety and tolerability.
• 9:34
  SPEAKER_00: Reported short-term symptoms were relatively common, but generally mild.
• 9:38
  SPEAKER_00: Burning was reported by approximately 20% of patients with dequafisol and rebamipide.
• 9:44
  SPEAKER_00: Foreign body sensation occurred in approximately 17% to 20%.
• 9:48
  SPEAKER_00: Dryness was reported by approximately 13% with decoafosol and 23% with rebamipide.
• 9:55
  SPEAKER_00: No significant tolerability difference was found between the treatments.
• 9:58
  SPEAKER_00: Likely responder phenotype.
• 10:00
  SPEAKER_00: Mucin sicretagogs may be most useful for patients with short tear breakup time.
• 10:05
  SPEAKER_00: Ocular surface staining with relatively preserved aqueous production, goblet cell or mucin layer dysfunction, mixed aqueous deficient and evaporative disease.
• 10:16
  SPEAKER_00: Contact lens-related or screen-associated tear film instability.
• 10:20
  SPEAKER_00: Dicquafasol may have an additional potential advantage because it can stimulate fluid, mucin, and mibomian gland lipid secretion.
• 10:27
  SPEAKER_00: Rebamipide is more directly associated with mucin support and may also have anti-inflammatory effects.
• 10:34
  SPEAKER_00: Neither diquaphasol nor rebamipide is currently an approved United States dry eye treatment.
• 10:39
  SPEAKER_00: Their availability and dosing differ by country.
• 10:43
  SPEAKER_00: Lipid layer stabilization, perfluorohexaloctane and lipid tears.
• 10:47
  SPEAKER_00: MEBO, the strongest current option for evaporative disease, perfluorohexaloctane, marketed in the United States as MEBO, is a water-free liquid designed to reduce excessive tear evaporation.
• 10:59
  SPEAKER_00: It is especially relevant to dry eye associated with mibomian gland dysfunction.
• 11:05
  SPEAKER_00: In the Phase III Mojave study, 620 patients were randomized.
• 11:09
  SPEAKER_00: Treatment was given four times daily for eight weeks.
• 11:12
  SPEAKER_00: Total corneal fluoresceining improved by my-23 points with perfluorohexaloctane versus minus 1.1 points with saline.
• 11:21
  SPEAKER_00: The treatment difference was minus 1.2 points.
• 11:24
  SPEAKER_00: Dryness improved by my-29.4 points versus minus 19.2 points with saline.
• 11:30
  SPEAKER_00: The treatment difference in dryness was minus 10.2 points.
• 11:35
  SPEAKER_00: Sign and symptom differences were present as early as week two.
• 11:38
  SPEAKER_00: Ocular adverse event rates were similar to saline with no serious adverse events or treatment discontinuations caused by adverse events.
• 11:46
  SPEAKER_00: MEBO phase 3 Mojave study, likely responder phenotype, MEIBO is most logically matched to patients with evaporative dry eye, maibomian gland dysfunction, low or unstable lipid layer measurements, short tear breakup time, symptoms that worsen with wind, fans, air conditioning, or prolonged screen use.
• 12:05
  SPEAKER_00: Unlike trip tire, MEIBO does not primarily stimulate aqueous tear production.
• 12:10
  SPEAKER_00: A patient can therefore have a good response even when the Schermer score changes very little.
• 12:16
  SPEAKER_00: Lipid-containing artificial tears.
• 12:18
  SPEAKER_00: A July 2026 randomized study evaluated lipid-containing versus non-lipid-containing artificial tears in 39 patients with a low tear film lipid layer.
• 12:29
  SPEAKER_00: After three months, lipid layer thickness remains stable with the lipid-containing drop.
• 12:35
  SPEAKER_00: Lipid layer thickness declined with the non-lipid drop.
• 12:38
  SPEAKER_00: Tear film thinning remains stable with the lipid-containing formulation.
• 12:42
  SPEAKER_00: Fluorescene tear breakup time increased to approximately 6.33 seconds with the lipid containing drop compared with approximately 4.44 seconds at baseline.
• 12:53
  SPEAKER_00: The non-lipid drop did not produce a similar increase.
• 12:57
  SPEAKER_00: This was a small supportive study rather than a phase 2 or phase 3 prescription drug trial.
• 13:03
  SPEAKER_00: It suggests that formulation matters.
• 13:05
  SPEAKER_00: Not all artificial tears provide the same lipid layer effect.
• 13:09
  SPEAKER_00: 2026 Lipid-Containing Artificial Tear Study.
• 13:13
  SPEAKER_00: Other phase 2 and phase 3 programs.
• 13:15
  SPEAKER_00: What was not yet available in August AZRMD001.
• 13:20
  SPEAKER_00: AZRMD001 is a selenium sulfide ophthalmic ointment intended to improve obstructed or poorly functioning mybomian glands.
• 13:28
  SPEAKER_00: Its planned phase 3 program uses twice-weekly bedtime dosing and measures.
• 13:33
  SPEAKER_00: Change in the number of mybomian glands producing liquid secretion.
• 13:37
  SPEAKER_00: Change in the total ocular surface disease index score at month 3.
• 13:41
  SPEAKER_00: The study record showed the phase 3 trial as active but not recruiting, with no definitive results posted.
• 13:47
  SPEAKER_00: It remains one of the most phenotype-specific investigational treatments for evaporative dry eye, but its value cannot be judged until the phase 3 results are publicly available.
• 13:58
  SPEAKER_00: AZRMD001 Phase III study.
• 14:02
  SPEAKER_00: Licomin LIMAB is a topical antitumor necrosis factor alpha biologic being studied in the genotype selected Predict 1 phase 2-3 trial.
• 14:11
  SPEAKER_00: The trial began in April 2026, enroll adults with dry eye disease who agree to genetic testing, uses three times daily dosing for approximately 29 days, focuses on ocular discomfort severity, selects patients with a specific tumor necrosis factor receptor 1 genotype.
• 14:29
  SPEAKER_00: The registry lists the trial as recruiting, with completion estimated for December 2026.
• 14:35
  SPEAKER_00: Therefore, there were no mature August 2026 efficacy results to summarize.
• 14:41
  SPEAKER_00: Predict1 Clinical Trials.gov record, PL9643.
• 14:45
  SPEAKER_00: PL9643 is a melanocortin receptor agonist intended to reduce inflammation and support ocular surface repair.
• 14:53
  SPEAKER_00: The earlier phase 2 study did not meet its primary endpoints in the full study population.
• 14:58
  SPEAKER_00: A moderate to severe subgroup showed nominal improvements in several staining measures and tear breakup time, but these findings were exploratory.
• 15:06
  SPEAKER_00: No drug-related adverse events or drug-related discontinuations were reported.
• 15:11
  SPEAKER_00: The Phase III Melody 1 study was completed, but no definitive phase 3 results were publicly posted in the clinical trial record available by August 22, 2026.
• 15:23
  SPEAKER_00: Phase 2 PL9643 study Melody 1 trial record.
• 15:27
  SPEAKER_00: Platelet lysate biologics.
• 15:30
  SPEAKER_00: Fibrinogen-depleted human platelet lysate is being developed as a biologic tear substitute for moderate to severe disease.
• 15:37
  SPEAKER_00: The approach is intended to provide growth factors in proteins that may support epithelial healing and reduce surface damage.
• 15:44
  SPEAKER_00: The CAM 101 Phase III program had not produced an August 2026 efficacy readout.
• 15:51
  SPEAKER_00: CAM 101 Phase III study, comparison with existing therapies.
• 15:56
  SPEAKER_00: Artificial tears.
• 15:58
  SPEAKER_00: Preservative-free artificial tears remain appropriate for many patients with mild or intermittent disease.
• 16:04
  SPEAKER_00: They can provide rapid comfort, but their effect is usually temporary and they do not directly treat chronic inflammation, mybomian gland obstruction, or sensory nerve dysfunction.
• 16:15
  SPEAKER_00: A 2026 six-month study of preservative-free lubricants found improvements in ocular surface disease index, sand-e, tear breakup time, and staining overtime, but tear production remains stable.
• 16:28
  SPEAKER_00: This supports the value of regular lubrication while also showing that symptom improvement does not necessarily require increased tear production.
• 16:37
  SPEAKER_00: Enriched preservative-free lubricant trial, cyclosporin and lithograst.
• 16:42
  SPEAKER_00: Cyclosporin and lithograst remain important anti-inflammatory therapies for aqueous deficient and mixed dry eye disease.
• 16:49
  SPEAKER_00: They are generally used as longer-term treatments rather than immediate rescue drops.
• 16:55
  SPEAKER_00: Formulation can affect patient experience.
• 16:57
  SPEAKER_00: Nanomycellar cyclosporin, for example, is a clear aqueous formulation that does not require the same shaking step as an emulsion.
• 17:06
  SPEAKER_00: In phase three testing, it improved Schirmer testing and corneal and conjunctival staining, although global symptom scores improved in both active and vehicle groups without a significant difference between them.
• 17:18
  SPEAKER_00: Nanomycillar cyclosporine phase III study.
• 17:22
  SPEAKER_00: Varenicline nasal spray.
• 17:24
  SPEAKER_00: Varenicline nasal spray stimulates a nasal sensory reflex that increases natural tear production.
• 17:30
  SPEAKER_00: It is a useful comparison with tryptyre because both approaches use neural pathways rather than relying only on surface lubrication.
• 17:39
  SPEAKER_00: Nasal delivery may also be attractive for patients who struggle with eyedrop administration or who need to preserve contact lens wear during the day.
• 17:46
  SPEAKER_00: Miibo Mibo has the clearest evidence for a primarily evaporative mibomian gland dysfunction associated phenotype.
• 17:54
  SPEAKER_00: It is not a replacement for anti-inflammatory treatment when ocular surface inflammation is prominent, but it may be more logically targeted than a water-based teardrop in patients with an unstable lipid layer.
• 18:06
  SPEAKER_00: Adherence and formulation considerations.
• 18:08
  SPEAKER_00: Triptire advantages.
• 18:10
  SPEAKER_00: Twice daily dosing.
• 18:12
  SPEAKER_00: Rapid tear production effect.
• 18:14
  SPEAKER_00: Single dose vial can be used for both eyes.
• 18:17
  SPEAKER_00: No shaking is required.
• 18:19
  SPEAKER_00: Limitations.
• 18:20
  SPEAKER_00: Burning or stinging occurs in about half of users in clinical trials.
• 18:23
  SPEAKER_00: A new vial is used for each dose.
• 18:26
  SPEAKER_00: Contact lenses must be removed before treatment.
• 18:28
  SPEAKER_00: The duration of benefit between doses is not fully established.
• 18:32
  SPEAKER_00: MEBO Advantages, specifically targets evaporation.
• 18:36
  SPEAKER_00: Four times daily dosing is familiar to many patients using lubricants.
• 18:40
  SPEAKER_00: Phase 3 data support both symptom and corneal surface improvement.
• 18:45
  SPEAKER_00: Particularly logical for mybomian gland dysfunction.
• 18:48
  SPEAKER_00: Limitations, more frequent dosing than trypter, may be less useful as a sole treatment when aqueous deficiency or inflammation dominates.
• 18:56
  SPEAKER_00: Patients may still need eyelid care or mibomian gland treatment.
• 19:00
  SPEAKER_00: Dichosol and Rebemopy advantages, rapid mucin effect, potential to improve tear film quality rather than simply adding water, particularly relevant to short-tier breakup time and mucin layer dysfunction.
• 19:13
  SPEAKER_00: Limitations, not routinely available in the United States, often require repeated daily administration.
• 19:19
  SPEAKER_00: Burning, dryness, and foreign body sensation can occur.
• 19:22
  SPEAKER_00: The most recent rapid onset study was relatively small and not a registration trial.
• 19:28
  SPEAKER_00: AZRMD001, twice-weekly dosing could be a major adherence advantage if phase 3 efficacy is confirmed.
• 19:35
  SPEAKER_00: However, the ointment formulation may be less convenient during daytime use, and the absence of public phase 3 results means its benefit risk profile remains uncertain.
• 19:46
  SPEAKER_00: Genotype selected biologics licaminlimab illustrates a different adherence issue.
• 19:51
  SPEAKER_00: Treatment may require genetic testing, more frequent dosing, and a prior authorization process if eventually approved.
• 19:58
  SPEAKER_00: The advantage would be a potentially more precise treatment for patients with a particular inflammatory biology.
• 20:06
  SPEAKER_00: Responder phenotypes, which patients may benefit most?
• 20:10
  SPEAKER_00: Dry eye disease is usually mixed rather than purely evaporative or purely aqueous deficient.
• 20:15
  SPEAKER_00: Still, treatment selection can be guided by the dominant pattern, predominantly aqueous deficient disease.
• 20:21
  SPEAKER_00: Typical findings may include low Schirmer test result, autoimmune disease, or Shogrin disease, significant staining, reduced tear volume, symptoms that improve temporarily with increased tear volume.
• 20:34
  SPEAKER_00: Potentially relevant approaches include trip tire, varenoclean nasal spray, cyclosporin, or lymphytograst when inflammation is present, mucin secretagogues when tear quality is also abnormal, predominantly evaporative disease.
• 20:47
  SPEAKER_00: Typical findings may include mybomian gland dysfunction, thick or absent mybomian gland secretions, low tear breakup time, symptoms that worsen with wind, airflow, or screen use, relatively preserved schirmer testing.
• 21:01
  SPEAKER_00: Potentially relevant approaches include meibo, lipid-containing artificial tears, mybomian gland-directed treatment, AZRMD001 if phase 3 benefit is confirmed, diquafosol in countries where it is available because it may influence both mucin and lipid secretion, mucin or epithelial surface dysfunction.
• 21:20
  SPEAKER_00: Potential findings include short tear breakup time, surface staining, symptoms out of proportion to tear volume, goblet cell dysfunction, or chronic surface inflammation.
• 21:31
  SPEAKER_00: Potentially relevant approaches include diquifosol, rebimopide, anti-inflammatory treatment, regenerative biologic approaches under investigation, neuropathic or sensory predominant disease.
• 21:44
  SPEAKER_00: Some patients have severe burning or pain with little staining or tear abnormality.
• 21:49
  SPEAKER_00: Others have reduced corneal sensation and severe surface damage with surprisingly few symptoms.
• 21:54
  SPEAKER_00: These patients require caution.
• 21:56
  SPEAKER_00: A tear stimulating sensory drug may help when the reflex path.
• 22:00
  SPEAKER_00: Remains functional, but it may not address neuropathic pain itself.
• 22:04
  SPEAKER_00: Corneal sensitivity, medication history, prior surgery, and signs of nerve dysfunction may be important in treatment selection.
• 22:12
  SPEAKER_00: Payer coverage in the United States.
• 22:14
  SPEAKER_00: Coverage is highly plan specific.
• 22:16
  SPEAKER_00: For Medicare, each Medicare Part D plan has its own formulary, cost-sharing tiers, quantity limits, and prior authorization rules.
• 22:25
  SPEAKER_00: The Centers for Medicare and Medicaid Services maintains formulary data that include coverage tiers, step therapy, quantity limits, and prior authorization indicators.
• 22:35
  SPEAKER_00: Centers for Medicare and Medicaid Services prescription coverage information.
• 22:40
  SPEAKER_00: Medicare formulary data.
• 22:42
  SPEAKER_00: Commercial plans can also require prior authorization or documentation of clinical improvement.
• 22:48
  SPEAKER_00: For example, a 2026 United Healthcare Commercial Policy listed CEQA, MEBO, Rostasis, Tirva, Triptur, and Shiidra under prior authorization or notification requirements.
• 23:00
  SPEAKER_00: Its policy included diagnosis criteria, restrictions on combining prescription dry eye therapies, and reauthorization based on clinically significant improvement.
• 23:10
  SPEAKER_00: This is an example of one insurer's policy, not a national coverage rule.
• 23:14
  SPEAKER_00: United Healthcare dry eye coverage policy.
• 23:17
  SPEAKER_00: For a coverage request, documentation that may help includes diagnosis and severity of dry eye disease, ocular surface disease index, or sandy score, tear breakup time, corneal or conjunctival staining, Schirmer test result when relevant, mybomian gland findings for evaporative disease, previous use of preservative-free artificial tears, previous prescription therapies, and treatment response.
• 23:41
  SPEAKER_00: The reason a specific mechanism is appropriate for the patient's phenotype.
• 23:46
  SPEAKER_00: Investigational agents such as AZRMD01, Licominlimab, and PL9643 are not routine formulary treatments.
• 23:54
  SPEAKER_00: Until approval, access is generally through clinical trials.
• 23:58
  SPEAKER_00: Overall clinical perspective.
• 24:00
  SPEAKER_00: The 2026 evidence supports a more mechanism-based approach.
• 24:04
  SPEAKER_00: Tripter is the most important recent neurosensory advance.
• 24:08
  SPEAKER_00: It produces rapid, reproducible tear stimulation, but symptom relief was not statistically replicated across both pivotal studies and burning is common.
• 24:17
  SPEAKER_00: MiBO currently has the clearest clinical evidence for evaporative dry eye associated with maibomian gland dysfunction, including improvement in both staining and dryness.
• 24:28
  SPEAKER_00: Dequafazole and Rebamipide provide compelling evidence that mucin secretion can improve within minutes, although their availability in the United States is limited, and the latest study was not a large registration trial.
• 24:42
  SPEAKER_00: Lipid-containing artificial tears may be especially useful when the tear film lipid layer is demonstrably thin, but they should not be assumed to be interchangeable with prescription lipid layer therapies.
• 24:54
  SPEAKER_00: AZRMD001 could become an important gland-directed treatment if its phase 3 results confirm meaningful improvement.
• 25:03
  SPEAKER_00: Licumin LAMAB represents the field's move toward genetically guided anti-inflammatory treatment, but its pivotal data were still pending as of August 22nd, 2026.
• 25:14
  SPEAKER_00: Existing therapies remain important because many patients have mixed disease and may need both anti-inflammatory treatment and correction of aqueous, mucin, or lipid abnormalities.
• 25:25
  SPEAKER_00: The most realistic future is not one universal best dry eye drug.
• 25:30
  SPEAKER_00: It is a combination of phenotype matching, better formulations, fewer daily doses, improved tolerability, and pair systems that recognize clinically meaningful improvement rather than requiring every patient to follow the same treatment sequence.
• 25:45
  SPEAKER_00: Conclusion Novel dry eye treatments are becoming more biologically targeted.
• 25:50
  SPEAKER_00: Neurosensory modulators may increase tear production, mucin secretagogues may improve tear film quality, and lipid layer stabilizers may reduce evaporation.
• 26:00
  SPEAKER_00: The early results are encouraging, but the data also show why dry eye disease remains difficult to treat.
• 26:06
  SPEAKER_00: Signs and symptoms often separate, trial populations are heterogeneous, and one mechanism may help one phenotype while doing little for another.
• 26:14
  SPEAKER_00: As of August 2026, the strongest practical choices remain phenotype dependent.
• 26:20
  SPEAKER_00: Low tear production.
• 26:21
  SPEAKER_00: Consider a reflex tear stimulant or anti-inflammatory treatment.
• 26:26
  SPEAKER_00: Maybomian gland dysfunction and evaporation.
• 26:29
  SPEAKER_00: Consider MEBO, lipid-containing tears, and gland-directed treatment.
• 26:34
  SPEAKER_00: Short tear breakup time or mucin dysfunction, mucin supportive strategies may be especially relevant where available.
• 26:41
  SPEAKER_00: Inflammatory or autoimmune disease, anti-inflammatory therapies remain central, while genotype-selected biologics remain investigational.
• 26:51
  SPEAKER_00: Patients should discuss treatment selection with an eye care professional who can assess tear production, tear stability, staining, eyelid and mibomian gland function, corneal sensation, and insurance requirements together.
• 27:02
  SPEAKER_00: Selected sources.
• 27:04
  SPEAKER_00: Food and Drug Administration Drug Trials Snapshot.
• 27:07
  SPEAKER_00: Triptur Food and Drug Administration Integrated Review for Triptur, a Culturman Phase III, Comet II, and Comet III Publication, MEBO Phase III, Mojave Study 2026, DICWAFO CILANDRE BIMAPITER and OMIS Study 2026, Lipid Containing Artificial Tear Study, AZRMD001 Phase III Trial Record, Licamin Limab Predict 1, Phase 2 3 Trial Record, PL 9643, Phase 2 Melody 1 Trial Record, Centers for Medicare Medicaid Services, Prescription Coverage Information, Information all links to sources area available in the text version of this article.
• 27:38
  SPEAKER_00: You can find the full article at VisualFieldTest.com.
• 27:42
  SPEAKER_00: Thanks for listening.
• 27:43
  SPEAKER_00: To check your visual field, click the link at the bottom of this article or visit visualfieldtest.com.