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    Dry eye therapy seeks to fill unmet need in artificial tears

    A look at the history of artificial tears traces progression of products, dry eye market


    Second generation: The transition from first- to second-generation products brought along the concept of preservative-free and multi-dose formulations with softer, gentler preservatives. This shift in the dry eye artificial tear market—from the overwhelming use of strong preservatives to the use of preservative-free, “disappearing” and other, more gentle preservatives for those patients who are hypersensitive to preservatives—was a critical point in the over-the counter, artificial tear landscape.

    Polymers are the second-generation of products, existing of two groups: natural polymers (e.g., methycellulose derivatives) and synthetic polymers (e.g., polyethylene glycol, polyvinyl alcohol, povidone, carbopol, polyguar, and HP guar). Nowadays, this group represents the widest class of marketed products. Polymers have hygroscopic and high-viscosity properties, offering a better retention time than saline products. These products also provide good lubrication of the ocular surface and can compensate for inadequate tear production. Unfortunately, the challenge with this group of products is to find a compromise between high viscosity and low blurring at instillation. Examples of this group of tears include Systane Ultra (Alcon Laboratories) and Refresh Classic (Allergan).

    Third generation: The inclusion of hyaluronic acid in artificial tears is considered to be the third generation of dry eye therapy. Hyaluronic acid is long-chain mucopolysaccharide with high-molecular weight. Products with hyaluronic acid have both hygroscopic and osmocorrective properties. Additionally, they support the regeneration of the corneal epithelium and improve the ocular surface structure as a result of mucoadhesive properties, which prolong the retention time on the ocular surface. This allows for a more convenient dosing regimen without impeding blinking or causing the marked visual blurring associated with earlier-generation artificial tears. These first three generations of artificial tears have found some performance in certain patient populations, but are not effective in all types of dry eye patients.

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