In the midst of growing incidence of dry eye disease, news that Cationorm is now available on the Pharmaceutical Benefits Scheme (PBS)1,2 – is sure to be welcomed by eye health professionals and the community alike.
The new, preservative-free, hydrating and lubricating emulsion, delivered in a 10mL multidose bottle, protects the ocular surface, reducing discomfort and irritation due to persistent dry eye.
In-licensed in Australia by Seqirus, Cationorm targets and treats dry eye disease (DED) caused by prolonged use of contact lenses or environmental conditions, using cationic nanoemulsion technology,3,4 through interactions between the positively charged oil nanodroplets and the negatively charged ocular surface.
The reimbursement of an additional treatment option for DED represents a significant milestone for Seqirus in addressing a common and chronic disease
Administered as one drop, up to four-times daily, in the affected eye, Cationorm is suitable for use with contact lenses, and is conveniently delivered via an easy-to-use, preservative-free, multi-dose bottle.5
According to In2Eyes Optometrist and Director of Dry Eye Group, Jason The (Melbourne), the availability of an additional, preservative-free treatment option for DED is a welcome step for clinicians and patients.
“It’s estimated that tens of millions of people worldwide are affected by dry eye disease (DED), with the prevalence involving symptoms with or without clinical signs, ranging from approximately 5% to 50%.6
“Importantly, patients often present with a lack of correlation between signs and symptoms.7,8 In fact, several studies have demonstrated less than 60% of those showing objective evidence of DED, are symptomatic,”9 said Mr Teh.
“While the full impact of DED on a patient’s quality of life (QoL) is not easily quantifiable,10 the economic burden and impact of DED on vision, QoL and work productivity, is considerable.”6,10
The management of DED is highly complicated due to its multifactorial aetiology.11 In severe cases, and in the latter stages of DED, conjunctival scarring, filamentary keratitis, epithelial defects, and corneal ulceration may also occur.12,13 If managed inappropriately, or left untreated, DED can lead to keratitis – inflammation of the cornea – and ultimately, loss of vision.7,9
Contact lens wearers have been found to be more than twice (2.38) as likely to have a diagnosis of DED, compared with non-contact lens wearers.6,14
More recently, a marked increase in dry eye symptoms among regular mask users has been reported, including among those who had never previously experienced dry eye, due to the COVID-19 pandemic.15 Moreover, the surge in virtual remote learning and working from home, coupled with governmental measures to encourage stay at home practices to help minimise the spread of the global virus, has driven a substantial increase in the use of digital media, such as desktops, laptops, tablet computers, and mobile devices.16
“Decreased blinking during extended visual tasks, such as computer use, watching television and prolonged reading, are some external factors known to precipitate and exacerbate dry eye,”17 Mr Teh said.
“Furthermore, in the younger population, DED is growing more common due to the surge in digital screen time.18,19
“Indoor environmental factors, including air conditioning, ceiling fans and forced air heating systems, can all lower humidity, and exacerbate tear evaporation, causing dry eye symptoms,”12,18 said Mr Teh.
Dr Jonathan Anderson, Seqirus Head of Medical Affairs Asia Pacific, said the company is committed to pursuing innovative treatment options for eye care.
“DED represents the most common reason for seeking medical eye care,20 with one in four patients who visit ophthalmic clinics reporting symptoms of the disease.21
“The reimbursement of an additional treatment option for DED represents a significant milestone for Seqirus in addressing a common and chronic disease, afflicting many Australians,” said Dr Anderson.
Increased osmolarity associated with DED activates an inflammatory cascade at the ocular surface that initiates epithelial damage, apoptosis of the cells of the conjunctiva and cornea, and altered mucin production.7,8 This exacerbates instability of the tear film, thereby increasing hyperosmolarity, and contributing to a vicious cycle of chronic ocular dryness, further ocular surface damage, and self-perpetuating symptoms.3,7,8,22
Although a mainstay of therapy, ocular lubricants (e.g. artificial tears) mainly provide palliative relief.23 Treatment strategies for DED involving topical instillation of artificial tears or lubricating gels, do not adequately address the pathophysiology.7,8
“Due to the chronic and often self-perpetuating nature of this disease,3,7,8,22 an additional treatment option should, therefore, be appreciated, by those living with DED,” Mr Teh said.
- Therapeutic Goods Administration. Australian Register of Therapeutic Goods – Public Summary Seqirus PTY LTD – Lubricant, eye. [cited 2021]; Available from: www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=406945E40B6D2CA4C A25843C0042145B&agid=(PrintDetailsPublic)&actionid=1.
- Pharmaceutical Benefits Scheme (PBS). Available from: www.pbs.gov.au/medicine/item/12612T.
- Amrane, M., et al., Ocular tolerability and efficacy of a cationic emulsion in patients with mild to moderate dry eye disease – a randomised comparative study. J Fr Ophtalmol, 2014. 37(8): p. 589-98.
- Robert, P.Y., et al., Efficacy and safety of a cationic emulsion in the treatment of moderate to severe dry eye disease: a randomized controlled study. Eur J Ophthalmol, 2016. 26(6): p. 546-555.
- Cationorm product package.
- Stapleton, F., et al., TFOS DEWS II Epidemiology Report. The Ocular Surface, 2017. 15(3): p. 334-365.
- Baudouin, C., et al., A randomized study of the efficacy and safety of 0.1% cyclosporine A cationic emulsion in treatment of moderate to severe dry eye. Eur J Ophthalmol, 2017. 27(5): p. 520-530.
- Leonardi, A., et al., Efficacy and safety of 0.1% cyclosporine A cationic emulsion in the treatment of severe dry eye disease: a multicenter randomized trial. Eur J Ophthalmol, 2016. 26(4): p. 287-96.
- Leonardi, A., B. Flamion, and C. Baudouin, Keratitis in Dry Eye Disease and Topical Ciclosporin A. Ocular Immunology and Inflammation, 2017. 25(4): p. 577-586.
- Uchino, M. and D.A. Schaumberg, Dry Eye Disease: Impact on Quality of Life and Vision. Current ophthalmology reports, 2013. 1(2): p. 51-57.
- Şimşek, C., et al., Current Management and Treatment of Dry Eye Disease. Turkish journal of ophthalmology, 2018. 48(6): p. 309-313.
- Messmer, E.M., The pathophysiology, diagnosis, and treatment of dry eye disease. Deutsches Arzteblatt international, 2015. 112(5): p. 71-82.
- Pisella, P.-J., et al., Topical ocular 0.1% cyclosporine A cationic emulsion in dry eye disease patients with severe keratitis: experience through the French early-access program. Clinical ophthalmology (Auckland, N.Z.), 2018. 12: p. 289-299.
- Kojima, T., Contact Lens-Associated Dry Eye Disease: Recent Advances Worldwide and in Japan. Investigative Ophthalmology & Visual Science, 2018. 59(14): p. DES102-DES108.
- Moshirfar, M., W.B. West, Jr., and D.P. Marx, Face Mask-Associated Ocular Irritation and Dryness. Ophthalmol Ther, 2020. 9(3): p. 397-400
- Sultana, A., et al., Digital screen time during COVID-19 pandemic: A public health concern. 2020.
- Findlay, Q. and K. Reid, Dry eye disease: when to treat and when to refer. Australian prescriber, 2018. 41(5): p.160-163.
- Yazici, A., et al., Change in Tear Film Characteristics in Visual Display Terminal Users. European Journal of Ophthalmology, 2014. 25(2): p. 85-89.
- Fenga, C., et al., Comparison of Ocular Surface Disease Index and Tear Osmolarity as Markers of Ocular Surface Dysfunction in Video Terminal Display Workers. American Journal of Ophthalmology, 2014. 158(1): p. 41-48.e2.
- Zeev, M.S.-B., D.D. Miller, and R. Latkany, Diagnosis of dry eye disease and emerging technologies. Clinical ophthalmology (Auckland, N.Z.), 2014. 8: p. 581-590.
- Gayton, J.L., Etiology, prevalence, and treatment of dry eye disease. Clinical ophthalmology (Auckland, N.Z.), 2009. 3: p. 405-412.
- Craig, J.P., et al., TFOS DEWS II Introduction. The Ocular Surface, 2017. 15(3): p. 276-283.
- Lin, H. and S.C. Yiu, Dry eye disease: A review of diagnostic approaches and treatments. Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological Society, 2014. 28(3): p. 173-181.