Newly approved Miebo holds power for the treatment of dry eye disease

Image credit: Adobe Stock/©frankenphoto

For decades, eye care practitioners have struggled with replacing the lipid layer of the tear film when the Meibomian glands are not producing adequate amounts or poor-quality meibom. We have tried petroleum-based ointments, lipid-containing artificial tears of various formulations and delivery platforms, and other natural oils in and around the eye to bolster the lipid layer of the tear film.

With the approval of Miebo (perfluorohexyloctane; Bausch + Lomb, Novaliq), we now have a first-in-class drug with a novel mechanism of action to treat the signs and symptoms of dry eye disease (DED) associated with Meibomian gland dysfunction (MGD).

Miebo is a 100% perfluorohexyloctane eye drop. 100%! No other ingredient. No water. No preservatives. Nothing else. It is a non-aqueous liquid, non-blurring wetting agent. Honestly, how great is that? No wondering if the drop excipient ingredients or a preservative are cause for irritation vs the active ingredient. Miebo is not a steroid, NSAID or immunomodulator. Perfluorohexyloctane demonstrates strong spreading properties due to low surface tension, facilitating small drop sizes and interacting with the lipophilic part of the tear film to form a layer at the film-air interface and to prevent evaporation.

Miebo spreads uniformly over the ocular surface upon application, forming a protective surfactant layer over the tear film restoring fluidity, which then prevents evaporation and secondary, sensitizing osmolarity changes. It has the ability to restore tear film balance by increasing and stabilizing the lipid layer for hours to protect the underlying aqueous and mucin layer of the tear film. Miebo also penetrates the Meibomian glands.

Perfluorohexyloctane (F6H8) is a semifluorinated alkane liquid that has been used in ophthalmology as a long-term vitreous substitute. This compound is physically, chemically, and physiologically inert, slightly amphiphilic, colorless, and laser-stable. It also boasts a density higher than water and very low surface and interface tensions. In addition, as it is a non-aqueous liquid, microbial growth is not possible and therefore, it does not need any preservative.

Can this single-ingredient tear stabilizer become the choice therapeutic to standardized corneal surface measurements in cataract and refractive surgery? There would be no question as to the impact of the various lubricant eye drop properties (ingredients, delivery system, viscosity, residence times) on keratometric/other eye measurements. As refractive endpoints become more and more precise—think light-adjusting IOLs—having a standard, predictable, tear-stabilizing agent will be paramount.

I am excited to see how Miebo changes the lives of patients. Are we at the cusp of a paradigm shift in DED management?