so two of the most common prescription dry eye treatments is that of Xiidra
and restasis. So in this video we're gonna break down what the science says
about Xiidra Vs restasis, so that you know how they work,
potential side effects, and why your doctor may prefer one versus the other. plus i'll be sharing
some of my own thoughts and tips about how to use them that's today's video let's take a look.
Hey what's up Dr joseph allen, OD FAAO here from the dr eye health show and i'm excited today to
talk to you about xiidra versus restasis and how these medications work as a dry eye treatment.
now first off i do want to start off by saying that this video is not in any way shape or form
sponsored by any pharmaceutical company. I think that would be unethical this video is purely just
educational content so that you know about these medications how they work and how they can help
you with dry eye. However, this video does have a sponsor and that's from Tear Restore
who happens to make what i think is one of the best warm compress masks for dry eye and they
happen to make one of my favorite eyelid wipes so shout out to Tear Restore for supporting the
channel and making this video possible. let's start off talking about Xiidra, Xiidra is an
eye drop prescription medication that is usually prescribed twice a day once in the morning and
then once at night. The active ingredient for Xiidra is something called lifitigrast and it's
prepared as a five percent ophthalmic solution in a preservative free vial. Now how does Xiidra
work? well unfortunately we don't fully understand exactly how Xiidra works but we do know that
lifitigrast, the active ingredient, kind of works as a small molecule that blocks the binding of
inflammatory cells onto different parts of the eye including the conjunctiva which is a clear
outer coating membrane on the white part of the eye as well as the lacrimal gland which produces
your tears and essentially the blocking of these inflammatory cells kind of shuts down the entire
inflammatory cascade which plays a major role in dry eye syndrome now Xiidra as a medication, did
go through four multi-center placebo-controlled randomized double-masked fda clinical trials,
including over a thousand people and these studies did reveal that the groups using Xiidra
did have statistically significant improvements in both corneal signs, meaning corneal staining
or ocular surface damage, as well as reduced symptoms so kind of the eye dryness feelings
versus people who are taking a placebo which is honestly pretty huge that in these studies
they weren't able to just show that hey people's symptoms reduced but from a doctor's perspective
the surface of the eye improved as well. And in a specific study called the opus 3 study where
they looked at dry eye symptoms in groups being treated with both Xiidra versus placebo and these
groups had like over 350 different patients in there they found a statistically significant
improvement in patients symptoms after just as early as 14 days at 42 days and again at 84 days.
so this was not just good early on but even long lasting improvements. Now outside of how awesome
that sounds let's talk about Xiidra side effects. Side effects from Xiidra are only reported up to
about 25 percent of people going through these studies but they include namely any sort of sight
irritation like when you first put it in your eyes may kind of not feel very well they might
be kind of irritated reduced visual acuity. And i've only heard some people report this
but usually it's reported on the first 30 minutes after putting it in kind of like where your vision
will go a little fuzzy or kind of fluctuate for a little bit and then finally an unusual taste
or sensation in the back of your throat and that side effect only occurs because the medication can
drain down your tear duct into your nasal cavity and then back to your throat. And less than five
percent of people in these studies ever reported any conjunctival hyperema or redness allergies
discharge or sinusitis. Now as personally i've been prescribing Xiidra since basically it first
came out I find that patients do respond really well to it it's been very rare that i've had to
take a patient off of it because either they find it didn't help at all or perhaps a side effect of
some kind like they really didn't like it and most of the time when someone does have a side effect
it's usually the taste and honestly it's pretty easy to kind of overcome. Two kind of tips for
you is that you can either block your teardrop after you put it in just for about 30 seconds,
that way it prevents it from getting through the drainage canals and another idea is that since
you should be using this medication twice a day it's best to brush your teeth at the same time.
So that you can put the drops in and brush your teeth and whatever type of toothpaste you're using
should mask any of the flavor of the medication in the back of your throat. Now again remember that
Xiidra and then the next medication we're going to talk about Restasis, they're both really designed
to help control or manage that inflammatory role that occurs on the eye with dryness but remember
that inflammation is really occurring secondary to something else that's occurring on the eye
namely some loss of homeostasis in the tear film and it has been found that up to 86
of people with dry eye have some level of oil gland deficiency. Something related to what's
called mgd or meibomian gland dysfunction and this can result in problems with evaporation
of the tear film. That's exactly why eye doctors will recommend doing some form of warm compress on
a regular basis to help manage this oil gland issue and I mentioned that because I want you
to think about that while I talk about today's sponsor here. Now if you're somebody who's doing
warm compresses on a daily basis like I am then you know how frustrating can be to set aside 10
15 minutes of your day just to sit there with your eyes closed but that's exactly why Tear
Restore went out to design a mask that you could keep your eyes open. That allows you to
stay productive, focus on emails, do things around the apartment or your house,
and it does this still while providing appropriate heat for the right amount of time, to the eyelids.
And it has the extra benefits of not needing a microwave, it's not putting direct pressure onto
the eyeball itself which in case you don't know that direct pressure on the eyelids from other
warm compress masks is the reason why your vision is often fuzzy after doing it for a few minutes
and the other thing i like is that because the eyelids are open you're allowed to blink.
That means that the melted oils are actually pumping and coming out of those glands. So if you
haven't checked out the Tear Restore Mask for warm compresses yet again something i really love and i
think it's a great product. Also the same company makes a great eyelid wipe called the Hyla Wipe
again if you want to check out any of these things i'll put information in the description below. All
right, so now let's break down Restasis. Now if you haven't heard of Restasis before it's been out
for a long time, actually since about 2003. and its active ingredient is that of something called
cyclosporine A and specifically at a 0.05 percent is where it was first approved for. Just some fun
facts, cyclosporine a was originally derived from a mushroom from the netherlands and then it really
became big time in the medicine world because it was used and very effective for organ transplants
and specifically when it comes to dry eye it is a medication that's similar to Xiidra and that it's
only used twice a day one drop in the morning, one drop at night. How does Restasis work?
Well Restasis is very similar to Xiidra, the both work by suppressing inflammation,
the inflammation of t cells that you will find in your tear film the cornea and even in the lacrimal
gland and then with Restasis Vs Xiidra, they did show in their studies to improve tear production
after 12 months. Specifically Restasis or cyclosporine will bind to a protein called
cyclofin which will prevent the proliferation of cytotoxic t cells and prevent the recruitment
of helper t cells and what's important to know is that cyclosporine will help stop
the activation of inflammatory t cells but doesn't necessarily stop the already activated t cells.
What i mean by that is that the inflammatory cells that are already bound and activated aren't just
going to release and drift away because they're using Restasis, over time those have to go on
their own but then Restasis blocks the future binding of more inflammatory cells. This is
important because of when you can expect to have a benefit while using this medication because
for those already active t cells to release and drift away it takes roughly three to six months
and that's exactly why a lot of people may not notice any benefit with Restasis right away.
In fact, they're gonna have to use it for at least three months to before they really start having a
clinical benefit now one really good thing about Restasis is that it has been out for a long time
and being that it's been out for longer there's been a lot more research on it being it not
just used for dry eye but rejection of coronal transplants, pterygium surgeries, a lot of things
but one thing specific for dry eye is that there have been studies showing that you patients using
Restasis can have an increased number of goblet cells after four to 12 months. Goblet cells on the
surface of the eye, they produce more mucus which is significantly important if you have dry eye.
If those goblet cells are damaged or non-existent then you're not going to produce much of the mucus
to even hold liquid to the eye to begin with so some doctors may think hey my patient's
goblet cells may be damaged let's get them on Restasis. Now as far as Restasis side effects go,
one of the issues with the cyclosporine in general is that that molecule is not very stable in an eye
drop form and because of this it's required to be suspended in an emulsifier agent such as castor
oil or glycerin. Which can cause other side effects such as burning stinging and hyperemia
which is just another name for redness of the eye. In reported studies most common side effects with
Restasis is that of ocular burning of around 17 percent of people and then less than five
percent of people taking it report any other sort of symptoms. Now since Restasis has been out for
some time it did recently become generic and back in 2018 another medication using the same active
ingredient cyclosporin a came out and that new medication is called Cequa. Cequa is Cyclosporine
A but at a higher concentration where Restasis was 0.05 percent cyclosporine a sequa is almost double
that at 0.09 percent cyclosporine but with Cequa they also combined a type of micellular technology
which helps stabilize and get that medication into the eye tissues faster. i'll just report
to you anecdotally that I personally see patients put on Cequa respond better, somewhere closer to
four to six weeks after initiating it, otherwise right now it's just this tough battle between
brand name Restasis and a lot of patients now being forced to go on generic Restasis and we're
getting a lot of calls because a lot of patients are saying that the generic form of Restasis
doesn't seem to work as well as the original form but again that's very anecdotal and I encourage
you let me know in the comments section if you've used either Xiidra or Restasis your personal
kind of experiences with it. If you were put on a generic does it work as well as the original form
let us know but of course and as always please consult with your local eye care provider a dry
eye specialist hopefully who can help you out and recommending which medication may be best for you.
if you did enjoy this video it helped you out hit that like button for us and subscribe to
the channel. if you want to learn more about dry eye education and if you haven't seen our video
walking through what a dry eye evaluation at our clinic looks like or you need some help finding
a dry eye specialist in your area then click over here to the side to check out our full
series all about dry eye. Otherwise Hey thanks for joining us for this video.
I sure hope it helped you. Otherwise keep an eye on it. We will see you soon.