Interview with Dr. Clive Peckar Consultant Ophthalmic Surgeon at Spire Cheshire Hospital, UK

Dr Peckar, how big a problem is dry e ye for your patients?
Dry eye is a major problem to patients because of the discomfort. Usually, dry eye is permanent and tends to increase with age. However, in some patients it’s temporary: e.g. they may have a temporary dry eye after LASIK that may improve with time.

What happens if dry eye is not treated?
There is an increased risk of conjunctivitis / keratitis, especially for the moderate to severe dry eye.

Which treatments do you use?
I often use intra-canalicular thermodynamic hydrophobic acrylic implants, as well as sodium hyaluronate eye drops.

Why sodium hyaluronate?
The chemistry of tears is complex, and there’s no drop that’s exactly the same as the patients’ own tears. But sodium hyaluronate is water retentive and muco-adhesive, which helps to “coat” the cornea and prevents epithelial desiccation; it also has a relatively long action of use, so patients with mild dry eye may require fewer daily instillations.

Why are preservative-free treatments important?
Firstly, some patients develop a chronic mild “toxic superficial punctate epitheliopathy” related to the preservative, and this can be difficult to differentiate from a “dry eye superficial punctate epitheliopathy”. So you want to exclude the preservative as a possible cause, as well as avoid inducing a “chronic epitheliopathy” through the use of preservative, particularly in long-term treatment of dry eye.

How long have you been using preservative-free eye drops?
Twelve years.

TRB: In which forms?
In 1999 I started using 0.18% preservative-free sodium hyaluronate drops (VISMED^®) as the first product of this type available to me. Now, patients always have a preference either for the single-dose vials or the multi dose pump (VISMED^®multi).

Have you used VISMED® gel?
Yes, when VISMED^®gel 0.3% became available in 2004, patients with moderate to severe dry eyesrequiring hourly or two-hourly VISMED^® medication, were transferred over to the VISMED^®gel.

Dr Peckar, thank you very much for the interview.