With renowned dry eye expert Milton Hom, OD, as this episode’s guest, hosts Kaleb Abbott, OD, and Andrew Pucker, OD, PhD, lead a spirited discussion of so-called “artificial tears” and contact lens rewetting drops as distinct product categories. They begin by exploring whether or not FDA definitions align with the perception of clinicians and their recommendations to patients, noting that much of the terminology and categorization structure of these products stems from the original FDA product monograph, which dates to 1988.

Dr. Abbott argues that these categories are outdated and should rightly be combined and renamed “lubricating drops” to reflect real-world use. He also points out that there’s less than 1% similarity between artificial and human tears, as the latter contains thousands of proteins and growth factors, so the term “artificial tears” creates unrealistic expectations with patients.

The conversation then turns to ingredients in tear products and their role in product selection. Dr. Hom favors drops containing hyaluronic acid when wound healing or improved contact lens comfort is needed, a trehalose-containing drop if he sees corneal staining and an emulsion-based product (mineral oil or castor oil) for evaporative dry eye. The trio are intrigued by newer products that aim to mimic natural tears by including vitamin C, vitamin B12, amino acids and other ingredients but we need to see the data supporting their efficacy.

They return to the topic of the FDA monograph when discussing why Meibo is considered an artificial tear in Europe, and sold over the counter, but not in the US; its formulation doesn’t meet the FDA criteria for OTC status and so the product was developed as an Rx drug. The experts point out that Meibo has a much longer ocular surface retention time than regular artificial tears—roughly 6-8 hours vs. 30 min—and thus does perform differently.

The episode ends with a discussion of how to approach patients with overlapping allergy and dry eye, and a general wrap-up on the debate over whether certain artificial tear products truly have properties that distinguish them from others. The consensus is that some indeed do but none truly replicate the natural tear film.

Relevant articles worth reading:

It's time to retire the terms artificial tears and rewetting drops: A call for accurate terminology and updated clinical usage in eye care

By Kaleb Abbott, OD, MS, and Andrew Pucker, OD, PhD

Over the counter (OTC) artificial tear drops for dry eye syndrome

• By Andrew Pucker, OD, PhD, Sueko Ng, MHS, and Jason Nichols, OD

Artificial Tears: What Matters and Why

With advice from Jennifer S. Harthan, OD, Suzanne Sherman, OD, Cecilia Koetting, OD, and Meaghan Horton, OD

Artificial Tears: Looking Beneath the Surface

By Mike Christensen, OD, PhD, and Tressa Larson, OD