Do patients want injectable therapy for dry eyes?

How can sophisticated market research help make innovative injectable therapy more appealing to patients with dry eye syndrome?

Mark Duckham and Emma Burrows

Though most of us experience dry eyes occasionally, for some people the condition can be truly debilitating. If left untreated, severe dry eyes can lead to eye pain, redness, inflammation, corneal damage and visual impairment. Beyond the physical damage, patients often lose their confidence (due to the redness), avoid certain social situations (e.g. air conditioning and smoky atmospheres), and their productivity falls as they find it unbearable to use computer screens or use their eyes for long periods of times.

One thing is clear; the condition affects a huge number of individuals. Estimates range from <5% to above 30%, depending on age, gender, ethnicity and other medications e.g. antidepressants.

Huge opportunity

With CAGR in the region of 12%, this market is a real growth driver for many pharma companies. Novel pipeline drugs are being developed and existing products continue to innovate to gain valuable market share. However, the need to consult patients along the way can be forgotten.

Topical treatments range from CE mark aqueous drops, to hylaronic acid and lipid-based gels and ointments. However, most only deal with the short-term signs and symptoms; providing instant comfort, lubrication and relief but failing to solve the cause and provide a longer-term solution. That said, pharma companies have demonstrated ingenuity by continually innovating 'new' variants or by creating elegant packaging options to help keep their product fresh and their brand top of mind.

Traditional treatments require multiple eye drop applications throughout the day (and night), which are, unsurprisingly, impractical and unpopular. Therefore, pharma companies are now looking at novel mechanisms of action (MOA) and delivery technologies in an attempt to improve patient compliance and, ultimately, symptoms.

Otsuka Pharmaceuticals has a launch programme for Mucosta, which increases production of a mucin-like substance on the front of the eye, delivered in single-use vials (unit doses). Likewise, Santen is rolling-out Diquas, which promotes the production of mucin and water – a totally new MOA, delivered as drops. Restasis, from Allergan, has been a blockbuster for many years in the US as a single-use vial, and continues to be investigated and trialled. Furthermore, an injectable (sub-conjunctival) platelet-rich plasma is also in development.

Would patients accept the treatments?

However, with such novel and, in some cases, invasive new options, has the homework been done and have patients been asked whether they would accept them? In some conditions injections into the eye have become almost routine and accepted by patients. But are people suffering from dry eyes really ready for the new sub-conjunctival options? Admittedly, for patients mildly affected this probably wouldn't even be an option – but how severe does it have to be for a patient to consider this kind of treatment? Unlike conditions such as age-related macular degeneration (AMD) or diabetic macular oedema (DME), where patients are faced with the harsh reality of either having an injection into the eye (intra-vitreal) or going blind, the trade-off between an uncomfortable procedure and the ongoing discomfort of dry eyes is not so obvious.

Equally, the reality is (as with most ophthalmic diseases) that this is a chronic condition with chronic treatments, so a treatment wouldn't be a one-off injection. Patients may require monthly, quarterly or bi-annual injections just to manage their symptoms. This is not an easy prospect for the patient or, indeed, a straightforward choice for the healthcare system that may have to foot the bill.

Truly understanding the customer

As in most markets the successful pharma companies in dry eye syndrome will be those who truly understand the problem their brands are trying to fix and spend time differentiating their products from those of competitors. Furthermore, it is vital to evaluate the size of the market and the potential scope for any new product with the prescribing and referring population – in this case, ophthalmologists. To be fair, marketing teams within pharma companies and market research specialists already do this exceedingly well. However, the ultimate end users – the long-suffering dry eye patients – must be listened to carefully. They may not be the prescribing decision maker or personally paying for these new treatments, but if they refuse such treatments from ophthalmologists, will we get the dry eye blockbusters of the future?

In all health sectors, power is really beginning to shift into the hands of patients, who have unlimited access to various sources of information through the Internet and patient forums. For dry eye patients, after years of pouring drops and ointments into their eyes and spending a small fortune at the pharmacy trying to find relief, it is no surprise that many take the matter into their own hands and become extremely well informed. These patients have often tried 'everything' and feel desperate and miserable – especially if they're at the moderate-to-severe end of the spectrum. Are they really ready to consider an injectable treatment option?

In all cultures, eyesight is often considered the most valuable sense and most of us recoil at the thought of anything in our eyes. However, those who have not suffered severe dry eye conditions cannot make assumptions about their personal treatment choices. The only way to really know is to understand the patient.

The importance of patient research

With the right approach and the right skills, pharma companies can use market researchers to dive deep into the rational and emotional beliefs of patients, to get a real sense of likely uptake, drivers and barriers. Experienced market researchers can employ tools and techniques, such as abstract boards and diary homework. And by using online resources they can virtually live in patients' homes for a period of time, to really get to the heart of what they are thinking and feeling and, ultimately, a better interpretation of whether they really would or would not try a product. Naturally, in patient research, products have to be described in laymen's terms and patients may need a bit more time to understand very new and different products, so online research over a period of time offers many benefits. Ophthalmologists can 'endorse' new treatments, but if patients are not brought along to accept the benefits of innovation a dissatisfied user base will remain and, therefore, a market that has not achieved its full potential.

It is to be hoped that the industry, armed with a thorough understanding of patient needs, will create the next dry eye blockbuster. Using a variety of tools and techniques and in-house ophthalmology specialists who understand the market is the key. Behavioural economics and neurolinguistic programming (NLP) are among the tools being developed to surface the truths and identify how best to overcome any barriers which might prevent patients – including dry eye sufferers – from embracing the next revolution in ophthalmology.

About the authors:

Mark Duckham started his career in consumer advertising working on global brands like Nintendo, Ray Ban and Tia Maria. With US pharmaceutical brands engaged in direct-to-consumer advertising he was enticed into healthcare, working both client- and agency-side. With experience in every type of advertising from TV to digital, PR and Med Ed, Mark is a valuable creative and strategic resource for both agency and clients.

He joined THE PLANNING SHOP international in September 2015 as managing director of the London office, having previously managed Grey Healthcare and Kantar Health.

Mark's ophthalmology experience includes advertising a variety of ophthalmological brands and working for Bausch & Lomb marketing contact lenses, surgical equipment, IOL's and general eyecare products.

Mark holds an MA in Classics from the University of Oxford.

Emma Burrows has over 16 years' pharmaceutical market research experience, the last seven focusing on ophthalmology, particularly dry eyes, retina diseases (e.g. DMO, RVO, AMD) and glaucoma. Emma has an active interest in patient research and the role of the patient in treatment decisions and compliance with long-term therapies. She is a consultant at THE PLANNING SHOP international.

The company regularly applies the principles of behavioural economics and neurolinguistic programming (NLP) to discover the thoughts and behaviours of patients.