The source of your eye discomfort might be cradled in your hands. If you’re like many people, your eyes spend much of the day fixed on digital displays. Before reading this, maybe you watched videos on a tablet or scanned social media on your phone. Try to remember the last time you blinked. Come to think of it, do your eyes feel dry?
Some eye doctors are finding more cases of dry eye in young adults, and even children. That has Rob Thornhill seeing opportunity. He’s the CEO of San Diego medical device startup Tear Film Innovations, which recently raised a new venture round. He points to studies suggesting that children and teenagers who view screens for extended periods blink less, which could contribute to their dry eyes.
“We’re going to see younger and younger people being treated for this disease going forward,” Thornhill says.
By some estimates, dry eye already affects more than 16 million Americans. The condition becomes more prevalent with age, and for reasons that aren’t entirely clear, women develop the condition at nearly twice the rate as men, according to a study published last year in the American Journal of Ophthalmology. Though dry eye is common, research linking digital devices to the condition is limited. Nonetheless, Thornhill hopes patients will seek treatment with his company’s FDA-cleared device (more on that below). But first, let’s get a better understanding of dry eye.
When glands in the eyelid don’t produce enough tears, or the quality of tears is poor, people can develop dry eye, according to the National Eye Institute. The tear film that protects and lubricates the eye consists of three different layers. The inner mucus layer keeps the eye wet. The watery middle layer carries proteins dissolved in the fluid. The oily outer layer floats on top, keeping the inner layers from evaporating quickly. This oil is produced by meibomian glands in the eyelids.
“Dry eye” is an umbrella term whose symptoms and signs are linked to a variety of factors, says Anat Galor, an ophthalmologist and spokesperson for the American Academy of Ophthalmology. Some of those factors are environmental and others are traced to problems producing any one of the tear film’s three layers. Galor says the prevalence of dry eye in women could be related to hormones or other biological differences. She adds that it’s also possible that the condition is underdiagnosed in men because they don’t see a physician about their symptoms as frequently as women do.
“Dry eye isn’t one thing, so there isn’t going to be a one size fits all [solution],” says Galor, who is also a professor at the University of Miami’s Bascom Palmer Eye Institute. “There are many different kinds of dry eye.”
Some medications have the side effect of dry eyes, and the condition is also associated with some medical conditions such as Parkinson’s disease and high blood pressure, the National Eye Institute says. When the condition is traced to meibomian gland dysfunction, it’s like a plumbing problem. Meibum, the oily substance secreted by the glands, can harden and clog the ducts. As a result, not enough oil reaches the eye, allowing the tear film to evaporate more quickly.
Older dry eye treatments include steroids to reduce inflammation, or artificial tears taken as eye drops. But some startups have approached meibomian gland dysfunction like a plumbing problem. In 2011, Morrisville, NC-based TearScience received FDA clearance for LipiFlow, a device that uses a combination of heat and pressure to liquefy hardened meibum and clear it, allowing the oil to flow onto the eye. TearScience’s product is a countertop system that enables a physician to see the tear film on a computer screen. Treatment is administered by a single-use, cup-like component that envelops the eyelids. The device applies heat and pressure to each eyelid to clear meibum in a 12-minute procedure.
LipiFlow drew interest from Johnson & Johnson (NYSE: [[ticker:JNJ]]). In a move to bolster its eye portfolio, the health products giant acquired TearScience last year for an undisclosed sum. TearScience, founded in 2005, had raised more than $70 million in venture capital investment before it was acquired.
Meanwhile, Tear Film Innovations got its start in 2014, three years after TearSciences’ dry eye device was cleared for the market. The medical device company was developed within Tigris Ventures, a San Diego seed-stage investment firm that also incubates startups. Thornhill says Tear Film was founded by biomedical engineers and optometrists who saw room to improve on TearScience’s approach.
The Tear Film medical device, called iLux, was developed to provide a more targeted treatment. Rather than treating the entire eyelid, the Tear Film device targets only the part that has the clogged meibomian glands, Thornhill says. The patented device, designed to be held in a physician’s hand, uses a light-based heat source to melt the blockages, which are then pressed out by the device. Thornhill adds that iLux also has a magnifying lens for viewing the glands during the procedure, which enables physicians to see that they’ve squeezed out the meibum.
In a clinical trial testing iLux head-to-head against LipiFlow, the Tear Film device was equivalent to its predecessor. That’s sufficient for FDA clearance, which the Tear Film device received last December. Mild side effects in
