The Science Behind MIEBOⓇ (perfluorohexyloctane ophthalmic solution)

What this episode covers

Understanding the Complexity of Dry Eye Disease Historically, dry eye disease (DED) was oversimplified, often attributed solely to aqueous tear deficiency. However, research shows that approximately 86% of DED cases involve an evaporative component, where the tear film loses stability, leading to faster tear evaporation. This can be due to many factors, including meibomian gland dysfunction, prolonged screen time, and environmental influences. As professor and optometrist Dr. Chris Lievens explains, “Dry eye sounds so basic—if it’s dry, make it wet. But actually, the science is incredibly complex.” Today’s comprehensive approach to DED considers various aspects of the tear film, including the mucin, aqueous, and lipid layers. It’s the evaporative aspect that MIEBO targets, making it a unique and essential addition to dry eye management. The Science Behind MIEBO MIEBO is the only Rx eye drop for DED that directly targets tear evaporation. Its active and only ingredient, perfluorohexyloctane forms a protective layer on the eye’s surface. The dual properties of this molecule—aerophilic (high affinity for air) and lipophilic (high affinity for fats/oils)—allow it to form a monolayer on the surface of the eye that inhibits evaporation. Although the exact mechanism of action for MIEBO in DED is not known, MIEBO can help provide patients with an effective way to manage tear evaporation: the leading cause of DED. Dr. Jenn Lyerly, an optometrist, states, “The tear film is not a simple sandwich layer; it’s a matrix. And when it’s out of homeostasis, it disrupts everything from contact lens wear to surgical outcomes. The protective layer of MIEBO addresses this complex structure, providing relief.” Clinical Data and Real-World Results In its pivotal phase 3 trials, GOBI and MOJAVE, MIEBO was shown to significantly improve both objective and subjective measures of dry eye. These trials involved over 1200 participants, of which 614 patients received MIEBO, providing a solid sample size for reliable results. Researchers measured 2 primary endpoints: total corneal fluorescein staining (tCFS) and the patient-reported eye dryness score. Results indicated that by ~8 weeks, there was a 2x improvement in tCFS vs the control and a 1.5x improvement in eye dryness vs the control. At ~2 weeks is when significant improvement was first noted. Dr. Jessilin Quint, a leading voice in dry eye disease management, noted that the trial design mirrored real-world conditions, addressing both signs and symptoms. The level of improvement at Day 15 means that patients can experience relief relatively quickly. Key Differences in the MIEBO Experience One of the standout features of MIEBO for practitioners is its excellent tolerability profile.* In the pivotal trials, 1% to 3% of patients reported blurred vision and conjunctival redness, making MIEBO not only an efficacious drop for DED, but a tolerable one, too. Further, the small drop size of MIEBO (11 μL) means patients may not feel it upon instillation. “Setting clear expectations is critical,” says Dr. Quint. “I tell my patients that MIEBO might not trigger a blink reflex and any initial blur will fade quickly. Once they know what to expect, they’re more likely to stay the course.” Reminding patients to follow the administration instructions in the Prescribing Information can help to ensure correct instillation of the drop. For patients who wear contact lenses: MIEBO should not be administered while wearing them. Contact lenses should be removed before use and for at least 30 minutes after administratio...

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