AAOpt 2026: New dry eye data on perfluorohexyloctane relief, cyclosporine safety

Patients newly prescribed perfluorohexyloctane (PFHO; Miebo; Bausch + Lomb) reported significant reductions in dry eye symptom scores within 2 weeks in a real-world analysis presented at the American Academy of Optometry Annual Meeting, held in Anaheim, California.¹ A separate 12-month controlled trial found no loss of corneal endothelial cells with cyclosporine ophthalmic solution 0.1% in perfluorobutylpentane (CsA 0.1%/PFBP).²

The 2 posters, presented at the American Academy of Optometry annual meeting, address questions optometrists weigh when choosing a prescription dry eye agent. One measures how quickly patients notice relief in routine care, and the other tests whether a year of dosing affects the corneal endothelium.

Perfluorohexyloctane real-world outcomes in dry eye disease

Marc Bloomenstein, OD, FAAO, and colleagues identified adults aged 21 years and older with a first PFHO prescription between November 2025 and May 2026 in the Veradigm Network health record database linked to claims data.¹ Patients completed the Ocular Surface Disease Index (OSDI) and a visual analog scale (VAS) at baseline, 2 weeks, and 4 weeks. The VAS covered 8 symptoms, including dryness, burning or stinging, light sensitivity, eye pain, and blurred vision.

The cohort included 111 patients at baseline, with a mean (SD) age of 64.3 (12.9) years; 90.1% were women. Nearly all had been treated before, as 86.4% had used at least 1 over-the-counter dry eye product and 99% had at least 1 prescription dry eye drug in the prior year. Among patients with a cataract diagnosis (n = 66), 68.2% had undergone cataract surgery at baseline.

Mean (SD) OSDI total score decreased significantly from 46.4 (21.9) to 33.1 (20.6) at two weeks among 61 patients with follow-up data. Among 60 patients assessed at four weeks, the score fell from 44.0 (21.2) to 29.5 (18.8). Every VAS symptom showed a significant reduction at both follow-up points (P <.001).¹

Does cyclosporine 0.1% affect corneal endothelial health?

Patrick Vollmer, OD, and colleagues randomly assigned 204 patients at six US centers 2:1 to CsA 0.1%/PFBP or 0.6% saline solution between April 2024 and June 2025.² Patients instilled one drop in each eye twice daily, and enrollment required a baseline endothelial cell density (ECD) above 1800 cells/mm² in each eye.² The primary safety end point was a change from baseline in ECD by specular microscopy at three and 12 months.²

Patients were predominantly women (76%), with a mean age of 61.5 years and a mean baseline ECD of 2495 cells/mm². Overall, 183 patients (89.7%) completed the study. At 12 months, mean (SD) change in study-eye ECD was +6.4 (90.47) cells/mm² with cyclosporine and −1.0 (81.43) cells/mm² with saline.

Other endothelial measures also held steady. The mean (SD) coefficient of variation started at 36.3 (5.60) with cyclosporine and 35.9 (5.25) with saline and did not change, and roughly 60% of cells remained hexagonal in both arms at every visit.² Central corneal thickness, 534.3 (38.09) µm and 537.5 (34.27) µm at baseline, stayed stable across 12 months, with similar results in fellow eyes.

For optometrists, the PFHO analysis offers a real-world benchmark: patients in routine care reported lower OSDI scores by the 2-week mark.¹ The analysis had no control arm, and about 55% of the baseline cohort completed each follow-up survey, which limits conclusions about durability.

The cyclosporine trial addresses a safety question for long-term users, showing stable endothelial parameters over 12 months with labeled dosing. Bloomenstein and Vollmer both reported consulting relationships, and several coauthors on each poster disclosed industry employment or financial support.^1,2

References

1. Bloomenstein M, Talwar A, Manjelievskaia J, et al. Assessing dry eye symptoms and impact of vision-related functioning in patients with dry eye disease using perflurohexyloctane ophthalmic solution. Poster presented at: Academy 2026 Anaheim; October 1, 2026; Anaheim, CA.

2. Vollmer P, Meides A, Hindman N, Wirta D, Krösser S. A clinical trial to evaluate corneal endothelial health in dry eye disease patients treated with cyclosporine ophthalmic solution, 0.1%. Poster presented at: Academy 2026 Anaheim; October 1, 2026; Anaheim, CA.