Joining the ranks of Restasis and Xiidra, Miebo is the newest prescription eye drop for the treatment of dry eye and “ocular surface disease.” Miebo is 100% perfluorohexyloctane and contains no water or preservatives. That fact is unique as most prescription eyedrops contain only a small percentage of the actual medication with the rest of the drop being an inert liquid “vehicle” and often times an irritating preservative.
How does Miebo work? Dry eye is often caused by “Meibomian Gland Dysfunction” in which the meibomian glands along the eyelash line do not secrete enough natural oils into the tears, leaving the eye open for excessive evaporation. Miebo (obviously short for Meibomian!) is apparently very comparable to your tear’s natural oils and helps prevent evaporation and the associated dry eye symptoms.
How does Miebo differ from Restasis or Xiidra? Miebo acts only to add to your own tear’s oil layer and prevent evaporation. Restasis and Xiidra are non-steroidal anti-inflammatory eyedrops which reduce inflammation on the surface of eyes and eyelids, allowing for more tear production.
How often does Miebo have to be used? For maximum effectiveness, it is recommended that Miebo be used FOUR times per day in each eye.
Can Miebo be used with contact lenses? Yes and No. Miebo is not to be used directly over contact lenses and patients must wait 30 minutes before inserting (and reinserting) contact lenses.
Does Miebo have side effects? The only reported side effects have been blurred vision directly after use and eye redness in a small percentage of patients.
Can Miebo be used with other eye drops? Yes. Miebo can be used with Restasis or Xiidra and other lubrication drops but not within 30 minutes of any other eyedrop.
Which dry eye patients will benefit most from Miebo? Patients who have continued dry eye even while consistently using Preservative Free Lubrication drops (PFL), warm compresses and other more conservative dry eye therapies. We do not recommend Miebo, Restasis, or Miebo as a “first line of defense” in the treatment of dry eye and ocular surface disease.
Is Miebo a “Cure” for dry eyes? Patients must continue to use Miebo ongoing (forever) to achieve desired effectiveness.
How much does Miebo cost? At the time of this writing, Miebo can cost up to $1000(!) per month when not covered by insurance. With some insurance (not Medicare), Miebo is offering the first month for free and at a discounted price thereafter. However (big disclaimer!), every insurance company has different coverage for Miebo and other medications. Please contact your insurance provider for the specifics of your plan.
Is there a generic Miebo? Currently there is no generic alternative for Miebo available in the United States. In our research, we have found over the counter eyedrops containing perfluorohexyloctane to be available in Europe. However, for safety reasons, we do not advise or recommend the purchase any “knock off” eye drops from any non-FDA approved manufacturers or vendors. These eyedrops may be fraudulent and dangerous!
Practical Considerations….
In our opinion, the majority of mild to moderate dry eye problems can be treated with regular use of preservative free lubrication (PFL) drops such as Retaine which is available at our clinic for a far less price than prescription dry eye treatments. The recommended dosage of Miebo is FOUR times per day. For most patients, that is a lot of drops! And tough to fit into our already busy days. To make good use of your time, be sure that you are using Retaine eyedrops four times per day (without good effect) before switching to Miebo .
Miebo is not to be used within 30 minutes (!) of inserting contacts. So, in the morning you will have to wait 30 minutes before inserting contacts and then remove your contacts TWICE during the day, apply Miebo, wait 30 minutes and reinsert your contacts TWICE and then apply Miebo again after removing your contacts before bed. Contact lens wearers will have to be seriously motivated to go through all of those steps when PFL drops can be directly applied over most contact lenses.
While experimenting with Miebo drops in our office, our staff noticed that getting a whole month’s use out of one bottle of Miebo to be very difficult. We did find this instructional video on proper installation or Miebo drops which appears to be still another special step in the process.
Please let us know if you have any questions about dry eye or Miebo.
Dr. Steve