The U.S. Food and Drug Administration (FDA) has approved Bausch + Lomb’s LUMIFY™ (brimonidine tartrate ophthalmic solution 0.025%) as the first over-the-counter (OTC) eye drop developed with low-dose brimonidine tartrate for the treatment of ocular redness. It recently hit the shelves this month.
Photo credit: Lumify.com
What is Brimonidine?
Brimonidine is an alpha-2 adrenergic agonist with dual mechanism of action: decreasing the production of aqueous humor, and increasing the amount that drains from the eye through uveoscleral outflow. Brimonidine was first approved by the FDA in 1996 for the reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.
In addition to reducing ocular redness, brimonidine helps treat skin redness (erythema), too. In 2013, the FDA approved the topical application of brimonidine 0.33% gel (MIRVASO®) for persistent facial redness of rosacea.
How Does It Treat Ocular Redness?
Red eyes are caused by swollen or dilated blood vessels on the white outer surface of the eye. Essentially, brimonidine (the active ingredient in LUMIFY™) selectively narrows these blood vessels in the eye, which increases the availability of oxygen to the surrounding eye tissues so they appear brighter and whiter.
Before-and-after images as featured on Lumify.com. Images representative of clinical trials results; individual results may vary.
For a recap of ocular pharmacology, keep reading below…
Adrenergic alpha-agonists (α) are a class of sympathomimetic agents that selectively stimulates alpha-adrenergic receptors (α-AR agonist) located on the arteries. The alpha-adrenergic receptor has two subclasses α₁ and α₂:
α₁-AR agonists: located on the radial dilator muscle of the iris. Stimulation causes pupillary dilation (mydriasis).
α₂-AR agonists: located on the ciliary epithelium. Stimulation causes a decrease in aqueous humor production, thereby lowering intraocular pressure.
When the alpha receptor is stimulated by epinephrine or norepinephrine, the arteries constrict. This increases the blood pressure and the blood flow returning to the heart.
LUMIFY™ with low dose brimonidine is a selective α₂-agonist. It targets the venule and constricts it, while maintaining availability of oxygen to surrounding tissue. Other OTC redness relievers are non-selective α₁or α₁/α₂-agonists that act on the arteriole, and conversely, decrease the availability of blood and oxygen to surrounding tissue.
Did you know that eye drop bottle caps are color coded?
A purple cap, as found on LUMIFY™, represents
an alpha-agonist. To learn more about what each eye drop cap color means, read this post.
How Is This Different from Clear Eyes or Visine?
Clear Eyes and Visine are non-selective redness-relieving eye drops that constrict blood vessels in the eye. Frequent use of these eye medications may cause you to develop a tolerance or loss of effectiveness (known as tachyphylaxis), as well as rebound redness. Thus, starts the endless cycle of: eyes look red, use drops; eyes still look red, so use more drops (all the while, the drops aren't working like they once did, so you keep applying drops with the hope that it'll work). This may lead to overuse and potential corneal toxicity, which is not good.
In contrast, low-dose brimonidine (the active ingredient in LUMIFY™) selectively constricts blood vessels in the eye, thereby reducing the likelihood of rebound redness and side effects. Six clinical studies were conducted in over 600 patients to evaluate safety and efficacy, with low risk of allergic reactions among all patient groups.
Phase III efficacy study results. Image courtesy of Bausch+Lomb.
What Are the Ingredients?
The active ingredient in LUMIFY™ is brimonidine tartrate 0.025%. The inactive ingredients include: benzalkonium chloride, boric acid, calcium chloride dihydrate, glycerin, potassium chloride, sodium borate decahydrate, sodium chloride, water for injection. Hydrochloric acid and/or sodium hydroxide may be used to adjust pH. It does not contain any bleaches or dyes.
A higher dose formulation of brimonidine (0.1% or 0.15%) is used to treat open-angle glaucoma or ocular hypertension.
How Do I Use It?
LUMIFY™ is approved for adults and children 5 years of age or older. You simply instill one drop into the affected eye(s) every 6-8 hours while awake (do not use more than 4 times daily), for up to three days.
Remove contact lenses before use and wait at least 10 minutes before re-inserting your contact lenses. If using other eye drops while using LUMIFY™, wait at least 5 minutes between each product. To avoid contamination, do not touch the tip of the bottle to any surface, including your eye. Remember to replace the cap after each use.
Do not use if the solution changes color or becomes cloudy. Stop using LUMIFY™ and seek care from your eye doctor if you experience eye pain, changes in vision, or if your eye condition worsens or persists for more than 3 days.
LUMIFY™ is useful for the treatment of ocular redness due to minor eye irritations. It is not intended to treat allergies or infections, so if you think you are suffering from one of those conditions, visit your local eye doctor.
LUMIFY™ is fast-acting and long-lasting, working in 60 seconds and lasting up to 8 hours. In clinical trials, 95% of patients reported significant improvement in just one minute, and 79% maintained significant redness reduction at eight hours post-instillation.
Does It Really Work as Advertised?
From my experience, you can see the difference almost immediately. Here are the before-and-after results from my own experiment:
My before (top) and after (bottom) results.
I tried LUMIFY™ to alleviate red eyes caused by allergies, dry eye, and pingueculitis, and was surprised by how quickly and dramatic the results were; the photos simply don't do it justice.
Where Can I Find It?
LUMIFY™ is available in two sizes (2.5 mL or 7.5 mL). You can find it over-the-counter in the eye care aisle at most major retailers or online on Amazon!
Which Size Bottle Should I Get?
It’s math time! As a rule-of-thumb, 2.5 mL bottles contain approximately 50 eye drops (although this number can vary). Split that number in half to account for both of your eyes, and you end up with 25 doses. If you use LUMIFY™ only once daily, the bottle should last you 25 days, but if you are using it four times daily (the maximum daily dose), it will last you just under a week (approximately 6 days).
If you’re prone to chronic ocular redness that is not caused by an infection or allergies, consider purchasing the larger bottle (7.5 mL), as it is the better price per volume. The 7.5 mL bottle contains approximately 150 eye drops (or 75 doses) and will last you anywhere from 18 (at four times daily dosing) to 75 days (at once daily dosing).