CCS 2025: Taking a contemporary approach to dry eye disease with Dr Mitch Ibach

During his presentation titled "Rethinking Dry Eye Disease: A Contemporary Approach to a Complex Condition," Mitch Ibach, OD, FAAO, discussed the prevalence of dry eye disease, a significant ocular condition affecting approximately 18 million patients in the United States - 4 times more than those diagnosed with open-angle glaucoma. Ibach emphasized the growing patient awareness and motivation surrounding dry eye, which distinguishes it from other eye conditions like glaucoma. The key innovation in dry eye treatment is not a single technology, but a more nuanced approach focused on understanding and identifying the underlying causes of dry eye. Ibach advocated for a personalized diagnostic strategy that considers various factors such as systemic conditions, inflammatory versus evaporative dry eye, lacrimal lake volume, and specific patient symptoms and signs.

Diagnostic tools play a crucial role in this approach. Ibach highlighted MMP-9 testing as an example, which helps clinicians determine inflammatory markers and guide treatment decisions through clear, systematic protocols. The goal is to simplify complex diagnostic processes by creating straightforward "if-then" treatment pathways. The presentation also recommends several treatment strategies:

1. Intense pulse light (IPL) or low-wavelength UV light treatments for patients with ocular rosacea and meibomian gland disease
2. Moving beyond over-the-counter artificial tears
3. Developing proficiency with prescription medications
4. Utilizing targeted therapies like:

• Topical steroid drops
• Topical immunomodulators
• Punctal plugs

The overarching philosophy is to move away from generic, one-size-fits-all treatments and instead focus on precision medicine. Clinicians should become experts in specific therapies and understand how to match treatments to individual patient needs. Key recommendations include:

• Identifying the specific cause of a patient's dry eye
• Using prescription therapies strategically
• Exploring advanced diagnostic and treatment technologies
• Personalizing treatment approaches

Ibach believes that by adopting this comprehensive, targeted approach, eye care providers can significantly improve dry eye management and patient outcomes.