Introduction and overview

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EP: 1.Introduction and overview

EP: 2.Consequences and epidemiology of untreated dry eye

EP: 3.Diagnosis and overlooking asymptomatic patients with DED

EP: 4.Standard testing and assessment for DED

EP: 5.General Principles of Treatment of DED

EP: 6.OD and MD communication for optimal care

EP: 7.Review of artificial tears for DED

EP: 8.Corticosteroids and Immunomodulators for the treatment of dry eye

EP: 9.The role of nutritional supplements and antibiotics in DED

EP: 10.How to treat meibomian gland dysfunction

EP: 11.In-office procedures and patient resistance for DED treatments

EP: 12.Treatments for aqueous dry eye

EP: 13.Challenges in the management of DED

EP: 14.Counseling and formulary concerns for DED therapies

EP: 15.Overlapping diseases and COVID-19's impact

EP: 16.Agents in the pipeline for DED

EP: 17.Novel agents in the pipeline for DED

Marguerite McDonald, MD: Hello, and welcome to this Ophthalmology Times® and Optometry Times® Viewpoint, “Advancement in the Management of Dry Eye.”

I’m Marguerite McDonald, an ophthalmologist from Manhasset, NY. Joining me in this discussion are my colleagues Dr. Eric Donnenfeld, an ophthalmologist from Garden City, NY; Dr. Tracy Swartz, an optometrist from Huntsville, AL; and Dr. Crystal Brimer, an optometrist from Wilmington, NC.

Today we’re going to discuss a number of topics pertaining to dry eye, including the diagnosis and clinical manifestations, traditional treatment options, and the potential new agents on the horizon. Let’s get started on our first topic.

First, we’ll talk about an overview of dry eye disease. Eric, if you could start, how is dry eye disease defined?

Eric Donnenfeld, MD: Dry eye disease has many definitions, but essentially it’s an abnormality of the tear film that affects the quality of the tears, and it’s been associated with hyperosmolarity as well as a change in the consistency of the tears, and it can affect any of the layers of the tear film. It can be the mucin layer, the aqueous layer, or the lipid layer. All 3 components of the tear film are commonly involved in dry eye disease.

Dr. McDonald: How common is it? Do we have any good numbers on this?

Dr. Donnenfeld: Dry eye disease is extremely common. As a matter of fact, it’s arguably the single most common reason why patients come into an optometrist or an ophthalmologist office. Medicare numbers have proven that. But the studies that have looked at that are studies like the Salisbury Eye Evaluation study, the Melbourne, Australia Study, the Beaver Dam Offspring Study, all show between 14% and 15% incidence of dry eye.

It’s probably underdiagnosed, but it’s been suggested that maybe 1 in 7 people in the United States suffers from dry eye disease. It’s more common in women, but it affects men as well. It’s more common in older patients, but it affects young people as well. It’s associated with several systemic diseases. We know it’s very common in collagen vascular disease, and that includes thyroid disease, lupus, and rheumatoid arthritis. It’s also very common in patients who have diabetes. It’s seen after surgery very commonly. It’s almost ubiquitous.

The problem with dry eye is that it’s an epidemic in the United States, and there are a variety of reasons. Notably, it’s nutritional. We’ve changed our nutritional status: We’re eating less omega-3s and more saturated fats. It’s also associated with screen time. People don’t blink as much because they’re looking at screens. The lack of blinking doesn’t allow the meibum to flow through to the tear film.

I won’t belabor it anymore, but dry eye is a public health concern. It’s extremely common, it affects quality of vision and quality of life, and it’s 1 of the most underserved areas in eyecare professional disease.

Dr. McDonald: Absolutely.