Profiles in Dry Eye

Affecting patients young and old, from all walks of life, dry eye is an essential part of your practice.

Contrary to popular belief, the approximately 20 million people in America experiencing dry eye aren't entirely comprised of contact lens wearers and the elderly (though estimates do say that 50% to 80% of contact wearers and 75% of the population over the age of 65 have dry eye). With triggers ranging from central heating and air pollution to driving and reading, it's a wonder that everyone doesn't suffer from burning, itchy, sensitive eyes. In fact, you'd be hard-pressed to find an ocular condition that affects such a broad swath of your patient base as dry eye: teens wearing (or overwearing) contact lenses, young professionals who work long hours in the office, post-LASIK or cataract patients whose otherwise stellar results have been marred by ocular surface compromise, seniors with a host of medical conditions to manage—different presentations, but similar stories.

Though many practitioners dismiss the severity of dry eye simply because it may seem less consequential than cataract, AMD or glaucoma, sufferers know all too well that quality of life takes a serious hit from the disease. As people spend more time than ever staring at computer, cell phone and tablet screens, dry eye is booming among younger adults and the middle aged.

Researchers led by Uchino et al. at the Keio University School of Medicine in Tokyo distributed a survey in 2008 to young and middle-aged Japanese office workers. They observed that 1,147 of 3,549 respondents (32%) experienced severe dry eye, with a higher prevalence among women. Tech-savvy people buy gadgets to increase their work efficiency as well as quality of life, but when such a high percentage experience chronic vision-related discomfort, does the productivity boost really justify the discomfort? Luckily, it needn't be an either-or proposition: with a bit more care and attention toward ocular surface conditions, patients of all stripes can minimize the daily discomfort they've learned to live with.

Perhaps cases of primary dry eye might not make it to ophthalmologists all that often, but seeing dry eye secondary to or concomitant with ocular disease is likely an everyday occurrence in your practice. These patients can be the most troublesome for ophthalmologists since, despite achieving emmetropia or slowing glaucoma progression, patients will blame their physicians for developing dry eye. Approximately 40% to 50% of glaucoma patients are said to experience dry eye, with women more likely than men to have it. In March 2006, Cintia S. de Paiva et al reported in the American Journal of Ophthalmology that 36% of LASIK patients have dry eye six months postop.

In this issue's article, “Dry Eye Disease & Advanced-Technology IOLs,” Kevin Waltz, OD, MD, and Brenda Wahl, OD, report that one of every six of their cataract surgery patients has previously undiagnosed dry eye disease.

Sometimes dry eye is a sign of a systemic problem. Sjögren's syndrome, the autoimmune disorder impacting more than four million Americans each year, primarily occurs in postmenopausal women. Ophthalmologists can often play a large role in a patient's diagnosis of the disease. In other cases, dry eye is an unfortunate side effect of medications—particularly birth control pills, systemic acne prescriptions and other hormone-altering treatments.

Common? Certainly. But the burden of dry eye is one that patients are desperate to unload. While researchers struggle to find a definitive cure, dry eye remains a frustrating condition for both physicians and patients from all demographics. This month's issue calls attention to a few of these patient subsets, and highlights some of the groundbreaking new research and drug development currently underway. Stay attuned to patients' reports of discomfort and you'll be able to help improve their quality of life as well as quality of vision.