Dry eye disease doesn’t need to be a hindrance to happy patients.
Dry eye disease (DED) is a chronic, progressive condition that often leads to damage to the ocular surface, decrease in vision and overall reduction in quality of life. Not only is this disease extremely prevalent, but it is underdiagnosed, undertreated and is often a source of frustration and a great burden for clinicians and patients alike.
WHEN SIGNS ≠ SYMPTOMS
To approach DED effectively, eye-care practitioners need to be aware that there is a lack of correlation between signs and symptoms along with a myriad of factors that contribute to this disease. It is not uncommon for patients to come into the clinic with no ocular symptoms but have significant signs on exam, such as punctate keratitis. Patients presenting in this manner should be evaluated for neurotrophic keratitis, which is usually a progressive disease that may lead to corneal ulceration and/or perforation.
On the other end of the spectrum, some patients come in with significant discomfort but no signs of dryness whatsoever. Patients with neuropathic pain present more of a challenge since many patients have few physical signs of ocular damage and may be seen as drug-seeking or perceived as overly anxious by providers. We want to aggressively screen and treat this disease, since DED can adversely affect our biometry and refractive measurements before cataract and refractive surgery. Additionally, ocular surgery can exacerbate or induce DED, which can increase symptoms and reduce the quality of vision, resulting in dissatisfied patients.
Regardless of the etiology, we are fortunate to live in an era in which we have more diagnostic and treatment options for these patients whose lives are affected by DED. Additionally, there are exciting therapies in the pipeline that may represent a potential paradigm shift in the treatment of DED.
IN THIS ISSUE
Some of the top dry eye experts have contributed to this month’s issue of Ophthalmology Management addressing some of these key topics in dry eye.
Although dry eye is one of the most common reasons patients visit their eye-care practitioner, several barriers and misconceptions persist, especially among eye-care practitioners not specialized in ocular surface diseases. These barriers and misconceptions often hinder the correct diagnosis and the proper management of dry eye in routine clinical practice. Darrell White, MD, dispels common myths and misconceptions in dry eye (page 30), and Nandini Venkateswaran, MD, provides advice on removing the barriers associated with diagnosing and treating DED (page 26).
In addition, Rachel Dandar, MD, and John Sheppard, MD, teach us about novel treatment options for DED (page 34). Also, Cynthia Matossian, MD, addresses the discussion on whether omega-3 supplements work for this disease (page 40).
Finally, Ana Carolina Victoria, MD, reviews the diagnosis and management of thyroid eye disease (page 44) and why this is a diagnosis we cannot afford to miss.
BREAK DOWN THE BARRIERS
Considering the high prevalence of DED and the devastating effects it can have on our patients, eye-care practitioners should screen and treat all patients for signs or symptoms of DED, especially surgical patients who have a desire to reduce their dependence on corrective lenses. This can be accomplished without investing in expensive equipment or diagnostics.
We are at an exciting crossroads with respect to dry eye treatment, with promising and novel therapies in clinical development that should continue to improve our ability to effectively manage DED. OM
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