Dry eye is a polarizing topic in the eye-care world. For some, discussing and reading about the topic elicits excitement for new treatment options. For others, it leads to an immediate desire to gloss over the topic and move on to the next new and exciting surgical procedure or technique that has become available.
Regardless of our personal response to the disease, dry eye is increasing in prevalence with our aging population and must be given the critical analysis and attention it deserves. Even (and especially) in our surgical practices, dry eye is of immense importance. It is often a principal driver of a patient’s perception of the result of surgery — unstable vision or an uncomfortable eye rarely leaves a patient happy with their outcome. Uncontrolled ocular surface disease (OSD) can lead to delays in surgery, inaccurate biometry and IOL selection and patient dissatisfaction.
INNOVATION MOVES FAST
Luckily, we are fortunate to work in a field where innovations in diagnostics and pharmaceutical and procedural treatments are valued, invested in and constantly moving forward.
We now have easily accessible tools that can help us to determine core causes of and contributors to dry eye, from point of care tests for inflammation and osmolarity to imaging devices that can capture and display meibomian gland structure and give quantitative information on tear film structure and function. Utilization of diagnostic testing and devices helps to direct targeted treatment. These point of care tests and imaging devices also serve as excellent patient education tools that can build patient confidence in our recommendations and improve treatment compliance.
Our pharmaceutical treatment options have improved drastically in recent years as well. The available medications that target key pathways in the cycle of OSD are ever increasing. We have an expanding armamentarium of anti-inflammatory drugs, both steroid and steroid-sparing agents with established and new formulations of lifitegrast and cyclosporine 0.05%, 0.09% and 0.1%, targeting a key end common pathway of all etiologies of OSD.
Targeted evaporative dry eye treatments for meibomian gland disease, such as tear film stabilizing medications like perfluorohexyloctane, can be effectively paired with thermal expression and pulsation procedures or intense pulsed light treatments to more effectively treat this common subset of disease. These procedures have given us interventions that work quickly and fit the lifestyles of many of our busier and less compliant patients. These new procedures and therapeutic options can also be paired with the now-available FDA-approved Demodex treatment lotilaner, offering patients a finite treatment option for this often chronic and hard to manage exacerbator of blepharitis and OSD in many patients.
VALUABLE INSIGHTS
Transitioning into a landscape where we have multiple diagnostic and therapeutic options does require growth of our technology in clinic, reorganization of our personal nomograms for treatment and adoption of new patient education strategies and tools.
In this Dry Eye/OSD edition of Ophthalmology Management, our brilliant contributors review new innovations in the field of dry eye, from diagnostics to treatment options and perioperative management strategies. In addition, they give valuable suggestions and advice based on their personal experience on how to successfully adapt, expand and incorporate new technology into busy clinical and surgical practices. Thank you to each of our contributors, and enjoy! OM
