Dry Eye Dx and Tx
Stay Current to Create a Dry Eye Center of Excellence
By Jack L. Schaeffer, OD
We are inundated with so many new messages, conflicts, and technologies related to ocular surface disease (OSD) that staying current can be difficult. We are all familiar with epithelial basement membrane dystrophy and meibomian gland dysfunction and their causes and treatments, for example, but we are just becoming familiar with lid wiper epitheliopathy. We're starting to understand the role of corneal dystrophies and their true relationship to dry eye.
The more we learn, however, the more questions arise. Is meibomian gland probing effective? How important is osmolarity in treatment and diagnosis? Which stains are most useful in the clinical setting? Do we need to perform a Schirmer's test on all dry eye patients? Let's see where we are likely to see change.
Dry eye treatment has come a long way from merely handing artificial tears to patients after their eye examinations. Our armamentarium of treatment options is diverse and evolving. We have any number of treatments, but with no defined algorithms. The treatments include:
Over-the-Counter: Artificial tears (usually as adjunctive therapy), suspension or gel drops, ointments, lid scrubs, herbal remedies and vitamins
Prescription Medications: Cyclosporine ophthalmic emulsion (Restasis, Allergan), systemic and ocular antibiotics, ophthalmic steroids (drops and ointments), hydroxypropyl cellulose ophthalmic inserts (Lacrisert, Valeant Ophthalmics), cevimeline (Evoxac, Daiichi Sankyo)
Compounded Agents: Autologous serum tears, dehydroepiandrosterone (DHEA) tears, tea tree oil
Office Procedures: Meibomian gland expression (traditional and thermal pulsation [LipiFlow, TearScience]), punctal occlusion, meibomian gland probing, epithelial debridement
Devices and Device-Related Strategies: Scleral lenses, bandage lenses, prescribed contact lens replacement schedules and care solutions, and specific contact lens materials.
As new therapies are introduced, tracking the effectiveness of our management plans will become increasingly important so we can answer questions that arise. For instance, is a bland ointment better than a hypotonic ointment is to treat epithelial basement membrane dystrophy? Are vitamins the wave of the future? What is the role of systemic medications? Current and future research will provide more data that will help revolutionize how we think about the ocular surface and its complications.
Trends to Watch
OSD prevention and treatment is becoming a growing trend. We are seeing more emphasis on comprehensive dry eye work-ups following the initial diagnosis to properly assess treatment efficacy and patient adherence to therapy. Now is the time for you to develop a Dry Eye Center of Excellence. By helping our patients maintain a clear and comfortable ocular surface, we can make a difference in their lives. CLS
|Dr. Schaeffer practices in Birmingham, Ala., where he is also president of a 15-location, 17- doctor group practice and a refractive laser center. He is a consultant or advisor to Allergan, AMO, Vistakon, CooperVision, Optovue, B+L and Essilor. He has received educational grants from Hoya and Ista Pharmaceuticals, and he has received lecture or authorship honoraria from Allergan, AMO, Zeiss, Essilor, Hoya, Vistakon, and Alcon.|