ASCRS 2026: Eric D. Donnenfeld, MD, highlights early response patterns with lifitegrast in dry eye

The management of dry eye disease may benefit from earlier intervention, according to data presented by Eric D. Donnenfeld, MD, at the American Society of Cataract and Refractive Surgery (ASCRS) 2026 annual meeting, held April 10 to 13, in Washington, DC, where he reviewed treatment-response patterns among patients receiving lifitegrast.

Donnenfeld, a clinical professor at New York University and with Ophthalmic Consultants Long Island in New York, NY, presented an analysis of patients enrolled in the FDA pivotal trials of lifitegrast. The review examined “hundreds of patients” and stratified outcomes into five distinct response groups based on timing and degree of symptomatic improvement.

“We looked at five different subgroups of patients,” Donnenfeld said, including those who “responded immediately by the first visit,” those who demonstrated “serial improvement over the three visits of the trial,” and patients whose improvement was more limited by the end of follow-up. Additional groups included patients with less than 60% improvement and a smaller subset with “less than 30% improvement.”

The findings underscored variability in the onset of response. A notable proportion of patients experienced early symptomatic relief, with Donnenfeld noting that “a number of patients showed very early response to therapy, with improvement of symptoms.” In these cases, patients “felt better, they were more comfortable, they had resolution, they dry,” and improvement was seen at the first post-treatment visit.

Other patients improved more gradually. “Another group of patients showed steady improvement over time,” he said, while in some cases “it took up to six weeks before they really showed response to therapy.”

A key clinical observation from the analysis was the relationship between baseline disease severity and treatment response. “The take-home message from the trial that we learned was that patients who had milder disease were the ones that responded best to therapy,” Donnenfeld said. He added that this aligns with day-to-day clinical experience: “the more severe the disease, the less likely the patient will respond adequately.”

For clinical practice, Donnenfeld emphasized the implications for earlier intervention. “Take-home message for me as a clinician is that I want to treat patients with dry eye earlier, and I want to treat them before they become very symptomatic,” he said, noting that “they'll get a better response.”

He also briefly reviewed mechanism of action, describing lifitegrast as “a LCA antagonist” that “prevents the adhesion of T lymphocytes to the ocular surface.” By affecting “all forms of T lymphocytes,” he said the therapy “works quickly, it works effectively.”

His concluding message was direct: “if you have dry eye, manage the patient aggressively and treat early.”