Exploring the Management of Dry Eye - Episode 12
A panel of ophthalmologists and optometrists conclude a discussion about dry eye disease by commenting on advances occurring in the field and future expectations for managing patients.
Cynthia Matossian, MD, FACS: We’re coming to a close on this program. I want to go around 1 more time. I’ll start with you, Kelly. Any closing remarks that you wish to add? Is there a topic that we didn’t cover in adequate detail or another thought that you wish to add?
Kelly K. Nichols, OD, MPH, PhD, FAAO: Goodness. To wrap up, dry eye is very exciting. The pipeline is probably what is the most exciting, with Oyster Point’s product, the nasal spray. We’ll find out in October whether the FDA approves it. That’s probably the closest to getting approval. But there are several others in phase 3 and a number in phase 2. If you pay attention to this space, several are also in phase 1 and moving forward. That’s so exciting. For the longest time, we would have 1 or 2 that were in some development, and now there are 15 or so that are, and many could actually get approved. That’s very exciting. What we will need along with that are diagnostic tools to help us determine the most appropriate candidates to take these new therapeutics and then what the outcomes will be, to see if there’s success and how we can measure that best in practice. Because if we knew that a patient looked a certain way and we were able to detect that, and then we prescribed a certain medication for them and then they had an outcome that we could carefully watch, that’s going to result in the best care for our patients. Personalized dry eye care would be great to the point if we could do that. Let’s keep on our eyes on the pipeline but keep the diagnosis and treatment simple and in a sequential order, and explain it very well to your patients.
Cynthia Matossian, MD, FACS: I love that. Milt, we’ll go to you and then to Rahul to wrap up.
Milton M. Hom, OD, FAAO: This is a very exciting time to be an eye doctor. I don’t think there’s any time in our history when we’ve had so many exciting new innovations and drug treatments. It’s crazy. It’s really wonderful. For dry eye, before we only had 1 drug, but now there are many drugs and a lot in the pipeline. Not only that, but we’re also looking at presbyopia, myopic progression, Demodex mites. It’s a very exciting time to be an eye doctor, and I’m glad to be here for the ride.
Cynthia Matossian, MD, FACS: We want to thank our industry partners. Without them listening to what our needs are and without them understanding how these help treat our patients, we would not have this collaboration. Thank you so much for putting all those millions of dollars into R&D [research and development] to come up with such a robust pipeline. Rahul, what do you think? What are you excited about, and what are your closing comments?
Rahul S. Tonk, MD, MBA: I just want to echo everything that’s been said. Our partners in the industry have done a great job. Also, they have provided opportunities for a number of investigator-initiated trials at academic centers. That has been a fantastic pathway and something that I’ve been privileged to take part in. It’s very nice on that end. On a clinical side, to ophthalmologists and optometrists who want to take it to the next level with their dry eye care, demystifying dry eye care is very important. As it gets more complicated, as we have more diagnostics, as we have more therapeutics, as we have procedural therapeutics as well as things that we prescribe, the basics are just the most important. At the end of the day, the principal thing that we need from our patients is buy in. We need patients to understand what’s happening on the ocular surface. So we need patient education tools. Milt mentioned a counselor. If you can do that, that’s great. If not, Kelly mentioned having a photograph or a meibography picture. I have a keratograph, so I print a report. Once the patient sees their tear break-up time on a video, they can understand what it means to be lipid deficient.
But low-tech tools are great if you have them. Just a fluorescein slit lamp photo can give you a sense of staining. Having patients buy in—understanding that it’s an ongoing partnership, that you’re going to go through the lumps and bumps together—is important. One other thing that I think is effective, at least I hope, is that I always tell a patient what’s coming next. As I close out my encounter and say, “We’re going to start here,” and then just as we know in our minds what’s next—the sandwich or the pyramid, whatever we want to call it. I put a note to myself in the chart to consider future therapeutics of a certain sort, and I tell the patient that much so we maintain their hope. Some of these patients have learned to deal with their dry eye disease or are bounced around among providers. To keep them optimistic about their care—not to mention that limbic optimism plays into their response to our treatment, so let’s be honest about that too—a partnership is so important. All the other comments across the panel were excellent. It’s been a fantastic opportunity to share this discussion with you all.
Cynthia Matossian, MD, FACS: Thank you very much to my wonderful panelists, Rahul, Kelly, and Milt. You guys have been terrific in sharing your wisdom with our audience. And I want to thank our audience for the time that you’ve spent with us. I hope you found Ophthalmology Times® and Optometry Times® Viewpoint discussion rich and informative.
Transcript edited for clarity.