Exploring the Management of Dry Eye - Episode 1

Identifying Dry Eye Disease

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A panel of ophthalmologists and optometrists begin a discussion on the management of dry eye disease by defining the condition and highlighting common symptoms.

Cynthia Matossian, MD, FACS: Hello, and welcome to this Ophthalmology Times® and Optometry Times® Viewpoints. Today’s title is “Exploring the Management of Dry Eye.” I’m Cynthia Matossian from Matossian Eye Associates. I am exclusively focused on dry eye disease. I’m the founder and medical director of Matossian Eye, and we have offices in New Jersey and Pennsylvania. I am honored to be joined by my wonderful colleagues, who are esteemed in the area of dry eye disease. We have Dr Rahul Tonk, assistant professor of clinical ophthalmology and medical director at Bascom Palmer Eye Institute in Florida. We also have Milton Hom, an optometrist at Canyon City Eyecare in Azusa, California. And Dr Kelly Nichols, the dean at the School of Optometry at the University of Alabama at Birmingham. For today’s discussion, we are going to focus on dry eye disease, the various opportunities to diagnose, and the different treatment modalities that are available to us. Toward the end we’re going to talk a little about exciting new agents in the pipeline. Let’s get started. Is everybody ready?

Milton M. Hom, OD, FAAO: Yes.

Cynthia Matossian, MD, FACS: Good. Dry eye disease has so many names, right? Like dysfunctional tear syndrome, ocular surface disease, MGD [meibomian gland dysfunction]. Rahul, we’ll start with you. How do you define dry eye disease?

Rahul S. Tonk, MD, MBA: To me, dry eye is a multifactorial disease that involves both symptoms and objective signs. At the root cause, many people would agree, as established by the Tear Film & Ocular Surface Society, that inflammation is at its core. There can be a variety of culprits at play, from lipid layer insufficiency and evaporative dry eye to aqueous deficiency, and there can be broad overlap with these subtypes. But there’s also a neurosensory component that we must recognize where we may not always be able to identify these portions and treat them in a purely scientific way, and we must give some thought toward the higher cortical aspects of neural sensation and pain. Broadly speaking, that was my sense of dry eye, and but there are many ways to define that.

Cynthia Matossian, MD, FACS: Milt, do you want to add anything to the wonderful description that Rahul gave?

Milton M. Hom, OD, FAAO: No, that sounds like a perfect description of what’s going on. I remember we were part of the Delphi panel a few years ago. It was the dysfunctional tear syndrome, and 1 of the things that we really struggled with was defining what dry eye was. We probably spent maybe half the discussion talking about what dry eye is. The problem is, as some of the clinicians brought up, “What happens if somebody has a wet eye? Is that considered to be a dry eye?” Things like that. Finally, we came up with dysfunctional tear syndrome. But what Rahul was saying, I perfectly agree with. That’s the updated definition of dry eye.

Cynthia Matossian, MD, FACS: That’s great. Kelly, in your position, you’re always with your students. What are the common symptoms of dry eye disease that you teach your students?

Kelly K. Nichols, OD, MPH, PhD, FAAO: Originally, we thought of dry eye symptoms as dry eye—just saying do you have dry eye?—but also discomfort, irritation, even itching can be a common symptom of dry eye. Now we focus on some of the visual symptoms that patients can have; blurry, distorted vision, vision that you need to blink to clear. Sometimes it might be a situation when they’re using computers or all the devices that we use; we’re hearing more of that. So you can’t just have it be the irritation type symptoms anymore when we listen to patients and try and understand their symptoms.

Cynthia Matossian, MD, FACS: I’m so glad you brought that up, Kelly. You’re right. As our understanding of dry eye disease is getting better, we are becoming more inclusive in what we are including in the definition. Don’t you agree?

Transcript edited for clarity.