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Ophthalmologists who responded to questions about treatment of dry eye indicated that there are limitations in the available treatment options, especially for patients with moderate to severe cases of the disease, and that only 5% of ophthalmologists saw existing treatments as effective for the patients with the worst cases.
"This survey showed what many clinicians know, specifically that moderate to severe dry eye disease is common and that we don't have all the tools we need to help our patients as much as we would like to," said Dr. Asbell. She is professor, Department of Ophthalmology, Mount Sinai School of Medicine, and director, Cornea Services and Refractive Surgery Center.
A total of 245 ophthalmologists completed this survey online; that number included 51 cornea specialists; about two-thirds were comprehensive/general ophthalmologists. Dr. Asbell explained that answers were solicited from survey respondents who treat a minimum of four to six patients with moderate to severe dry eye per month. On average, these ophthalmologists treat 25 patients with moderate to severe disease during the course of a month. The respondents have been in practice an average of 17.4 years.
The respondents noted that their most important goals when treating patients with moderate to severe dry eye are maintaining and protecting the ocular surface, and lubricating and hydrating it. Almost half and 30% of the respondents, respectively, cited these two goals as the most important. Other goals included inhibiting inflammatory factors, by 11% of respondents; prolonging the tear film breakup time, by 8%; stimulating tear production, by 4%; and helping patients tolerate contact lenses, by 1%, Dr. Asbell reported.
Treatment of dry eye disease
When deciding on the most appropriate treatment for patients with moderate to severe dry eye, the respondents reported overwhelmingly that the ability to provide continuous relief and patient acceptance of the treatment were paramount considerations, by 84% and 82%, respectively. Other factors that entered into the decision-making process were the ability to use the treatment over the long term (74%), the dosing frequency (66%), the length of time that the tear film was preserved (66%), the length of time to effectiveness (63%), the absence of a preservative (54%), the ability to use a treatment with contact lenses (51%), and ability to use a treatment with other medications (44%), and other (4%).
Successful treatment of this patient population was defined by ophthalmologists as relief of symptoms/patient satisfaction (67%), prevention of corneal damage (25%), and improved vision (6%). Other criteria for successful treatment were lengthening the tear film breakup time, an increased Schirmer's test score (2%), a decrease in the rose bengal score (1%), and increased tear film meniscus (1%), according to Dr. Asbell.
Importantly, 94% of respondents strongly or somewhat agreed that more treatments are needed for patients with moderate and severe dry eye. In addition, 92% noted that, usually, more than one treatment is needed to manage this condition. A large majority (82%) cited a treatment gap between artificial tears and more aggressive treatments for moderate and severe dry eye, with 80% believing that the signs and symptoms of moderate and severe dry eye can be improved but seldom eradicated. To support this finding, the survey showed that during a 1-year period, the respondents prescribe, recommend, or suggest an average of 1.9 treatment approaches for mild dry eye, 3.2 approaches for moderate dry eye, and 4.9 approaches for severe dry eye.