Over the course of my career as an ophthalmologist, I’ve experienced firsthand the challenges that come with diagnosing and treating dry eye disease (DED). I’ve also witnessed my patients’ continuous struggle to manage the disease and its chronic symptoms. DED affects millions of people worldwide,1 and its impact extends well beyond the ocular surface, as those symptoms affect both the physical and emotional wellbeing of our patients.2-6
The Role of Natural Tears in Combating DED
Dry eye disease is a multifactorial condition that primarily stems from a deficiency in natural tears4,7-8 whether due to decreased tear production or increased evaporation.9-10 Of the approximately 38.5 million individuals in the United States who are affected by DED,1 less than 10% of diagnosed patients are being treated with a prescription product.
Half of patients with categorized dry eye disease present with inadequate tear production.11 In healthy patients, when the eye senses dryness, it can respond by making more tears to keep the ocular surface moist. However, in patients with DED, inadequate tear production can impact the health of the ocular surface.4,7-8
Tear deficiency can result in inflammation, peripheral nerve damage, and sensory abnormalities, including reduced stimulation of the lacrimal functional unit (LFU).12-13
Symptoms that accompany a decrease in natural tear production can be exacerbated by the use of digital devices, aging, air pollution, and other daily vision stresses faced by today’s patients.14-15
The Psychological Impact of DED
Beyond the physical discomfort of DED and its impact on overall eye health, patients also face significant psychological and lifestyle challenges, including negative impacts on work productivity, social activities, reading, driving at night, use of digital devices, and the inability to wear contact lenses or to undergo cataract or refractive surgery.5,16-17 Recognizing the psychological burdens of DED is just as important as addressing the physical symptoms to ensure patient compliance and positive outcomes from treatment.5,18-24
If untreated, dry eye disease will often become chronic and progressive. While some patients may not initially present with these concerns, their symptoms and emotional challenges may grow over time.2-6 The subsequent cycling through different treatments in the hope of effective, lasting relief can amplify frustrations for both physicians and patients.21-23
A Comprehensive Approach to Addressing DED Burdens
Among patients with DED, only 13% feel their condition is well-managed,24** and research shows that 9 out of 10 DED patients discontinued initial medication within 1 year.23*** These statistics illuminate that many commonly used DED treatments have limitations, including slow onset and suboptimal efficacy, leading to patient dissatisfaction and poor adherence.18-24
Many patients are left feeling hopeless in their search for effective symptom management. In conjunction with the need for new treatment options, the complexity of DED requires a comprehensive and nuanced approach to managing the relationship between eyecare professional and patient.
Prompting our patients with questions like, “How often do you experience dry eye symptoms, and when do they seem to be the worst for you?” and “Are your symptoms interfering with your ability to complete everyday tasks?” can provide insights into how DED is affecting their daily life. Understanding these details allows us to make informed recommendations to manage their most troublesome symptoms and create an effective, ongoing disease management plan.
Regular check-ins with patients, during which they can openly discuss not just their symptoms but also how these symptoms are affecting their lives, can help us understand the disease progression and provide personalized recommendations tailored to their individual needs. OM
References
1. 2023 Dry Eye Products Markets Report, Market Scope, 2023.
2. Galor A, Britten-Jones AC, Feng Y, et al. TFOS lifestyle: impact of lifestyle challenges on the ocular surface. Ocul Surf. 2023;28:262-303. doi: 10.1016/j.jtos.2023.04.008
3. Basilious A, Xu CY, Malvankar-Mehta MS. Dry eye disease and psychiatric disorders: a systematic review and meta-analysis. Eur J Ophthalmol. 2022;32(4):1872-1889. doi: 10.1177/11206721211060963
4. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-283. doi:10.1016/j/jtos/2017.05.008
5. Uchino M, Schaumberg DA. Dry eye disease: impact on quality of life and vision. Curr Ophthalmol Rep. 2013;1(2):51-57. doi: 10.1007/s40135-013-0009-1
6. Chan C, Ziai S, Myageri V, Burns JG, Prokopich CL. Economic burden and loss of quality of life from dry eye disease in Canada. BMJ Open Ophthalmol. 2021;6(1):e000709. doi: 10.1136/bmjophth-2021-000709
7. Nattinen J, Aapola U, Nukareddy P, Uusitalo H. Looking deeper into ocular surface health: an introduction to clinical tear proteomics analysis. Acta Ophthalmol. 2022;100:486-498. doi: 10.1111/aos.15059
8. Bron AJ, de Paiva CS, Chauhan SK, et al. TFOS DEWS II pathophysiology report. Ocul Surf. 2017;15:438-510. doi: 10.1016/j.jtos.2017.05.011
9. Zemanová M. Dry eye disease: A review. Czech and Slovak Ophthalmology. 2021;77(3):107–119. doi: 10.31348/2020/29
10. American Optometric Association. Dry eye: causes, symptoms, and treatment. Available at: https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/dry-eye. Accessed November 26, 2024.
11. Matossian C, Crowley M, Periman L, Sorkin S. Personalized management of dry eye disease: beyond artificial tears. Clin Ophthalmol. 2022;16:3911-3918. doi: 10.2147/OPTH.S384819p3912
12. Sacks RA, Beaton A, Sathe S, Morris C, Willcox M, Bogart B. Towards a closed eye model of the pre-ocular tear layer. Prog Retin Eye Res. 2000;19(6):649-668. doi:10.1016/s1350-9462(00)00006-9
13. Dieckmann G, Fregni F, Hamrah P. Neurostimulation in dry eye disease—past, present, and future. Ocul Surf. 2019;17:20-27. doi.org/10.1016/j.jtos.2018.11.002
14. Mathers WD, Lane JA, Zimmerman MB. Tear film changes associated with normal aging. Cornea. 1996;15(3):229-234. doi: 10.1097/00003226-199605000-00001
15. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628. doi: 10.1016/j.jtos.2017.05.006
16. Akpek EK, Amescua G, Farid M, et al. American Academy of Ophthalmology Preferred Practice Pattern Cornea and External Disease Panel. Dry Eye Syndrome Preferred Practice Pattern.® Ophthalmology. 2019;126:P286-P334.
17. Barber L, Khodai O, Croley T, et al. Dry eye symptoms and impact on vision: related function across International Task Force guidelines severity levels in the United States. BMC Ophthalmol.
18. Wilson SE, Perry HD. Long-term resolution of chronic dry eye symptoms and signs after topical cyclosporine treatment. Ophthalmology. 2007;114(1):76-79. doi: 10.1016/j.ophtha.2006.05.077
19. Semba CP, Gadek TR. Development of lifitegrast: a novel T-cell inhibitor for the treatment of dry eye disease. Clin Ophthalmol. 2016;10:1083-1094. doi: 10.2147/OPTH.S110557
20. Restasis. Prescribing Information. Allergan; 2012. http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/050790s020lbl. Accessed July 8, 2024.
21. Hovanesian JA, Nichols KK, Jackson M, et al. Real-world experience with lifitegrast ophthalmic solution (Xiidra®) in the US and Canada: retrospective study of patient characteristics, treatment patterns, and clinical effectiveness in 600 patients with dry eye disease. Clin Ophthalmol. 2021;15:1041-1054. doi: 10.2147/OPTH.S296510 |
22. Cook N, Mullins A, Gautam R, et al. Evaluating patient experiences in dry eye disease through social media listening research. Ophthalmol Ther. 2019;8(3):407-420. doi:0.1007/s40123-019-0188
23. Mbagwu M, LaPrise A, Harris J, Nair AA, Fain J, Harrison DJ. Characterization of discontinuation and switching patterns of dry eye disease medications using linked EHR registry and claims data. Presented at: American Society for Cataract and Refractive Surgery Conference; April 5-6, 2024; Boston.
24. Morse H, Henneberger S, Reed J, et al. 2021 in American survey findings: living with chronic dry eye. ChronicDryEye. August 10, 2021. Accessed September 23, 2024. https://chronicdryeye.net/infographic/in-america-findings.
**Based on an online survey conducted by Chronic Dry Eye from February to April 2021 among 415 responders who reported being diagnosed with chronic dry eye. Of these, 44% reported a severe level of chronic dry eye (ie, levels 3 and 4).
***Among those who gave reason for switching.
^ Based on electronic health record data from American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) linked to Komodo pharmacy claims data (Jan 2018 to Jun 2021) using the Datavant token to identify dry eye disease prescription medication use.
