At the 2026 annual meeting of the American Society of Cataract and Refractive Surgery, Carolina L. Mercado, MD; Michelle Kwon, PhD; Michelle Ratay, PhD; and Lisa M. Nijm, MD, JD, ABO, presented data from the American Academy of Ophthalmology IRIS (Intelligent Research in Sight) Registry linked to pharmacy claims data sourced from the Komodo Health Research Dataset. Patient selection consisted of 143,005 patients who were older than 18 years and were diagnosed with dry eye disease (DED) (on or after January 1, 2016) and who initiated an index lifitegrast ophthalmic solution 5% (Xiidra; Bausch + Lomb) DED prescription between January 1, 2017 and December 31, 2024.
Dr. Mercado pointed out that the large cohort reflects a predominantly female population with broad geographic and insurance representation, providing a diverse and generalizable baseline for evaluating DED. They documented patient characteristics, diagnostic tests, and treatment of DED in patients outside of a clinical trial setting.
The mean age was 61 years old and the standard deviation was 14 years. The population of female patients was 114,563—about 80% of the patients with DED that started the lifitegrast therapy. In terms of race, White patients comprised about 55% of the patient population, and the rest was distributed between Black (5%), Asian (5%), other (9%), and unknown (25%) as reported in the IRIS Registry. In regard to ethnicity, about 60% were not Hispanic or Latino, and 7% were Hispanic or Latino. Cataract was the most common ocular comorbidity. Other ocular comorbidities like age-related macular degeneration, diabetic retinopathy, uveitis, and retinal detachment, were present but at substantially lower rates. Most patients had nonocular comorbidities, with hyperlipidemia (45%) and hypertension (43%) being the most common, whereas all other conditions occurred at much lower frequencies—about 18% had type 2 diabetes, and about 11% had Sjögren syndrome or rheumatoid arthritis.
Dr. Mercado highlighted that 10% of patients had used other therapies, and a small amount of patients had paid out of pocket to start with other medications.
“Most patients had not received prescription dry eye therapy prior to the index date, highlighting a large untreated population and an opportunity to better support patients earlier in their disease journey,” Dr. Mercado said.
There was wide clinical participation across eyecare specialties. For example, most patients were managed by therapeutic optometrists, with strong representation across multiple ophthalmic subspecialties, highlighting broad engagement in DED care: 44% of prescribers were optometrists, 19% were cataract and anterior-segment specialists, 14% were cornea and comprehensive ophthalmologists, 13% and the remainder included retina, oculoplastics, and glaucoma specialists (<5%).
“One of the biggest takeaways from this study is that people are prescribing these drops without doing a lot of dry eye testing,” said Dr. Mercado. “Only about 3.9% of the patients had a tear breakup time of less than 5 seconds, so about less than 4% had evaporative dry eye diagnosed by tear breakup time. The Schirmer test was abnormal in less than 2% and was unknown in 98%. So, we can see that dry eye management is not really being targeted based on the diagnostic algorithm; dry eye testing is underutilized.”
Dr. Mercado concluded that this large, real-world study shows that patients with DED often have significant ocular and systemic comorbidities. She also explained that diagnostic testing remains severely underutilized, highlighting practice gaps and informing future strategies to improve the diagnosis and treatment.