Eyeworld

DECEMBER 2019 | EYEWORLD | 59 C Dry eye clinical pearls from Drs. Farid and Honkanen •Keep DED in mind in younger patients with ocular discomfort and pain. •Aim for early identification of dry eye to avoid more severe clinical problems in the future. •Educate patients on how increased screen time may affect the occurrence of dry eye. years. With improvement in diagnostic technol- ogy and increased therapeutic choices, DED is [now] more readily identified and treated," she said. The study defining dry eye as someone taking medication for it likely lowered the prevalence rate as well, considering that many patients with DED do not use medication. The higher prevalence among females and patients over age 50 are also found among cor- nea and anterior segment doctors. These same doctors also observe a growth in dry eye among younger patients. "We have definitely seen an increase of incidence over the years," Dr. Farid said, citing better identification and an increase in risk factors. Despite advancements in diagnosis and treatment, the study shows there still is work to be done. "Ongoing research is still needed to better define the underlying pathophysiology of this complex entity in hopes of developing new and more optimal treatments and perhaps a cure," Dr. Honkanen said. Contact information Faulkner: wfaulkner@cvphealth. com Pflugfelder: stevenp@bcm.edu Sheppard: jsheppard@vec2020. com Outer limits of treatment The device can be helpful in patients with Sjogren's patients or graft-versus-host disease, Dr. Faulkner said. "However, with very severe disease some patients perceive no positive results," Dr. Faulkner said. "Similarly, the most severe MGD patients may not do well also." Dr. Sheppard warned against using the device in patients whose Schirmer's test found no tear production. "Those patients are few and far in be- tween—they are desperate," Dr. Sheppard said. "If there is complete atrophy of the goblet cells and the lacrimal apparatus, then your chance of getting a good benefit are pretty low for obvi- ous reasons." TrueTear costs $650 for the device, charger, and 1 month of tips, each lasting 48 hours (15 tips are included). Subsequent tips cost $43.50 each month, according to prices provided to Dr. Faulkner. and lactoferrin as compared to basal tears, Dr. Faulkner said. Patients self-administer the treat- ment and power is adjustable from level 1–5. Dosing usually starts at 4 times daily for 30–60 seconds and may be adjusted up or down based on response. The device may be used for up to 30 minutes per 24-hour period. And no tachy- phylaxis has been demonstrated. One study sampled and interviewed 28 patients on their initial experience with True- Tear and found overall positive results, includ- ing 71% with a favorable impression. Average rating on 1–10 scale was 6.92. Among those patients, 25% purchased the device immediate- ly, despite a lack of insurance coverage for the device, and non-purchasers all said they would consider purchasing it later.¹ "Since that publication we have used this in a small number of patients," said Dr. Faulk- ner. "I have some very loyal and appreciative patients. The main objection seems to be cost and no insurance coverage. However, treatment is easy and natural and effects are immediate." continued from page 56 Reference 1. Dana R, et al. Estimated prevalence and incidence of dry eye disease based on coding analysis of a large, all-age, United States health care system. Am J Ophthalmol. 2019;202:47–54. Relevant financial interests Dana: Aldeyra Therapeutics, Dompé, Kala Pharmaceuticals, Proteris Biotech, Takeda Farid: None Honkanen: None

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