Eyeworld

DECEMBER 2023 | EYEWORLD | 59 C Contact Tauber: jt@jteyes.com White: dwhite2@skyvisioncenters.com Relevant disclosures Tauber: None White: Allergan, Bausch + Lomb, Novartis, Tarsus "We've got patients who had a lot of inflam- mation, which caused them to have all kinds of symptoms and signs, and they're much better because they're on immunomodulator therapy, but they still have some symptoms," Dr. White said. "Our job has become easier simply because we have better widgets to put into the game," he said. Dr. White said he tries to put together a plan for patients that builds on fundamental things that are not particularly difficult or expensive to do. The challenge is that patients and many doctors think that artificial tears are a real therapy, he said, but with the exception of patients who have a really high tear osmolarity, artificial tears don't do anything. With that said, he will often start with an artificial tear so he is in control of which product they're using. This makes it easier to move on from artificial tears at subsequent visits. If the patient has evaporative dry eye associated with MGD, we start with some fundamental things like heating their eyelids, Dr. White said, noting that there are a variety of mask options available. "I find that patients are more likely to do lid heating if it's not quite as messy as a face cloth and the sink." He will also discuss nutrition with patients, as well as the effects of looking at a screen all day, which prompts people to blink less frequently and less completely. Dr. White said his practice has patients come back 6–12 weeks later. If they have a lot of signs of dryness and not too many symptoms, they will have the patient come back sooner. If they come back and they're doing great, we've had a simple intervention that's inexpensive and not particularly time consuming, he said. "It's the next visit for all but the disasters where we really start practicing modern med- icine because when they come back, the vast majority will notice a small, relatively transient improvement in their symptoms from that building block, but now they're aware of what the problem is and why they have it," Dr. White said. This is the visit where we start talking about medication. "We give them a chance to learn that they have a diagnosis, we give them the chance to learn that what people think of as typical treatment doesn't work if you have real dry eye disease. "It's been our experience that if we give the patient the opportunity to learn that what they have is real and that they're not going to be able to take care of it just by going to the pharmacy and picking something up on their own, they're much more receptive to what it's going to take and will get on the medications that are neces- sary," Dr. White said. LESSONS LEARNED Vincent de Luise, MD, Cornea Editorial Board member, shared a lesson he has learned to "level up": One lesson I have learned is that with the approval earlier this year of Miebo (perflu- orohexyloctane, Bausch + Lomb), we are now closer than ever to stratifying dry eye disease management by dry eye disease type. Miebo is helpful for evaporative dry eye disease, whereas the immunomodula- tors Restasis (cyclosporine, Allergan), Xiidra (lifitegrast, Novartis), Cequa (cyclosporine, Sun Ophthalmics), and Eysuvis (lotepred- nol, Kala Pharmaceuticals) work better for aqueous deficient dry eye disease. Marjan Farid, MD, Cornea Editorial Board member, shared a lesson she has learned to "level up": As IOL technology continues to advance, I am continuing to learn the importance of matching the technology to the patient. We now have the ability to adjust IOL power via the Light Adjustable Lens (RxSight), intro- duce pinhole optics with the IC-8 Apthera (Bausch + Lomb), or continue to personal- ize visual systems with enhanced depth of focus and multifocal optics. However, which technology works best for which patient remains a challenge as we ex- pand our options. I am learn- ing daily to ask the patient the right questions, gather the es- sential diagnostic information, optimize the ocular surface, and set appropriate patient expectations.

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