Eyeworld

58 | EYEWORLD | DECEMBER 2023 C ORNEA (plugs). "I never use temporary plugs because they're not reliable enough to show the patient what they're going to do," Dr. Tauber said. He is excited about the recent approval of Miebo (perfluorohexyloctane ophthalmic solu- tion, Bausch + Lomb). This eye drop is a third the size of a standard eye drop, and tears can't evaporate through it. "I think Miebo is poten- tially a breakthrough product because nothing does what it does, and the MGD component is present in at least 70% of dry eye patients." Darrell White, MD Dr. White noted that "every single eye doctor is a dry eye doctor whether he or she knows it and if they know it, whether he or she will admit it." In the first discussion with the patient, Dr. White said the conversation will depend on what the patient's symptoms are and if he or she has symptoms at all. Dr. White noted that one of his treatment rules is, "You can't make an asymp- tomatic patient feel better." You start off right away knowing that you've got a fighting chance if they come in with symptoms, he said, and that's the easiest place to start because you can benchmark everything that you discuss around the symptoms. "We have a one-question patient survey to see if we should be starting a dry eye evalua- tion; regardless of what their symptoms are, our technicians ask if they take eye drops," he said. "It doesn't matter what the patient thinks they're taking the eye drop for." Most people who take an eye drop turn out to have dry eye, Dr. White said. "The key is to not miss the op- portunity to find that it's dry eye in those classic symptoms that we all know of dry eye." From the patient's point of view, Dr. White said the dry eye talk may be overwhelming. Figuring out how to communicate with them in a way that allows them to understand is import- ant, he said. When first looking at patients, Dr. White said he's trying to determine if they are primari- ly an evaporative dry eye patient or an aqueous deficient dry eye patient. "You're not going to be able to get through everything that they need to know and you're probably not going to be able to get all the treatments started that they need in a single session," he said. Patients are often skeptical from the beginning that tearing could be dryness or that the burning sensation at the end of the day or not being able to see the com- puter could be dryness. For the first visit, Dr. White said his pearl is "less is more," but he added, "We want to try to go deep on one part of it." If you nail that and get the patient to feel a little better, when they come back, you've got more credibility and can expand the discussion. Continue to go back and hit the original symptoms and remind the patient that your ultimate goal is for them to feel well. If we're talking about a new patient, it's a different conversation than when dealing with a referral patient, Dr. White said. "With new pa- tients, you often are able to make a significant impact in whatever symptoms they've brought to the table relatively quickly," he said. "Once again, the key is trying to figure out what's the primary type of dry eye and going after that." There have been many advancements in what physicians can offer to patients. Previ- ously, Dr. White said the physician might jump to offering steroids, and for a long time, there was only one immunomodulator (cyclosporine, Restasis, Allergan), but there have been many improvements in options. Dr. White also men- tioned Miebo and said, "In Phase 3 studies on efficacy, both in terms of the signs and symp- toms, it was off the charts." Also recently approved was XDEMVY (lotilaner, Tarsus Pharmaceuticals), to help with Demodex mite infestation. The data is very good, Dr. White said, with 95% mite eradication in the pivotal Phase 3 trial and upward of 60% of people continuing to show no signs of mite infestation a year out. continued from page 57 Dr. White thinks it's important to have a study on how many people have dry eye and how many people are being treated. The most recent study was from 2014. "Thirty-eight million people in the United States had dry eye," he said, adding that he thinks it's now closer to 68 million people in the U.S. with dry eye. Similarly, he said that information from the previous study indicated that around 16 mil- lion dry eye patients are diagnosed, but he estimated that might be closer to 38 million diagnosed now.

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