Eyeworld

60 | EYEWORLD | WINTER 2024 C ORNEA YES CONNECT About the physicians Elvia Canseco, MD Opia Vision Center Houston, Texas Shaily Shah, MD Northern California Cornea Associates Walnut Creek, California by Ellen Stodola Editorial Co-Director We are fortunate to be practicing at a time with so many dry eye treatment options to help our pa- tients. Within the past year alone, we have added several new therapies targeting specific types of dry eye disease, including Demodex blepharitis and evaporative disease. As cornea specialists, we often must put on our detective caps to determine the specific etiologies of a patient's ocular surface disease. There is surely no "magic bullet," and it more often than not takes a multi-therapy approach to address the many facets of a patient's dry eye syndrome. The more tools in the toolbox, the better we can tailor individual treatments for these complex patients. I am excited to have two phenomenal cornea and dry eye specialists, Elvia Canseco, MD, and Shaily Shah, MD, share their early personal experiences and thoughts on several of these new options with the greater YES community. Mina Farahani, MD, YES Connect Editor P revious issues of EyeWorld have dis- cussed dry eye in detail, including the many options available for treatment and management. It continues to be an important topic because of the many patients impacted and different ways it can present. In this issue's YES Connect col- umn, Elvia Canseco, MD, and Shaily Shah, MD, highlight some of the newer treatment options in the dry eye armamentarium and how they are handling dry eye in their practice, including how they have updated their approach with experience. Dr. Canseco frequently manages dry eye in her practice. "In my practice, dry eye is very common; more than half of the patients I see have some version of dry eye, and I think it's important to mention that it's not one specific [type of] patient," she said, adding that she sees these issues with patients she evaluates for cat- aract surgery, those on glaucoma medications, etc. "We're talking about patients who might show up for routine eye exams or have been referred due to autoimmune disease, graft vs. host disease, or maybe a prior injury of the eye has left them with lagophthalmos or cicatricial changes." It's important to partner with patients to help them understand this is a chronic problem, Dr. Canseco said. "There's nothing that can com- pletely cure dry eye, but we can make patients feel better, function well, and get through each day. It's important as ophthalmologists to let patients know that there are changes we can incorporate into their daily routines that can make a difference," she said, adding that envi- ronmental modifications for some patients are often key to successful treatment. Dr. Shah has had training in dry eye and ocular surface inflammation. During her fellow- ship, she learned how much of an impact ocular surface disease can have on patients' vision, physical comfort, and overall quality of life. "I've realized over time just how ubiquitous dry eye is, and in my current practice, I treat dry eye disease every day," she said. "Typically, I see between three and 10 new consults for dry eye disease or ocular surface inflammation per week (including mild blepharitis, ocular rosacea, con- cerns for Demodex blepharitis, post-surgical dry eye, etc.); however, like most ophthalmologists (and particularly cornea specialists), I inciden- tally find and treat dry eye in more than a third of my patients." With mild or asymptomatic disease, Dr. Shah will typically start with conservative treat- ments, such as warm compresses, lid hygiene, and OTC artificial tears. "I'll often tailor the OTC options to the specific patient—lipid-based tears in those with meibomian gland dysfunc- tion or decreased tear breakup time, preser- vative-free options for those with suspected preservative sensitivities, etc." In patients with more significant or recalci- trant symptoms that have not responded to OTC treatment or in those with more severe and obvious ocular surface inflammation, Dr. Shah will quickly move on to other treatment options. "For those with low tear lake or significant fluo- rescein staining, I will often place punctal plugs. For patients with significant inflammation of the ocular surface, I will start an immune-modulat- ing therapy such as cyclosporine or lifitegrast often in conjunction with a short course of steroids. "Other great treatment options avail- able in our armamentarium include Tyrvaya Expanded treatment options in dry eye

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