Eyeworld

EW FEATURE 39 Multifaceted approach often needed E ven though dry eye disease has become more of an ophthalmic superstar in re- cent years—garnering at- tention both from ophthalmologists and the general public—the condition is still under- diagnosed and undertreated, said John D. Sheppard, M.D., professor of ophthalmology, microbiology, and immunology, Eastern Virginia Medical School, Norfolk. Add to this the consideration that FDA drug approvals have weak- ened, and practitioners have a smaller number of new dry eye treat- ment approaches. Ophthalmologists who frequently treat dry eye are ex- perimenting with already available medications not necessarily de- signed for dry eye, said Robert Latkany, M.D., founder and direc- tor, Dry Eye Clinic, New York Eye and Ear Infirmary, New York. One problem with dry eye treat- ment is that it can take time for pa- tients to notice a difference, said Esen K. Akpek, M.D., associate pro- fessor of ophthalmology, and direc- tor, Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University, Balti- more. "At first, patients don't get better, so they may not be sure if a treatment is helping. Patients might not appreciate the efficacy of a prod- uct," she said. For this reason, a multifaceted approach is sometimes necessary to provide symptom relief while other treatments target long-term inflam- mation. Using different treatments at the same time can also help im- prove symptom relief, considering that compliance is often a problem, Dr. Akpek said. Additionally, a weak economy means that patients may want to take a less expensive approach, which means considering non-phar- macological approaches or over-the- counter treatments before moving on to prescription drugs. Treatments should aim to maxi- mize the clarity and quality of tears while also targeting the exact type of dry eye a patient has, be it aqueous deficient, evaporative, or both, Dr. Sheppard said. Here are a number of treatments used by dry eye specialists as well as a brief look at other approaches on the horizon. Evaluating one's environment Ophthalmologists examining a pa- tient for ocular surface inflamma- tion need to take a comprehensive approach, Dr. Sheppard said. "They need an excellent history, and they need to look at medication use and the patient's home and work envi- ronment," he said. A comprehensive evaluation can help determine if pa- tients are suffering from allergies, meibomian gland dysfunction, or other conditions in addition to dry eye, he said. Dr. Sheppard finds that simple environmental changes can help soothe symptoms in a patient with mild or moderate dry eye. For exam- ple, using a coolness humidifier in- doors or using sunglasses outdoors can help with symptoms. He said that reducing the use of fans or heaters can also help. If patients use a computer frequently, he encour- ages them to make sure their screen is below eye level. When asking patients about their daily habits, physicians might identify certain habits that con- tribute to dryness. For example, "You'd be surprised how many pa- tients wash their eyes out with water," Dr. Sheppard said. Considering OTCs Physicians may recommend over- the-counter drops, or patients may already use an artificial tear they heard about or have randomly se- lected, Dr. Sheppard said. Although a number of patients are interested in over-the-counter products, their use may be more common in pa- tients who cannot afford prescrip- tion-based treatments or those who do not understand how bad their symptoms could get, Dr. Akpek said. Dr. Akpek believes that patient edu- cation is crucial in this area, not nec- essarily to stop patients from using over-the-counter drops but to make them more aware of how their symptoms could progress without a more serious treatment. Although there are a number of new over-the-counter tears available, Dr. Latkany does not see a major dif- ference between new products and those already in existence. "They seem to be similar plays on existing products," he said. "I rarely solve my patients' problems with over-the- counter products," he said. That February 2011 April 2011 OCULAR SURFACE by Vanessa Caceres EyeWorld Contributing Editor Treating dry eye A patient with significant dry eye from blepharitis. Inferior corneal staining with fluorescein and rapid tear film break-up, particularly in the peripheral cornea in a vertical streak fashion, are indicative of evaporative dry eye syndrome from blepharitis Source: Esen K. Akpek, M.D. Telangiectasia of the lid margin; inspissated gland orifices and a large glob of meibum plugging the duct in a patient with significant blepharitis AT A GLANCE • Ophthalmologists are finding new uses for existing medications to treat dry eye • A comprehensive evaluation can help determine causes of dry eye, the type of dry eye a patient has, and whether there are co-existing conditions • Simple changes to improve symp- toms can include modifying the pa- tient's environment or diet or trying over-the-counter tears • Medications such as Restasis, non- steroidal anti-inflammatory drugs, omega-3 supplements, steroids, and antibiotics are also used to help clear up inflammation • Ophthalmologists await more med- ication options to treat dry eye continued on page 40 032-047 Feature_EW April 2011-DL_Layout 1 4/10/11 8:01 AM Page 39

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