Eyeworld

EW CORNEA 92 byline plus fade April 2016 already lengthy evaluation for dry eye patients. "There needs to be a better understanding of and diagnostic testing for local and central pain," he said. "Additionally, there is an unmet need for better, non-narcotic medications to decrease or eliminate neuropathic pain." Dr. Levitt said further research with Dr. Galor's team will include gaining a better understanding of lipid make-up and other molecules in tears all the way up to the molec- ular genetics that could predispose someone to a central sensitivity syn- drome, resulting in comorbid CPS. The goal, he said, is to "relate pathophysiology to symptoms so that we can design a new paradigm for diagnosis and treatment of dry eye that's more mechanistic based." EW References 1. Galor A, et al. Neuropathic ocular pain due to dry eye is associated with multiple comorbid chronic pain syndromes. J Pain. 2015 Dec 1. [Epub ahead of print] 2. Cornea/External Disease PPP Panel, Hoskins Center for Quality Eye Care. American Acade- my of Ophthalmology. Dry Eye Syndrome PPP. 2013. www.aao.org/preferred-practice-pat- tern/dry-eye-syndrome-ppp--2013 3. Vehof J, et al. Shared genetic factors underlie chronic pain syndromes. Pain. 2014;155:1562–1568. Editors' note: The physicians have no financial interests related to their comments. Contact information Galor: AGalor@med.miami.edu Levitt: RLevitt@med.miami.edu Pflugfelder: stevenp@bcm.edu genetic mechanistic factors in mul- tiple comorbid chronic pain condi- tions, including [dry eye]." Still, Dr. Galor said most of the focus for dry eye symptomatology has been on the ocular surface. "Our main point is that we need to look beyond the ocular surface in order to really understand what's driving dry eye symptoms," she said. "The answer is not just in the eye, but ophthalmologists are very un- comfortable looking anywhere else, and that's why it's so great to have this collaboration between ophthal- mologists and pain specialists who are much more comfortable taking a holistic approach." Dr. Galor said that most oph- thalmologists, however, are open to and familiar with taking a multidis- ciplinary approach to other ocular issues, which could facilitate the same being done for some dry eye patients. "We've never thought of dry eye as anything beyond the eye, so there's never been a reason to collab- orate [with other specialists] on that particular disease," she said. Based on their findings that sug- gest dry eye patients with symptoms of neuropathic ocular pain could have a heritable pain disorder, the researchers suggest physicians screen dry eye patients for symptoms of neuropathic ocular pain and, if present, consider a multidisciplinary treatment plan. Galor et al. wrote that medications used to treat other forms of CPS might be useful for dry eye patients who also have neuro- pathic ocular pain symptoms. Dr. Pflugfelder agreed but noted that considering underlying pain conditions will add more time to an Study continued from page 90 " Our main point is that we need to look beyond the ocular surface in order to really understand what's driving dry eye symptoms. " –Anat Galor, MD

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