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Navigating Unmet Needs In Dry Eye Disease Therapies
Richard Adler, MD, FACS, Assistant Professor of Ophthalmology at the Wilmer Eye Institute, Johns Hopkins Institute, and Director of Ophthalmology Services at Belcara Health, discusses the critical unmet needs in Dry Eye Disease (DED) therapies and explores the potential impact of new agents in addressing these challenges.
This is a video synopsis/summary of a Post Conference Perspectives involving Richard Adler, MD.
There are many unmet needs in the treatment of dry eye disease (DED). Of the approximately 38 million Americans suffering from DED, only 17 million have received a diagnosis and just 1.1 million have been prescribed treatment. This compares to 4 million annual cataract surgeries and 3 million annual glaucoma diagnoses nationally. Successful dry eye treatments should aim to harmonize the frequently discordant signs and symptoms, address underlying inflammation and tear production issues, and improve patient quality of life. From a drug development perspective, ideal treatments would demonstrate rapid onset and durable symptom relief with improved delivery, bioavailability, and tolerability. Cyclosporine ophthalmic emulsion 0.05% (Restasis) was approved in 2002 but still has shortcomings after 20 years on the market, notably its poor water solubility given the aqueous environment of tears, leading to suboptimal drug delivery and tissue penetration. Innovations addressing these limitations by enhancing cyclosporine delivery and bioavailability remain unmet needs.
Video synopsis is AI-generated and reviewed by AJMC® editorial staff.
Picking A Treatment For Dry Eye
So when I'm creating a treatment plan for a patient's dry eye, the first step is to get them into the clinic. We have sophisticated diagnostic tools nowadays that can image the eyelid glands, that can measure the tear quantity and quality, that can measure the blink rate. You can tell if someone doesn't close their eyes all the way when they're blinking. We also have things to measure tear osmolarity as well as inflammation in the tears.The next step to creating a dry eye treatment plan is to determine the type of dry eye disease they have. And what I mean by that is there are three main types. The first type is called aqueous deficient dry eye. And that refers to an inadequate production of tears. The next type of dry eye is called evaporative dry eye. Evaporative dry eye is due to the glands in our eyelids known as the meibomian glands being clogged up. It's the most common type of dry eye disease.
The third type of dry eye is mixed mechanism. And as you can imagine, it's a combination of the two where you have a reduced tear production and a poor quality of tear. So determining what type of dry eye the patient has is really crucial to having a successful treatment plan. So once I determine what type of dry eye disease they have and the severity of it, that's when I start the treatment regimen.
So for some patients, it's as simple as warm compresses, lubricants, lid cleaners. For other patients, they do need the incorporation of medications or in-office procedures to be able to manage their dry eye. So nowadays with the advancement of diagnostic testing, there's not so much trial and error that goes on to dry eye management. We have all of the puzzle pieces to create the big picture to really know what's going on.
So what a patient can expect with a treatment plan is written out instructions. It's going to be thorough with a lot of information. I'm giving them the tools that they need to help fix their dry eye. It's on them to use those tools appropriately. They can be as compliant as they'd like, but certainly, compliance helps with success. So it's really important to just be open with your doctor and honest about your expectations and what your willingness is to follow the regimen or engage in the procedures. ","publisher":"WebMD Video"} ]]>
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[MUSIC PLAYING]LAUREN DYAK
So when I'm creating a treatment plan for a patient's dry eye, the first step is to get them into the clinic. We have sophisticated diagnostic tools nowadays that can image the eyelid glands, that can measure the tear quantity and quality, that can measure the blink rate. You can tell if someone doesn't close their eyes all the way when they're blinking. We also have things to measure tear osmolarity as well as inflammation in the tears.The next step to creating a dry eye treatment plan is to determine the type of dry eye disease they have. And what I mean by that is there are three main types. The first type is called aqueous deficient dry eye. And that refers to an inadequate production of tears. The next type of dry eye is called evaporative dry eye. Evaporative dry eye is due to the glands in our eyelids known as the meibomian glands being clogged up. It's the most common type of dry eye disease.
The third type of dry eye is mixed mechanism. And as you can imagine, it's a combination of the two where you have a reduced tear production and a poor quality of tear. So determining what type of dry eye the patient has is really crucial to having a successful treatment plan. So once I determine what type of dry eye disease they have and the severity of it, that's when I start the treatment regimen.
So for some patients, it's as simple as warm compresses, lubricants, lid cleaners. For other patients, they do need the incorporation of medications or in-office procedures to be able to manage their dry eye. So nowadays with the advancement of diagnostic testing, there's not so much trial and error that goes on to dry eye management. We have all of the puzzle pieces to create the big picture to really know what's going on.
So what a patient can expect with a treatment plan is written out instructions. It's going to be thorough with a lot of information. I'm giving them the tools that they need to help fix their dry eye. It's on them to use those tools appropriately. They can be as compliant as they'd like, but certainly, compliance helps with success. So it's really important to just be open with your doctor and honest about your expectations and what your willingness is to follow the regimen or engage in the procedures.
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Understanding Severe Dry Eye
Dry eyes can happen to anyone, but severe dry eye, or even dry eye disease, is a more complex problem.
Our eyes are coated with fluid — tears — that keep them hydrated, clean away debris, and lubricate eye movement.
Anyone can develop dry eyes from wind, a dry climate, dehydration, and more. Dry eye disease is considered severe when it's long lasting and doesn't respond to typical treatment options.
Severe dry eye isn't an official diagnosis. Severe, chronic dry eye, or dry eye disease (DED), is different than having sporadic dry eyes.
When you have dry eye disease, some part of the system that produces or excretes your tears doesn't work properly. The lack of tear production or a blockage in the flow of tears is what causes the dryness.
Learn more about dry eye syndrome.
You likely have experienced dry eyes on a windy day, alongside allergies, or even when you are tired. Symptoms of dry eye can include:
More severe cases of chronic dry eye or dry eye disease can also cause pain, significant vision problems, or leave you completely unable to produce tears.
Your healthcare team will begin to diagnose your eye condition with a routine eye examination, usually with the help of lights and magnification.
This exam may also include a vision screening but will mostly focus on checking the structure and anatomy of your eye and eyelid.
You may be asked to blink or move your eye in different directions, and measurement and testing of your tears is possible.
An official diagnosis of dry eye disease is usually only made if a healthcare professional identifies a structural or functional problem with how your eyes make and use tears.
Some tests that analyze your tear production and how your eye uses tears might include:
The treatment for your dry eyes will depend on the underlying cause. If environmental factors like wind, dust, or irritants are the cause of your dry eye, avoiding these irritants or protecting your eyes when you are outside can help.
Dry eyes that are caused by medications, chronic health problems like Sjögren syndrome, or issues with tear production are usually treated with things like:
Beyond irritation, untreated dry eyes can cause damage to the outer layer of your eye and may rarely lead to permanent vision damage or loss. Abrasions can develop on your cornea — the outer layer of your eye — with severe dry eyes.
Some people with these symptoms have significant discomfort and report experiencing depression over their symptoms.
Anyone may experience dry eye from time to time, but there are certain people at risk for more chronic or serious forms of this condition.
Risk factors for severe dry eye problems include:
Millions of Americans experience dry eye each year, but for most people, it's a manageable problem. You may need to use eye protection, avoid triggers, or use eye drops regularly to avoid flare-ups and severe complications. However, there are a lot of options for treating dryness in your eyes.
If your dry eye symptoms are caused by a problem with your tear ducts, tear composition, or glands around your eyes, treatment is feasible but also a bit more complicated.
For structural and functional problems in your eyes that are causing dry eye, your healthcare team may need to use intensive treatments like laser therapy or surgery.
You can't prevent every kind of dry eye. If a structural problem or systemic disease is causing your dry eye, those underlying issues must be treated for you to find relief.
For more general forms of dry eye, though, there are some steps you can take to help prevent dryness and irritation. These include:
There are many ways to treat dry eyes. Finding the right treatment will depend on what's causing your dry eye. You can try over-the-counter lubricating drops to start, but if this doesn't help, you may need to see a healthcare professional for a more in-depth examination.
What's considered severe dry eye?Severe dry eye or dry eye disease (DED) is usually diagnosed when the dryness is the result of poor tear quality or problems with the parts of your eye that produce tears. These problems may also be referred to as dysfunctional tear syndrome.
Can dry eyes be a symptom of something serious?Dry eye disease (DED) is usually only diagnosed when a structural or functional problem in the way your eye makes or uses tears is identified.
Without evidence of problems with tear production, your healthcare team may look to other causes of your dry eye. This can include other diseases or medical conditions — often autoimmune diseases such as Sjögren syndrome or connective tissue diseases like lupus.
How long does it take to recover from severe dry eye?If the environment around you is contributing to your dry eye problem, the dryness is likely to continue until you make changes to your habits and lifestyle.
Regular use of eye drops can help, but if you have dry eye disease, a full recovery may require prescription medications or medical procedures that repair or support your tear production.
Dry eye is a problem that many people face. Lubricating eye drops can provide relief in many cases, but your dry eye could be caused by a problem with your tears or tear production. Dry eye is considered severe when it doesn't respond to typical treatment options and is long lasting.
If you've taken steps to stay hydrated, protect your eyes, or tried over-the-counter products and your dry eye isn't getting any better, make an appointment for an eye exam to rule out more serious issues like tear duct dysfunction.
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