ASCRS 2025: Eric D. Donnenfeld, MD, on the effect of lifitegrast clinical signs and biomarkers in dry eye disease

Eric D. Donnenfeld, MD, presented clinical trial results evaluating the impact of lifitegrast on dry eye disease (DED) symptomatology and biomarkers—findings shared at the 2025 American Society of Cataract and Refractive Surgery Annual Meeting, held April 25–28 in Los Angeles, California. Lifitegrast, an immunomodulator that targets T cell pathways, stands out for its ability to modulate multiple aspects of the inflammatory cascade underlying DED. “What’s unique about it is it works on several different pathways of dry eye disease,” Donnenfeld noted.

The study focused on symptomatology assessed via the Ocular Surface Disease Index (OSDI), with evaluations conducted at 2, 8, and 12 weeks. According to Donnenfeld, “patients had a significant improvement in their dry eye symptomatology as early as 2 weeks, which just really mimics the FDA trial.” Beyond subjective symptom relief, objective biomarkers were also assessed. Tear osmolarity showed a particularly striking change, decreasing by nearly 20 mOsm/L within the first 2 weeks—a finding Donnenfeld emphasized as “probably the best indicator of dry disease management.”

Additional improvements were observed in fluorescein staining, lissamine green staining, tear breakup time, and Schirmer scores. Interestingly, MMP-9 levels did not change, which may reflect the qualitative rather than quantitative nature of current MMP-9 assays.

Donnenfeld underscored the multifactorial nature of DED and the need for personalized treatment strategies. “You have to think in terms of inflammation, which is probably the No. 1 cause of dry eye,” he explained, highlighting lifitegrast’s role as a T cell modulator. Ideal candidates for lifitegrast include patients with inflammatory risk factors, especially those with collagen vascular diseases such as thyroid disease. “These are patients where I always start them on a T cell modulator and then go on from there.”

He also discussed the role of adjunctive agents like perfluorohexyloctane, noting it offers symptomatic relief but “doesn’t treat the root cause of the disease.” In conclusion, Donnenfeld emphasized a team-based approach: “If you’re not taking care of dry eye, you’re not treating the whole patient.”