Defeating dry eye disease focus of WOC symposium

The importance of treating dry eye disease was the subject of "Advances in dry eye: disease perspectives, treatment options,and post-surgical management," a symposium held here in conjunction with the World Ophthalmology Congress (WOC).

Dry eye is believed to be one of the most commonly diagnosed ocular conditions, and it is estimated to affect more than 20million people in the United States. Yet, few studies have provided good data on the magnitude of the problem, according toDonald Tan, MBBS, FRCSE, FRCSG, FRCOphth, FAMS, professor and head, Department of Ophthalmology, Yong Loo Lin School ofMedicine, National University of Singapore, and director, Singapore National Eye Centre.

"We do know that tear deficiency is not the whole story," Dr. Tan said. Healthy tears, he said, are a complex mixture ofproteins, mucin, and electrolytes. Compared with healthy tears, tears of patients who suffer from chronic dry eye have fewerproteins, decreased growth factor concentrations, altered cytokine balance, a lower level of soluble mucin 5AC, increasedelectrolytes, and activated proteases.

Fortunately, a continuum of care is available to treat dry eye across four severity levels, ranging from mild tosevere.

According to Steven Wilson, MD, director of corneal research, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland,treatment options vary depending on the level of severity of the disease. These options range from patient education andenvironmental modification for the mildest level 1 disease, through a wide rage of lubricating eye drops and ophthalmiccyclospine for level 2, to oral tetracycline and punctal plugs (if inflammation is controlled first) for level 3, up tosystemic anti-inflammatory therapy, oral cyclosporine, and punctual cautery surgery for the most severe level 4disease.

"Left untreated, dry eye may become a progressive disorder," Dr. Wilson said. "Patients suffering from dry eye disease maymove between severity levels and can become worse if untreated."

He added that dry eye consensus guidelines developed by a panel of experts convened at the Wilmer Eye Institute, JohnsHopkins University School of Medicine, Baltimore, are easy to use and can prompt earlier treatment of dry eye disease.

"We conducted a nonrandomized, multicenter study in which nine physicians enrolled 183 patients with dry eye disease over a3-month period," Dr. Wilson said. "Physicians in the study found the treatment algorithm easy to implement in clinicalpractice, and use of the guidelines highlighted the potential for disease progression and prompted treatment at earlierstages."

Early treatment is essential, added Eric Donnenfeld, MD, FACS, Ophthalmic Consultants of Long Island and professor ofophthalmology, New York University Medical Center.

"The tear film is the most important refracting surface of the eye," Dr. Donnenfeld said. "Vision starts with the ocularsurface."

Controlling dry eye is particularly important when it comes to surgical patients, as dry eye can affect surgical outcomes,according to Dr. Donnenfeld.

"Pre-existing, uncontrolled dry eye is a contraindication for elective eye surgery, and dry eye is the most prevalentnonsurgical complication of eye surgery," Dr. Donnenfeld said.

Dry eye is the most common postoperative complication of LASIK, affecting more than half patients during the first 6 monthspostoperatively-many of whom have dry eye problems for 6 to 12 months afterwards, he added. Dry eye also is commonfollowing refractive procedures such as IOL implantation.

"When postoperative patients complain about fluctuations in vision with blinking, always think of the ocular surface as beingthe problem," Dr. Donnenfeld said.

Preoperative measures are important to maintain a healthy tear film and optimize surgical outcomes, Dr. Donnenfeld said. Herecommended treating patients with signs or symptoms of dry eye prior to surgery to restore the tear film and maintain ocularsurface health. In addition, preoperative use of cyclosporine can improve visual results in LASIK and IOL implantation.