Dry eye therapies continue to emerge

New Orleans-Looking to the future of dry eye management, Penny Asbell, MD, said she sees multiple examples of hope: a new device, trial findings, and emerging FDA and non-FDA approved therapeutics.

However, it is important to remember the simplest aspects as well, said Dr. Asbell, professor of ophthalmology, Mount Sinai School of Medicine, and director of the cornea service and refractive surgery center, New York.

“Why does the patient want to be here?” she said.  “That complaint will tell you how to identify the problem.”

Dr. Asbell said clinicians should use a symptom questionnaire. 

“Listen to the patient,” she said.  “Ask, ‘what drops did the patient use yesterday?’ because patients have poor recall.”

In particular, Dr. Asbell said she always asks patients if they are using drops.

“All of these drops have some type of preservative, usually benzalkonium chloride (BAK), which, at any level, is toxic to the eye,” she said.

More objective diagnosis for dry eye is the future, Dr. Asbell said.

Other specialties already have these, she said, such as blood testing for cholesterol, and the Keratograph by Oculus is similar in that it too provides objective numbers.

The device uses advanced corneal topography with a built-in keratometer and a color camera. Keratography provides objective measures for tear build-up time, tear meniscus height, the lipid layer, and meibomian gland drop out.

Another avenue to battling dry eye is therapeutics, she said.

Patients are using cyclosporine to good effect if used at least 3 to 6 months, Dr. Asbell said.

The DREAM clinical trial holds promise too, she said, because it explores the systemic use of omega-3 fatty acids to combat dry eye.

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