In my preparations for the 2019 national meeting of the Greek Ophthalmological Society and, on the same weekend, AECOS Europe, I found myself reflecting on the significant impact that dry eye disease (DED) can have on our surgical outcomes and marveling at how far we’ve come in diagnosing and treating it. In short, the more DED patients we are able to identify and treat prior to cataract and refractive surgery, the greater the level of surgical care—and postoperative outcomes—that we can provide to our patients.
DED is one of the most common eye diseases. According to a Gallup poll, about 29 million Americans will have DED by 2022.1 We know that DED is a multifactorial disorder of the ocular surface and tear homeostasis. Its symptoms include ocular discomfort, pain, and visual disturbance, and these symptoms can be derived from a multitude of disease processes, including inflammatory disease of the eyelids, meibomian gland dysfunction, mucin deficiency, and insufficient tear gland production.
Ophthalmic practitioners have a wide array of tools for managing DED, including at-home and in-office treatments and oral and topical medications, and we have a variety of diagnostic equipment that is useful to identify and track the progress of the disease. Then there are nutritional supplements, lacrimal inserts, and many more agents in the pipeline to ensure proper tear film balance.
But in order for DED management to make a significantly positive impact on our surgical results, we must find and use proper detection methods that extend beyond the comprehensive eye exam. We must ask patients about how their ocular surface feels, and we must listen when they describe their symptoms. When a patient describes symptoms that point to DED, the next steps are to measure the volume or quantity of their tears and to determine the quality of those tears. Certainly there are also other tests that can aid in appropriately defining their disease.
I am excited for the future of DED management. I think all of the strides we have made with regard to its treatment, and the diagnosis and treatment options now in the pipeline, will help us to elevate the level of care we can provide.
I look forward to learning new information from my colleagues on how to manage this very important aspect of eye disease.
A. John Kanellopoulos, MD
Associate Chief Medical Editor
1. Understanding dry eye syndrome. www.allaboutvision.com/conditions/dryeye-syndrome.htm. Accessed June 11, 2019.