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Surgeon: Early treatment key to avoiding dry eye progression
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DANA POINT, Calif. — It is important to treat patients with mild to moderate dry eye before it worsens to severe or chronic dry eye, according to a surgeon speaking here.
At the Ocular Drug and Surgical Therapy Update, Y. Ralph Chu, MD, said dry eye is often underdiagnosed, and the recent paradigm shift can be helpful in treating patients before their condition deteriorates.
"We have learned over the last several years that tear deficiency is not the whole story. It is really not lack of aqueous, but also a change in the physiology in the surface of the eye," Dr. Chu said. "Artificial tears do provide moisture to the tear film, but they don't repair the surface of the eye. That is where some of the newer treatments fit into our practices."
A 2005 Gallup study showed 92.5 million people in the United States suffer from dry eye, he said.
There are multiple factors in the pathogenesis of dry eye, such as environmental conditions, inflammation or an altered tear film composition.
"I explain to patients that we are actually chemically improving the quality of their tears. The tears are a mixture of proteins, mucins and electrolytes that lead to the nourishing environment to the epithelial cells of the cornea," he said.
Dr. Chu said he and colleagues use a dry eye questionnaire to begin the discussion about the importance of a healthy ocular surface.
A treatment algorithm categorizes dry eye into four categories. The first two categories are mild and moderate and the third and fourth categories are severe and chronic, respectively.
"You are looking for those mild and moderate patients to intervene earlier so you can prevent the progression of the disease from 1 and 2 to 3 and 4," he said.
Dr. Chu recommended starting with environmental modifications, and as signs and symptoms increase, some of the more aggressive treatments can be added.
"There is a new tear available for the mild to moderate patient that complements the use of Restasis (cyclosporine ophthalmic emulsion, Allergan)," Dr. Chu said.
Optive (carboxymethylcellulose, Allergan) has been shown to bind the epithelial cells to retain moisture in the tear film, he said.