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Tiny thoughtlets to ring in the New Year
A specialist looks ahead to what 2017 has in store for dry eye disease.
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The holiday lights have all been extinguished. Across the country Christmas trees once abloom with tinsel adorn the sidewalks. Windows lit just yesterday now sit dark and quiet, the menorahs all packed away for another year. Contrary to that famous poem, now is the time of our long winter’s night. In North America our seasons of thanks and giving step aside in favor of the hope and promise of the New Year.
What can we expect in the dry eye community this coming year? There is the new, the nearly new and the newly reimagined. Let us channel another holiday cliché and take a tour led by a now underemployed Ghost of Christmas Future. Look — I think he is holding an ophthalmoscope.
The new ‘it’ thing
DED really is the new “it” thing in all of eye care. You cannot pick up a journal or a periodical in our world and not see a paper or an article on DED. Don’t believe me? Follow Laura Periman, MD, (@Dryeyemaster) on Twitter. Laura drops a minimum of three academic citations on her feed every day. I really cannot figure out how she has time to read them all; she is a busy ophthalmologist, wife and mother of two brilliant, overachieving children. It must be because she is a CrossFitter, too. Laura is part of an extremely active cadre of DED docs who congregate on Twitter. That is new, too: social media as a gateway to important new information about the newest eye care specialty. I learn something new there every day.
Not convinced that DED is the new “it?” Even huge high-volume cataract surgeons — we are talking 4,000, 5,000, 6,000+ cases per year surgeons — are calling up their Allergan and Shire reps and asking to learn about the benefits of treating the ocular surface as part of cataract surgery. Why? Well, as opposed to the most recent new “it” thing in cataract surgery, treating DED around the time of cataract surgery actually improves visual outcomes. Heck, even something like true dropless cataract surgery (intracameral or intravitreal antibiotic/steroid coupled with intraoperative NSAID infusion) is giving off some DED love. We are even starting to hear whispers of refractive cataract and laser cases being bundled with LipiFlow (TearScience) so that concurrent meibomian gland dysfunction does not sabotage an otherwise technically excellent procedure. Expect all of this to be part of what is new in the New Year.
2017 is the year that glaucoma specialists will discover the ocular surface, aided by some new and newly reimagined things. Look for not one, not two, but three MIGS devices to be approved for the treatment of glaucoma at all stages of the disease in both phakic and aphakic patients. What better way to avoid the discussion of medication cost, or for that matter the issue of increased local side effects from generic versions of common medications such as Travatan Z (travoprost ophthalmic solution 0.004%, Alcon) or Alphagan P (brimonidine tartrate ophthalmic solution 0.1% or 0.15%, Allergan), than to moot their need with a safe and effective outpatient procedure? The Glaukos iStent, Alcon CyPass and Allergan Xen will find a new and dramatically expanded user base among DED specialists.
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Competition is new in 2017. You may have noticed. Not since Ginger and Mary Ann have we had such a divided populace. Jennifer Aniston (Shire) and Marisa Tomei (Allergan) are squaring off in the DED direct-to-consumer marketing space pretty much everywhere you look. If you think DED as the new “it” thing in eye care is big, just wait until this marketing battle starts to gain some traction with your patients. New for 2017, we will quite likely see revamped marketing, new celebrity and professional spokespersons, and possibly at least some dabbling from other companies with new or reimagined products to tell us about. Alas, I will not be among this new wave, at least when it comes to visual marketing; I have been told, quite accurately, that I have the perfect face for radio.
New players in the market mean new attention for you, the DED doc. Conservative estimates are that we now have some 500 or so new sales representatives in our space, many of them in DED, perhaps a third of them truly new to eye care itself. If you are anything like me, you have asked your reps to bring you only new information, and now is the time for you to make good on your promise to listen when they do. There is a completely new drug to learn about (Xiidra) and a revolutionary new way to dispense a stalwart (multi-dose, non-preserved Restasis). This is the “Happy” in “Happy New Year” when it comes to DED medication. Pop a cork and rejoice.
Educational programs
As an add-on to this, 2017 is likely to be a Back to the Future kind of year when it comes to physician-led industry-sponsored educational programs. When there is truly new information about new or existing products, few venues offer a better opportunity to exchange information than a smallish dinner group of colleagues discussing new treatment options. Another indication of the “it-ness” of DED is audience members ambushing speakers with questions of deep scientific minutiae. At least in pharma, we have not seen this since 2003 or so, but I am experiencing it routinely. Will 2017 be the year in which we can openly discuss off-label indications for our best treatments? Now that would be really new.
What about you? How might we look forward to our latest New Year as eye docs? Well, I have to be honest: I sure hope that this New Year is the year that you resolve to add a DED treatment protocol to at least some part of your practice. Whether you are a busy anterior segment surgeon, glaucoma specialist or retinal doc, your patients will appreciate every little bit of effort you make on their behalf if they have any degree of dry eye. Do you see children as part of your practice? This will be the newest frontier in DED, one of the biggest stories of the second half of the year. I will get that ball rolling here next month.
As for me, this year I resolve to get someone to hire Linda Blair as a DED spokesperson. It is the least I can do. Happy New Year.
- For more information:
- Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; email: dwhite@healio.com.
Disclosure: White reports he is a consultant for Bausch + Lomb, Allergan, Shire and Eyemaginations; is on the speakers board for Bausch + Lomb, Allergan and Shire; and has a financial interest in TearScience.