VIDEO: Understanding unmet needs in dry eye

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I think unmet needs is really addressing as much as we can the meibomian glands and helping reverse the damage. We have some great tools at our disposal, whether it's using machines to actually remove the debris the epithelium of the lid margin. We have heating and ultrasound and expression to help express those glands. But how to keep them open long-term? How do we reverse some of the loss of meibomian glands and the goblet cells? Once we have apoptosis, we can't bring back those glands. So I think the more we can do to actually help the underlying pathology, the oils that our body makes.

Now, we talk about fish oils and omega-3 and there's certain types of omega-3 that are better than others, of course. But the idea is that we don't have a lot to actually address the underlying pathology as much as we want to, and especially when you start to lose those glands. Can we reverse those glands that are undergoing apoptosis, that are undergoing death? Can we reverse those before they're too late, as well? That's a big unmet need for me, as well.

I think now we're getting better diagnostics. There's a number of companies that are making diagnostic tools that are all-in-one machines that allow us to address very quickly and evaluate the tear film breakup time, meibomian gland meibography, looking at the composition of the tear films, companies like Quantel and iTrace and Lipa View. These are a number of different companies that have unique tools to help us identify patients earlier and see are these different treatments working? Because I think there's a lot of times an all or nothing response from a lot of our surgeon colleagues, right? We say, "Hey, I tried this, I tried cyclosporine, I tried lifitegrast, I tried this and one of those didn't work. Try something new and then, oh, didn't work. Okay, forget it." But I think we have to tailor, depending on the type of patient, depending on where the pathology is, tailor our treatments to the specific disease pathology. And I think we're getting better at that, but that's still an unmet need, is for us to be appreciative of what is actually causing the dysfunction.

The last thing I would say is just be aware. The ocular surface is the window into the eye, so to speak, right? The tear film, it helps us do 80% of the focusing power of the eye. So we have to appreciate it, respect it and identify pathology as early as possible, because again, if we can identify patients earlier, like glaucoma, like other conditions in the eye, the better chance we have of halting the progression, preventing it from progressing and the better chance a lot of these modalities, these treatment options that we have available to us now and coming down the road will actually have a better impact, as well. So identifying it, being respectful of it and educating our patients is the key.