Welcome 2024: New Year’s review and resolutions
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Wow! That was quick. Another year has come and gone, the pages of the calendar flying by like one of those old cartoon flip chart things.
How did 2023 treat you and yours? I am going to go with my standard answer to that question: I am still the second luckiest person any of you will ever meet! Who is the luckiest person? I have no idea, but all but one of those people saying that has to be wrong. There may be one person luckier than I am, but only one!
First, a word or two about who I am and what I am up to with this column (and my Dry Eye blog). I am a cataract and refractive surgeon, and I have been in what we would all recognize as traditional private practice. Three optometrists practice with me, all of whom are active in the care of our dry eye disease (DED) patients. Our practice, SkyVision Centers, is my primary gig. I devote roughly 85% of my professional time and effort to the care of our patients. Like most anterior segment surgeons, refractive surgery in 2024 is primarily an intraocular endeavor. While I still do laser vision correction, the lion’s share of what you and I would consider “refractive surgery” is now lens based in our practice. I spend about a third of my clinical time caring for DED of all stages.
Why the blog and this column? Easy: With these outlets, I get to talk to you, my peers, about a disease state that has historically been undervalued and ignored by industry and academia. The world is different now, to be sure. Every ophthalmology training program of any worth now has at least one specialist who treats DED. It took a while, but DED has been one of the “hot dots” for industry, garnering literally millions of dollars in investments and launching multiple companies. It has always been my goal to represent you, the doctor who goes to work and sits in front of patients all day, every day, making sure that our shared experience is heard and valued in the halls of academia and the offices in the C-suites of industry. Along the way, I hope that I might have offered a helpful tip or two as well.
2023 turned out to be a crazy year in DED, eh? Not one but two blockbuster drugs got FDA approval, Xdemvy (lotilaner ophthalmic solution 0.25%, Tarsus Pharmaceuticals) for Demodex blepharitis and Miebo (perfluorohexyloctane ophthalmic solution, Bausch + Lomb) for the signs and symptoms of evaporative DED. As cool as this is, bigger news might actually be that reproxalap from Aldeyra Therapeutics did not receive FDA approval. 2022 saw the withdrawal of Novartis and Allergan from this space. 2023 gave us a reborn, turbocharged Bausch + Lomb led by ophthalmology’s most interesting person, Brent Saunders. Will 2024 be the year that ushers Allergan back into the race via its option to acquire the Aldeyra RASP-inhibitor assets including reproxalap?
And how did I do with my 2023 New Year’s resolutions? Well, I read about twice as many books as I did in 2022, mostly because I still have not figured out how to get my TV to get Apple TV+ (pretty sure ours is the only household in America that has not seen Ted Lasso). While I did not really decrease my professional reading time, I did manage to dramatically increase the amount of time I spent watching videos created by colleagues such as Uday Devgan, Paul Singh, Cathy McCabe and a host of others. I still need to be a whole lot better about doing a Schirmer test on my DED consultations, but I am proud of how often I test for corneal sensitivity and think about neurotrophic keratitis.
With that, here are my Dry Eye New Year’s Resolutions for 2024:
- Might as well get it out of the way right up front: I resolve to do more Schirmer tests in 2024. I will be good to myself and make it part of our standard testing in the advanced dry eye evaluation.
- The more we learn about the visual effects of high tear osmolarity, the more important this test becomes in the perioperative period. I will work to make sure that we always have this important value on the chart whenever we face a confusing diagnostic situation with our surgical patients.
- While I am thinking about diagnostics, there is really no reason why I should not be using some form of topography in my initial DED evaluations. Looking at the Placido rings and paying attention to higher-order aberrations will give me a deeper insight into the visual significance of any patient’s DED.
- If you can believe it, we have kind of slacked off on using dry eye questionnaires. It still does not matter which one you use. Could be OSDI, SPEED, SANDE or some form of VAS — you just need to use one. I resolve to get us back into this habit.
- I am doing a good job of asking my patients to “look down” so that I can assess them for the presence of collarettes and consequently Demodex. I have failed miserably in showing my associates how key this step is now that we have an effective treatment in Xdemvy. By the time you read this, I will have nailed this resolution.
- Do you remember the minimum effective dose? This is the strategy where we try to get the desired effect from all aspects of treatment (better vision, less discomfort, etc) with the least amount of intervention (medicine, surgery, office visits, etc). With all our very cool new medications, it is tempting to simply layer new stuff onto the old, tried and true. I resolve to resist this temptation and continue to seek “less is more.”
- It is well past time to get some new music in the OR. I have fallen in love with Spotify and its “If you like this ...” algorithm for finding artists who are similar to my favorites. My clinic staff has long ago taken this out of my hands, but I still get to choose during surgery.
- I really enjoyed my early engagement in the development of Xiidra (lifitegrast ophthalmic solution 5%, Bausch + Lomb) and Miebo, and I sure hope that I will be asked to take on another similar project. I resolve to look for reasons to say “yes” when I am invited to participate.
- Travel, especially business travel without my wife, is something that I have shied away from. Compared with many of my peers, I am a real homebody. It is time to spread my wings. I resolve to say “yes” to more invitations to attend new conferences in unexplored territory.
And as always, I resolve to continue to represent the frontline eye doctor who spends his or her day taking care of patients. I will continue to bring you news of all that is new and all that is good in this little slice of eye care for as long as you will have me.
Happy New Year to you all.
- For more information:
- Darrell E. White, MD, of SkyVision Centers in Westlake, Ohio, can be reached at dwhite@healio.com.
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