VIDEO: ‘Great research’ underway in ocular surface disease

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I think there’s a lot of great research going on in ocular surface disease, a number of different products that are going to be hopefully available in the marketplace. We’ve got RASP inhibitors. We have mycophenolate, which we use in the systemic form to prevent fibrosis. We have other artificial tears that are being worked on as well. So, I think there’s a number of products on the pharmaceutical side that can really help engage and really help allow us to combat inflammatory cascade down as well. And I think more research on kind of the, “how do we actually stop the glands from going under,” so to speak, because we cannot reverse those as well. So, I think dry eye is a space that we can’t ignore. I think regardless of who you are, regardless of whether you’re a subspecialist, you’re comprehensive, you’re optometry, ophthalmology, I think that we have a number of patients — 30-plus million Americans have ocular surface disease, if not more — and what I think the key is for me is that not ignoring it because it has significant symptomatology associated with it.

So if you’re treating, let’s say, glaucoma, like I do, and you have someone with concomitant ocular surface disease, there are studies showed a 30% reduction of compliance if you have a concomitant ocular surface disease. Patients who have more glaucoma topical medications have more likelihood of developing ocular surface disease. More symptoms, tearing, burning, pain, redness, photophobia. There are very few other diseases in the eye that have as many associated symptoms as ocular surface disease. So when you have those symptoms, patients are less likely to do what you want them to do, whether it’s glaucoma, whether it's eye or cornea issues, or around cataract surgery. We talk all about getting the best IOL calculations for toric IOLs, etc. Well, we want to get them off the topical glaucoma drops. We want them to help treat the dry eye as best we can, get rid of that symptomatology, help that tear film be more stable.

We now have data and we have great diagnostic tools to allow us to understand the impact of ocular surface disease in our patients. We have aberrometry and ray tracing. We have ways to understand the higher-order aberrations of the cornea caused by a poor tear film. Now we understand, why are patients not happy even after cataract surgery. You have 20/20 vision on our Snellen chart, but they’re pissed off at us. Well, why is that? It’s not just about the Snellen chart — it’s about the quality of the vision. And now we have a number of diagnostic tools that allow us to understand, OK, this could be why their modulation transfer function curve is below. They have higher-order aberrations causing some of those issues with night vision and quality of vision in low light. So, I think that’s helping us understand the impact of the tear film as well.

So now that we have good diagnostics as well, LipiView (Johnson & Johnson Vision), we have other products, LacryDiag from different companies that allow us to identify meibomian gland loss, so meibography. We have ways to look at the lipid composition of the tears, a way to understand the tear film breakup time objectively. So with all these diagnostic tools now, these all-in-one dry eye tools from a number of different companies, we have ways to really understand now the health of the tear film and what we can do specifically for that. Of course, we have things like tear osmolarity, we have MMP-9 testing so we can look at inflammation. What’s the osmolarity? The higher the osmolarity, the likelihood of unstable tear film is there.

So, I think now we have a number of tools that allow us to help hone our treatment options for glaucoma patients. But even if you don’t have all those diagnostic tools, I tell doctors, pay attention to symptoms. If someone says, “My vision comes and goes when I blink my eye,” “I can’t read for more than 5 minutes without watering,” or “I watch TV and eyes start to water,” any of those kind of symptoms, that’s a symptom of unstable tear film. And so even that alone, you can identify, this patient needs to be treated. Now we could talk about honing our treatment options specifically for that condition, for that patient. But just paying attention to symptoms can really help you identify those patients who might need more treatment over time.