This article is more than 5 years old. Information may no longer be current.
BLOG: Treat dry eye like glaucoma
Drugs, topical therapies and diagnostics for dry eye differ worldwide; however, one evolving and favorable global pattern is the recognition of dry eye as a progressive, lifelong disease that requires early diagnosis and treatment to prevent worsening disability.
Dry eye has a well-demonstrated course of disease, from mild visual disturbance with minimal symptoms during stress periods (wind, fatigue, dehydration) at a young age to greater symptoms and intolerance of ocular surface stress in middle age. This leads to more advanced visual impact with dropout and irreversible atrophy of tear-producing glands in older age.
Counterintuitively, many older patients actually have fewer discomfort symptoms when the disease is at its worst because of slow, progressive denervation of the ocular surface.
Maybe we pay less attention to the older patient with painless dry eye because we believe it needs no treatment. But let’s think about what got the patient to that point: years of inadequately treated ocular surface disease.
If we are to be honest with ourselves, maybe we should treat dry eye like glaucoma. As more studies help us define the natural progression of dry eye in its various forms, and as new diagnostics help us objectively measure this progression, I believe our thinking about dry eye will become more proactive and glaucoma-like. Today, although the standard of care is still reacting to patients’ symptoms, maybe we should seek earlier intervention with asymptomatic or minimally symptomatic patients, prescribing treatment that is “one notch” more advanced than we would prescribe based on symptoms alone.
We all know how debilitating moderate to severe dry eye can be. If more aggressive early intervention can prevent that eventuality, don’t all of our patients deserve that?
Disclosure: Hovanesian reports that he consults for a number of companies that have products and services to treat dry eye.