Pathology and prevalence of dry eye

Laura M Periman, MD: Hello, I’m Laura Periman from Seattle, Washington. I am a board-certified ophthalmologist and cornea-trained ocular surface disease expert. I also do clinical research at the Periman Eye Institute. It’s great to be here.

What is dry eye? All day every day, we treat it and do clinical studies looking for innovations to treat it more effectively. In a nutshell, what you need to understand about dry eye is that it’s a busy, noisy, messy umbrella term for probably about 30 different clinical sub-diagnoses. There are all those conspirators that come with dry eye. But the consequence is interruptions in vision, tear film stability, eye discomfort and, above all, inflammation.

There is a well-described and well-understood impact on what we call neurosensory compromise in dry eye disease. This means that the electrical wiring, so to speak, which constantly monitors the quality of your tears and provides feedback, is damaged in some way. This is where modalities such as neural stimulation come in, which is particularly beneficial in cases of long-standing dry eye and conditions associated with peripheral neuropathy, such as diabetes, post refractive surgery and post surgery. -cataract. All of these conditions can negatively impact the electrical wiring of a healthy and stable tear film. You lose the ability to maintain what we call a homeostatic stable tear film, or even state. That’s when you have those impacts on inflammation, quality of vision, ocular surface damage, and neurosensory compromise. It’s a never-ending answer, but if you think of a circus tent with about 30 different animals running around inside while all the lights are off, that’s dry eye.

Our understanding of what a typical dry eye patient looks like has changed a lot over time. We see children and younger adults presenting with dry eye. There is no characteristic typical patient with dry eye. It handles all races, hormonal statuses and ages. It’s ubiquitous, and there are several risk factors that go with it. Lifestyle, screen time, contact lens wear, nutrition, underlying medical conditions, diabetes, high blood pressure, and any medications needed to control these underlying medical conditions contribute all to dry eye. There are all these funnels that contribute to the dry eye trough, which helps explain why it’s difficult to get the right diagnosis and treatment with the tools we have.

The prevalence of dry eye disease in the United States is estimated at between 16 and 50 million people. The reason for this variability lies in how and when these epidemiological studies define dry eye. We now have advanced diagnostics and approaches to diagnosing dry eye disease that have expanded what all of this means. That’s why you’re going to see such variability in the numbers.

Take a conservative number. While 17 million people suffer from dry eye, just over a million receive prescription medication. This is a problem because we know that the natural course of disease is progression if left untreated. And once you progress, the number of procedures and prescriptions and things you need to do to stabilize that tear film and make that patient functional and more comfortable increases dramatically if not detected and treated early. The prevalence varies relatively little. Then, as more diagnostic tools become available, we will have the power to determine exactly which variety of dry eye is occurring. We will be able to identify clinical risk factors and then be much more targeted and specific to patient needs from a prescribing and intervention perspective.

Transcripts edited for clarity.

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