Initiating Dry Eye Treatment


Eric Donnenfeld, MD, discusses initiating treatment for dry eye disease.

Kendall Donaldson, MD, MS: I wanted to ask Eric, we’re talking about this inflammatory cascade, when should we be intervening? Brandon made it sound horrible with how it cycles on itself, and you throw in a couple of autoimmune diseases. But when do you think we should be intervening to avoid some of these long-term consequences of dry eye? Because I think a lot of times maybe I should be starting a medication sooner to avoid some of this damage. What are your thoughts on that?

Eric Donnenfeld, MD: Kendall, you’re asking a very good question. That’s a question that our patients ask us every day in our office. Dry eye is the single most common reason patients seek care from an eye care professional. It’s estimated that 30% of patients who see an ophthalmologist have dry eye, and 40% of patients who see an optometrist. When they come in to see you as a patient, I don’t know how all of you react, but I wouldn’t go to see a doctor if it was a problem that was insignificant, that didn’t really bother me. So most of the people who come in to see us as professionals are coming to us with not level 1, but probably level 2 or higher dry eye. These are patients who are taking their dry eye seriously, they’re concerned about it, and it’s affecting their quality of life.

When a patient presents to me in the office with dry eye and we diagnose it, the first conversation I have with patients is [letting them know] we have 2 different buckets for how we’re going to treat your dry eye. The first bucket is where we can treat you symptomatically with palliative therapy to make you feel better. That’s where artificial tears and lubricants play a significant role. The second option is we can actually treat your disease. By treating disease we can reverse the process of dry eye, control the inflammation, and potentially stop you from progressing from a level 1 or 2, up to a higher level of dry eye.

For me…when a patient comes in I ask them that question, “Would you rather just feel better, or would you rather actually treat the disease?” It’s like saying to someone who has pneumonia, “Would you rather me give you aspirin to feel better, or should I give you an antibiotic to treat the infection?” That’s where anti-inflammatory therapy plays a significant role in treating dry eye. I think if you present this to patients, almost overwhelmingly patients are going to say to you, “I’d rather have a treatment for my disease than palliative therapy.”

Kendall Donaldson, MD, MS: Those are excellent points, Eric. So many times, we’re just treating the symptoms and not getting to the underlying cause. That’s very important.


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