Dry Eye Disease Still Lacks Effective Treatment Options

High discontinuation rates and limited switching between therapies in dry eye disease patients indicate a need for more effective and diverse treatment options, according to an abstract presented this week at the 2025 Academy of Managed Care Pharmacy (AMCP) Nexus Conference.

The abstract, titled ‘Real-world prescription drug treatment patterns in patients with dry eye disease,’ was co-led by Tony Okoro, Pharm.D., M.P.H., from Alcon and Ramaa Nathan, Ph.D., from Eversana Life Science Services.

Okoro, Nathan and their team discovered that at least 75% of dry eye disease patients discontinue their treatment, with just 10.8% moving to a second line of therapy.

The researchers analyzed Symphony Health Solutions claims data from 2018 to 2024 and identified 3,440,818 patients with dry eye disease, 73% of whom were female and 27% male, with an average age of 63 for both cohorts.

Almost all patients (98.2%) received immunomodulators as a first-line treatment, 1.4% received neuromodulators and 0.4% received anti-evaporatives.

Within 90 days, at least 75% of patients had discontinued their treatment and 10.8% had moved to another treatment option. Adherence was highest in the neuromodulator group, which had 54.9% retention, followed by 49.5% of patients given anti-evaportatives and 33.9% given an immunomodulator.

Dry eye disease is characterized by a lack of tears in the eye, which can be caused by tears drying up too fast or underfunctioning tear glands. It affects approximately 16 million Americans. Symptoms include burning, blurry vision and sensitivity to light. It is more common in female patients ages 50 and older and in patients who wear contact lenses. Some autoimmune diseases such as lupus or Sjögren syndrome, may also contribute to DED, as well as a deficiency in vitamin A or omega-3 fatty acids.

Tears are made up of three layers: oil, water and mucus. The oily layer comes from the meibomian glands and makes up the outside of the tear, which makes the tear smooth and locks moisture in. The watery layer keeps the eyes clear of impurities and debris and comes from the lacrimal glands. Finally, the mucus layer, on the inside of the tear, helps tears stick to the eye. The mucus is produced in the white tissue of the eye, otherwise known as the conjunctiva.

Dry eye treatments include over-the-counter eye drops and prescription medicines. The AMCP abstract included immunomodulators, such as Restasis, Xiidra, and Cequa; the neuromodulator, Tyrvaya; and the anti-evaporative, Miebo.

Immunomodulators control the inflammation associated with some forms of DED. Neuromodulators stimulate the nerves needed for tear production and anti-evaportatives improve tear retention by improving the oil layer.

Despite the availability of treatments for DED, discontinuation rates remain high, which may be from limited symptom relief, side effects such as burning or the high cost of medications.

“The relatively low adherence across all classes suggests that current therapies may not adequately meet patient needs,” the authors write in the abstract. “Emerging treatments may enhance treatment persistence by addressing underlying factors contributing to discontinuation.”