Management of Dry Eye Disease - Episode 1

Pathology and Prevalence of Dry Eye Disease

Dr Laura Periman, MD illustrates the current risk factors and prevalence regarding patients with dry eye disease.

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

What is dry eye disease? 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 disease is that it’s a busy, noisy, and messy umbrella term for probably about 30 different clinical subdiagnoses. There are all these conspirators that go along with dry eye disease. But the consequence is interruptions in vision, tear film stability, ocular discomfort, and most importantly, inflammation.

There’s a well-described, well-understood impact on what we call neurosensory compromise in dry eye disease. That means that the electrical wiring, so to speak, that constantly monitors the quality of your tears and provides feedback becomes damaged in some way. That’s where modalities such as neural stimulation come into play, particularly beneficial in long-standing dry eye and conditions associated with peripheral neuropathy, such as diabetes, post-refractive surgery, and post-cataract surgery. All of these are conditions that can negatively impact the electrical wiring of a healthy, stable tear film. You lose the ability to maintain what we call homeostatic, or same state, stable tear film. That’s when you have these impacts on inflammation, quality of vision, damage to the ocular surface, and neurosensory compromise. That’s a long-winded answer, but if you think of a circus tent with about 30 different animals running amuck inside while all the lights are off, that’s dry eye disease.

Our understanding of what a typical patient with dry eye looks like has changed a lot over time. We see children and younger adults presenting with dry eye disease. There’s no characteristic typical patient with dry eye. It runs all races, hormone statuses, and ages. It’s ubiquitous, and there are multiple risk factors that go with it. Everything from lifestyle, screen time, contact lens wear, nutrition, underlying disease states, diabetes, high blood pressure, and all the medications needed to control those underlying disease states all contribute to dry eye disease. There are all these funnels contributing to the pit of dry eye disease, which helps explain why it’s hard to get the diagnosis and treatment right with the tools that we have.

The prevalence of dry eye disease in the United States is estimated to be anywhere between 16 million and 50 million people. The reason for that variability is in how those epidemiologic studies define dry eye and when they were done. We now have advanced diagnostics and approaches to diagnosing dry eye disease that have expanded what all that means. That’s why you’re going to see such wide variability in the numbers.

Take a conservative number. If 17 million people have dry eye, only a little over 1 million are receiving a prescription medication. That’s a problem, because we know that the natural course of the disease state is progression if it’s left untreated. And once you progress, the number of interventions and prescriptions and things that you have to do to get that tear film stable and get that patient functional and more comfortable increases dramatically if it isn’t caught and treated early. The prevalence varies quite a bit. Then as we get new diagnostic tools, we’ll have the power to figure out exactly what variety of dry eye disease is happening. We’ll be able to figure out the clinical risk factors and then be much more targeted and specific about what the patient needs from a prescription and intervention perspective.

Transcripts edited for clarity.