In recent years, the therapeutic approach to diabetes has changed dramatically, with the definition of this disease occurring at much earlier states of the disease.
This shift — to identify and treat “pre-diabetic” patients — has occurred because we recognize the value of tests like HbA1c to tell us which patients are at risk. We also recognize that the vast majority of these patients will progress toward life-altering disease, so why not treat them early?
The same thinking can be applied to dry eye. A recent study at Duke University showed that 55% of asymptomatic children between age 4 and 17 years of age had signs of meibomian gland atrophy on meibography. Should these children be treated now for dry eye? Probably not with lubricant drops and warm compresses, which would create challenges for compliance, but perhaps at least by increasing their dietary intake of omega-3s, which are far less in today’s typical American diet than they were a generation ago.
While there remains some debate whether asymptomatic dry eye patients — adult or youth — should be proactively treated, there is little question that we should take seriously the treatment of those symptomatic patients at the earliest stages. In my practice, we routinely use diagnostics like tear film osmolarity, MMP-9 testing and meibomian gland imaging to document the type and progression of disease. These guide us in the type of treatment to administer and serve as a baseline, like an HbA1c test, to establish how treatment is progressing.
We have also found that earlier intervention with treatments like tears, plugs, Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) and Xiidra (lifitegrast ophthalmic solution 5%, Shire) are appropriate to prevent progression. Similarly, adjunctive therapies like BlephEx (BlephEx LLC) and LipiFlow (TearScience) can improve quality of life significantly for these symptomatic patients.
As clinicians, we owe it to our patients to stay up-to-date in our treatment approaches. If we treated age-related macular degeneration like we did just a few years ago — by treating every leaking lesion in the macula with argon laser — we would be guilty of malpractice. Why should we ignore modern dry eye treatment? With expanding, effective treatment options, we owe it to every patient to learn about and use every tool available to help them maintain a high quality of life.
Disclosure: Hovanesian reports he is a consultant to BlephEx, Shire and TearLab.