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A New Era of DED Relief

From thermal pulsation therapies to smart contact lenses, groundbreaking innovations for dry eye management promise to enhance treatment outcomes

Dry eye disease (DED) is a multifactorial condition affecting millions of individuals worldwide. With its increasing prevalence, especially in modern digital societies, more patients are experiencing symptoms that significantly impact their quality of life. Dr. Carmen Abesamis-Dichoso shared her insights on the causes, evolving understanding, and treatment landscape of this prevalent condition.

Dr. Abesamis-Dichoso, a seasoned optometrist from the Philippines with over 34 years of practice, highlighted the primary causes of dry eye disease as a combination of different factors.

“Aging, lifestyle, the digital world, and health issues requiring medications affect the ocular surface,” she explained. The impact on quality of life can be significant, with patients experiencing negative effects on visual function, activities, and work productivity. “Severe DED symptoms had a greater impact on vision-related quality of life and work productivity,” she continued.

In her private practice, Dr. Abesamis-Dichoso reported that 40% to 50% of her patients present with symptomatic DED, emphasizing the condition’s widespread nature.

Treatment innovations

Among the breakthroughs in DED treatment, thermal pulsation therapies like LipiFlow® (Johnson & Johnson; Ontario, Canada) have shown significant promise for managing dry eye caused by meibomian gland dysfunction (MGD).

Dr. Abesamis-Dichoso shared that randomized clinical trials conducted in 2021 indicated “significant positive changes” in various metrics, including the Standard Patient Evaluation of Eyelid Disease (SPEED), Meibomian Gland Yielding Secretion Scores (MGYSS), and Meibomian Gland Yielding Liquid Secretion (MGYLS).

She noted that regenerative therapies are also emerging as a vital part of the treatment landscape for moderate to severe dry eye.

She emphasized the effectiveness of cryopreserved amniotic membrane (CAM) treatments, stating, “CAM has demonstrated an improved ocular surface and decrease in the severity of dry eye for moderate to severe condition that doesn’t respond to topical artificial tears, cyclosporine-A, antibiotics, and steroids—even to those who required repeated treatment to complete healing. Apart from discomfort during CAM placement, there were no adverse events. This therapy shows promising results through the recovery of ocular surface health with a reduction in signs and symptoms,” she explained.

Meanwhile, the advent of smart contact lenses represents an exciting frontier in dry eye management. Dr. Abesamis-Dichoso said that the system uses electroosmotic flow (EOF), which causes the liquid to flow when a voltage is applied across a charged surface.

“In this case, a current applied to a hydrogel causes fluid to flow upwards from the patient’s temporary tear reservoir behind the lower eyelid to the eye’s surface. However, further research is needed to develop improved self-moisturizing contact lenses that are tougher and capable of operating at smaller currents,” she said.

A multifactorial disease

Over the years, the understanding of dry eye disease has dramatically evolved, observed Dr. Abesamis-Dichoso. “I have witnessed the prevalence and incidence of dry eye increasing rapidly not only in the aging population but also in the younger generation.”

She mentioned that the Tear Film & Ocular Society (TFOS) has redefined dry eye as a ‘multifactorial disease,’ emphasizing the loss of homeostasis of the tear film. This reclassification has prompted collaboration among industry leaders, scientists, and allied health professionals to delve deeper into the causes of tear film instability and available technologies for improvement.

Additionally, this comprehensive view of dry eye disease has significant implications for treatment. It encourages practitioners to adopt a more holistic approach that considers all potential contributing factors rather than focusing solely on tear replacement therapies. By understanding the multifactorial nature of dry eye, healthcare providers can tailor treatment plans that address the underlying causes, whether through lifestyle modifications, advanced
therapies, or collaborative care with other health professionals.

Future perspectives

Looking ahead, Dr. Abesamis-Dichoso anticipates significant developments in DED treatment over the next disease can vary according to the practitioner’s preference; the tools available in their toolkit, which largely depend on the area of practice; legal regulations; the skills developed through years of practice; and the resources available,” she explained.

“Since there is a wide range of factors to consider before one can offer the best treatment, accurate diagnosis is critical,” she stressed. “There has to be a standard of care that will benefit the patient at the end of the day without necessarily investing in expensive tools and equipment. Most dry eye conditions encountered in practice fall in the mild to moderate category, which can be diagnosed by simple questionnaires and managed with lifestyle modification, such as the World Council of Optometry Dry Eye Wheel.”

She noted that the World Council of Optometry has collaborated with industry leaders such as Alcon to introduce the Dry Eye Wheel.

“The Dry Eye Wheel is structured around three core components: Mitigation, measurement, and management. It categorizes dry eye into simple, intermediate, and advanced stages, represented by concentric rings. Additionally, the mitigation and measurement aspects are further broken down, enabling optometrists to consider various factors related to ocular health, general health, and patient lifestyle,” she explained.

As our understanding of dry eye disease deepens, integrating innovative treatments and holistic approaches is becoming essential. The rise of advanced technologies, such as thermal pulsation therapy and regenerative treatments, offers new hope for patients. Continued research and patient-centered care will lead to better management strategies, ensuring healthier eyes and improved quality of life.

Editor’s Note: A version of this article was first published in COOKIE magazine Issue 17.

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