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Tailoring Dry Eye Solutions

Eye care professionals highlight advances in diagnostic tools and therapies that are at the forefront of DED management

Tailored approaches to dry eye disease (DED) treatment are becoming the norm, with eye care specialists utilizing advanced technologies to create personalized care plans. Not to mention, patients now have access to various contact lens options designed for DED management. These developments not only enhance the understanding of dry eye but also open new avenues for relief, offering hope to those who struggle with this common condition.

While there remains no cure for dry eye condition, advances in technology and treatments offer hope to millions who suffer from it. According to eye care professionals, new ophthalmology equipment allows for more accurate diagnoses, while recently developed treatments have proven effective in combating symptoms. Additionally, there is an increasing understanding of how overall health impacts the condition, along with greater awareness of the effects of contact lenses.

The importance of accurate diagnosis

“Thorough investigation and examination to determine the correct dry eye diagnosis is crucial for establishing the most suitable treatment options,” opened Mr. Connan Tam, director of the Dry Eye Centre in London, United Kingdom.

Once an accurate diagnosis has been made, technological advances also offer better options for treating the condition. “It is important to identify where the patient falls on the spectrum of dry eye to determine whether to recommend treatment for aqueous deficiency, evaporative dry eye, or both,” he said.

“It is important to identify where the patient falls on the spectrum of dry eye to determine whether to recommend treatment for aqueous deficiency, evaporative dry eye, or both.”
— Mr. Connan Tam

According to Mr. Tam, there are now numerous devices that can aid in diagnosing dry eye more accurately, including meibography using infrared capture. “It is a very important technique that enables us to visualize the meibomian gland structure,” he continued.

Tailored approaches to dry eye treatment

Mr. Alisdair Buchanan, who leads Buchanan Optometrists practice in Kent, United Kingdom, noted that advances in diagnosis—such as tear film analysis, meibomian gland imaging, and new diagnostic tools—also help develop treatment plans tailored to individual patients.

Dr. Branka Marjanovic, consultant ophthalmologist and oculoplastic surgeon at Moorfields Eye Hospital, London, highlighted that another emerging trend in dry eye diagnosis is the use of biometrics and artificial intelligence (AI) to personalize treatment plans.

Introduced a little over 10 years ago, intense pulsed light therapy (IPL) for the treatment of dry eye has also seen significant advances over the years.

“IPL therapy has become a leading treatment of choice for meibomian gland dysfunction and rosacea-related dry eye,” said Dr. Marjanovic.

“This therapy delivers broadband, non-coherent light to the skin surrounding the eyes, typically using wavelengths between 560 nm and 1200 nm.”

Mr. Tam explained that there are several mechanisms by which this technology operates. “With the correct wavelength and fluency, IPL can obliterate the abnormal superficial blood vessels on the skin’s surface that developed due to inflammation. This restricts the delivery of inflammatory markers to the eyelid margin,” he said.

“The light itself has a photobiomodulation effect, increasing anti-inflammatory markers and inhibiting pro-inflammatory markers to reduce lid margin and ocular surface inflammation. Photobiomodulation also boosts the energy of the mitochondria in the meibomian gland cells to improve their function,” he added.

A more recent development in dry eye treatment is low-level light therapy (LLLT), which concentrates wavelengths towards the red and near-infrared spectrum to deliver photobiomodulation deeper into the skin surface.

“This treatment option has become an excellent alternative and even adjunct therapy to IPL,” confirmed Mr. Tam.

Innovative therapies for dry eye relief

According to Mr. Buchanan, intense restricted pulsed light (IRPL) and Blephasteam masks have also shown significant promise in managing dry eye. Emerging treatments—such as new in-practice cleaning procedures using okra-based products for eyelid cleaning and amniotic membrane contact lenses designed for severe cases of dry eye—also show promise.

“These lenses, made from amniotic tissue, promote ocular surface healing, offering relief in extreme cases,” he said. “Additionally, practitioners should also consider prescribing makeup products specifically formulated for dry eye patients to reduce further irritation.”

While light-based therapy has proven effective for dry eye, it also reduces reliance on traditional treatments such as oral antibiotics, which can affect gut health.

“We are becoming increasingly aware of the role that gut health plays in systemic inflammatory control and dry eye,” said Mr. Tam. “It is preferable to avoid oral antibiotics when possible to prevent disrupting the normal gut flora.”

Another treatment trend to consider is regenerative medicine, such as stem cell therapy, according to Dr. Marjanovic. “Research into stem cell therapy for regenerating damaged tear glands or repairing ocular surface damage could offer long-term solutions for chronic dry eye,” she said.

New medications and therapies are also being developed, including drugs that target specific pathways involved in the development of dry eye, she said. Additionally, remote monitoring, which provides real-time data to healthcare providers, enables them to adjust treatments more effectively.

Dry eye and contact lenses

According to Mr. Tam, while treatments have improved, the options offered by contact lenses have also advanced. Wearing contact lenses can have multiple negative impacts on dry eye, including disrupting tear film function and altering the normal blink reflex, which can exacerbate the condition.

With these issues in mind, Mr. Tam added, it is important for people with dry eye to carefully consider their choice of contact lenses, as the lens material plays an important role in their comfort and effectiveness.

Hydrogels with high water content can provide comfort during the first few hours of wear. As the day progresses, however, the water in the lenses evaporates. “The dehydrated lens can in turn draw water from the tear film, which further increases symptoms of dry eye,” he said.

Silicone hydrogel lenses provide better oxygen transmissibility, but their higher modulus level can add friction between the lid-lens as well as corneal-lens interaction. This can increase contact lens discomfort and aggravate dry eye symptoms, he added.

“Newer materials have been designed with better stability and improved wetting agents to increase surface wettability, reduce friction, and enhance resistance to dehydration. These lenses have been shown to perform better in individuals with dry eye,” Mr. Tam continued.

“Lens wear modality is also an important factor to consider when choosing a lens,” he added. He noted that longer-wear lenses require cleaning and disinfection to prevent infection, which can introduce preservatives and cleaning agents onto the ocular surface, potentially irritating the sensitive eye.

“Daily disposable lenses are the preferred modality for dry eye patients as they are packaged in blister packs with preservative-free solution,” he explained.

When the eye cannot tolerate conventional contact lenses due to severe dry eye, Mr. Tam recommends scleral lenses—larger-diameter rigid lenses that rest on the sclera while vaulting over the cornea, ensuring no contact with the corneal surface. The lens is filled with a non-preserved saline solution, creating a liquid reservoir that bathes the corneal surface and provides optimal hydration.

“A well-fitted scleral lens will have minimal or no movement, thereby reducing friction on the ocular surface. Visual correction with a scleral lens can be superior, especially in cases of irregular corneal surfaces. In chronic and severe dry eye, there may still be some discomfort experienced due to the lens-lid interaction, but scleral lenses can help minimize the bulk of the pain caused by corneal contact experienced with conventional lenses,” Mr. Tam explained.

A multifaceted approach to DED management

The future of dry eye management looks promising, with ongoing advances in technology and lens materials, allowing for more focused and targeted treatments and providing patients with better choices between contact lenses and spectacles.

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

Conan Tam

Mr. Connan Tam

is the director of the Dry Eye Centre in London, United Kingdom (www.dryeyecentre.co.uk), which was established in 2013 and has more than 10 years of experience in intense pulsed light therapy. He holds dual qualifications as both an orthoptist and optometrist, specializing in pediatric eye care, as well as complex contact lens fitting and dry eye management.

[Email: connantam@dryeyecentre.co.uk]

Alisdair Buchanan

Mr. Alisdair Buchanan

leads the award-winning Buchanan Optometrists practice in Kent, United Kingdom. His clinic won the Optician Award for ‘Technology Practice of the Year’ and ‘Independent Practice of the Year’ in 2023-2024. His expertise in dry eye management, combined with the adoption of cutting-edge technologies, has positioned his practice at the forefront of advanced eye care.

[Email: info@optometrists.co.uk]

Branka Marjanovic

Dr. Branka Marjanovic

is a leading consultant ophthalmic and oculoplastic surgeon based at Moorfields Eye Hospital London. She graduated from Guy’s and St. Thomas’ Medical School, University of London, over 20 years ago, later specializing in oculoplastic surgery at Moorfields Eye Hospital. She has contributed research to a range of medical journals and is a member of various prestigious ophthalmic organizations, including The British Oculoplastic Surgery Society. Additionally, Dr. Marjanovic also serves as a joint divisional director for Moorfields North and is actively engaged in teaching and training medical professionals. Her specialty interests include blepharitis, dry and watery eye treatments, eyelid inflammatory conditions, blepharoplasty, surgery for correction of droopy eyelids (ptosis), eyelid augmentation for ectropion, entropion, precision removal of periocular eyelid lesions, and anti-wrinkle injections for cosmetic and medical indications (blepharospasm).

[Website: www.drbrankamarjanovic.com]

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