dry eye dx and tx

Dry Eye Down Under

BY WILLIAM TOWNSEND, OD, FAAO

I was recently privileged to speak over a two-week period at various locations in Australia. The invitation came as a complete surprise to me, but I was more than happy to accept; going "down under" has always been something I wanted to do. Although I spoke on many topics, most lectures were directly or indirectly related to ocular surface disease in the form of dry eye. My interaction with faculty members and practitioners taught me a great deal about Australian optometry and ophthalmology as well as the people and healthcare system.

An Overview

Still a member of the British Commonwealth, Australia has many societal and ethnic characteristics of the "Mother Country." Approximately 90 percent of the population is of European descent, but the influx of numerous other groups during the past three decades has changed the balance of ethnicity. In particular, there has been a significant increase in the Asian population since revocation of the White Australia policy in the 1970s. Major changes in ethnicity bring new genetically associated diseases and challenges to health care.

Australia boasts a population of 22 million, approximately that of Texas, in a land mass roughly equivalent to that of the continental United States. The highest population concentration is around eastern coastal areas, which is also where the humidity is highest. Despite the high humidity levels where most people live, dry eye is a common and significant condition. This situation parallels that of the United States, where some of the major research centers for dry eye are located in cities that have high humidity levels for at least part of the year.

Australia has given us some of the premier researchers in ocular science, and this also holds true for dry eye. In 1987 Charles McMonnies and Arthur Ho published a study on the design of dry eye questionnaires that remains a mainstay. McCarty, Bansal, and associates in Melbourne have contributed to our understanding of the epidemiology of dry eye. Other Australians have contributed to our understanding of diagnosis and management of dry eye conditions.

Available Treatment Options

As I mentioned earlier, my lectures addressed a variety of ocular conditions. I frequently receive e-mails from attendees after lectures requesting more information or copies of printed materials we use for patient education and information. In Australia, the overwhelming majority of requests were focused on dry eye and how to diagnose, treat, and ultimately manage the long-term care of these chronic conditions.

My time in Australia made me acutely aware that so many of the products we use in everyday practice are developed in the United States and are often available for months or years before being introduced abroad. For instance, at the Queensland Gold Coast meeting, Optive (Allergan), a product that has been available in the United States for at least a year, was just being introduced to Australian practitioners.

Restasis (Allergan) is used on a very limited basis, in part because the government healthcare managers have deemed it experimental and recommend substituting a "safe" steroid such as fluorometholone for patients who have inflammatory dry eye. Systane Ultra (Alcon) has yet to be introduced, but Australian eyecare providers are looking forward to its arrival. All this is to say that we sometimes take for granted that many products are introduced in the United States before they are available elsewhere.

A Worldwide Concern

Without belaboring the pun, my experience in Australia was eye opening and it served to reinforce in my mind the bond that we share with other eyecare practitioners throughout the world. It also demonstrated that regardless of the continent or climate, dry eye is a condition that is problematic and that deserves our attention and expertise. CLS

Dr. Townsend practices in Canyon, Texas and is an adjunct faculty member at UHCO. E-mail him at drbilltownsend@gmail.com.