editor’s perspective

Dry Eye—A Look Back and a Look Ahead

BY JASON J. NICHOLS, OD, MPH, PHD, FAAO

Dry eye disease continues to be one of the most common—if not the most common—ophthalmic conditions that eyecare practitioners manage each day. As such, in 2009 we decided to devote an entire issue to dry eye, one to which you can turn as an authoritative summary of the field including trends in research, diagnosis, and management. Dry eye diseases include a vast array of conditions such as aqueous deficient dry eye, blepharitis and evaporative conditions, and contact lens dry eye that occur either independently or together. Therefore, we focus our attention on each of these areas and provide authoritative feature articles that address the leading thoughts in each area.

One of the most prominent trends in dry eye disease has been in the area of blepharitis, particularly meibomian gland dysfunction. The Tear Film and Ocular Surface Society has sponsored a workshop devoted to the topic that has included more than 50 worldwide experts in the field and is just now coming to a conclusion with a seminal report due to publish by the end of 2010. A second reason for the major focus on blepharitis has been due to the pharmaceutical activities in the area.

On the contact lens side of the equation, there is continued discussion about the proper management of contact lens dry eye. Most practitioners manage this problem by refitting patients into silicone hydrogels (or into a different silicone hydrogel), followed by refitting into a daily disposable. As we have covered throughout the year, there is interest in what role silicone hydrogels play regarding comfort and dry eye during lens wear—some specifically questioning whether or not the increased oxygen transmissibility through these materials has anything to do with dry eye in lens wearers or whether it’s some other material attribute that should be the focus of our attention. A point to consider in all of this is that silicone hydrogels have been available for 11 years in the United States, and while not all of these lens materials are the same nor have they been on the market for the same length of time, silicone hydrogels don’t appear to have had a dramatic impact on the overall contact lens dropout rate due to dry eye—estimated by our market research and discussed in the Dry Eye Annual Report in this issue to be about 15 percent of lens wearers per practice per year on average.

What remains clear is that contact lens dry eye and non-contact lens dry eye are not perceived in the same way, as they have different management strategies. I suspect that over the next year we will continue to see the influence of pharmaceuticals enter into the care of contact lens dry eye patients, with hybrid management strategies emerging as we strive to provide the best care for our patients. Stay tuned for more on these topics in future issues.