Eyeworld Supplements

therapeutic solutions: Ocular surface disease and episodic flares of dry eye disease 6 | SUPPLEMENT TO EYEWORLD | MAY 2019 Dry eye treatment: Decisions and need Gupta, MD, explained that she usually tells patients to expect there to be a 3-month gap before experiencing symptom relief with cyclospo- rine, whereas with lifitegrast she explains to patients that they may experience improve- ment in as little as 2 weeks, but it can also take up to 3 months. "Immunomodula- tors are excellent for treating dry eye; they're just not quick enough to treat flares," she said. Having to wait that long for relief from a dry eye flare U p until just a few years ago there was only one approved therapy for dry eye, topical cyclosporine, whereas today there are a variety of options. Despite this evolution, unmet needs remain in the dry eye treatment realm. Elizabeth Yeu, MD, point- ed out that there is an obvious unmet need for an anti-in- flammatory with quicker onset of action. "In order to even start chronic dry eye therapy, whether with lifitegrast or cyclosporine, we often have to have a concomitant induction therapy with a topical ste- roid. While we have a grow- ing number of options for meibomian gland dysfunction (MGD), there aren't necessar- ily any insurance-reimbursed options, and that is also an unmet need that currently exists," she said. The inflammatory connection In recognition of dry eye's chronic inflammatory disease etiology, Richard Lindstrom, MD, suggested that when making dry eye treatment de- cisions it helps to think about dry eye flares as one would think about an iritis flare. "We would treat those patients very aggressively and try to knock out the inflammation with a strong topical steroid, then taper down. We would not use palliative therapy," he said. One of the shortcomings of current therapies is the amount of time it takes for them to go to work. Preeya In your clinic, how many dry eye flares does the average patient experience on a yearly basis? 0–1 50% 50% 0% 0% 2–4 5–7 8 or more How strongly do you agree that: Strongly Agree 100% 0% 0% 0% 0% 0% 0% 0% 0% Agree Neutral Disagree Strongly Disagree a dry eye flare is a rapid onset inflammation-driven response to environmental triggers? patients on maintenance therapy can also have frequent dry eye flares throughout the year? The average patient experiences 2 to 7 dry eye flares on a yearly basis. All respondents strongly agree that dry eye flare is a rapid onset inflammation-driven response to environmental triggers and that patients on maintenance therapy can also have frequent dry eye flares throughout the year. • • Following their discussion, the physicians completed a survey on ocular surface disease. Their answers to the survey questions are located throughout this supplement.

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