Clinical Scorecard: Dry Eye Disease: The Vicious Cycle of Frustration and Search for Relief
At a Glance
| Category | Detail |
|---|---|
| Condition | Dry Eye Disease (DED) |
| Key Mechanisms | Tear deficiency leading to ocular surface inflammation, nerve damage, and reduced lacrimal functional unit stimulation |
| Target Population | Millions worldwide affected by DED, including those with chronic symptoms and emotional challenges |
| Care Setting | Ophthalmology clinics and eye care practices with multidisciplinary support |
Key Highlights
- High treatment discontinuation rate: 9 out of 10 patients stop initial medication within a year, leading to cycling through therapies and frustration
- DED impacts physical eye health and significantly affects emotional wellbeing, work productivity, social activities, and daily tasks
- Comprehensive, personalized care with strong physician-patient communication improves treatment adherence and satisfaction
Guideline-Based Recommendations
Diagnosis
- Engage in meaningful patient conversations beyond symptom checklists to understand symptom impact and daily life disruption
- Recognize chronic and progressive nature of untreated DED with potential for worsening symptoms and emotional burden
Management
- Utilize FDA-approved therapies including acoltremon ophthalmic solution 0.003% (Tryptyr), cyclosporine 0.05% (Restasis), lifitegrast 5% (Xiidra), perfluorohexyloctane (Miebo), semifluorinated alkane (Vevye), and arenicline 0.03% (Tyrvaya)
- Tailor treatment plans to patient priorities and symptom patterns to build therapeutic partnerships
- Incorporate staff support for patient education, proper treatment use, and ongoing encouragement
Monitoring & Follow-up
- Conduct regular follow-ups, including brief check-ins, to adjust treatment plans and reinforce commitment to care
- Validate patient experiences to maintain motivation and adherence
Risks
- Low compliance can lead to chronic, progressive disease with worsening ocular surface damage and nerve impairment
- Emotional and psychological challenges may increase if patients feel unsupported or hopeless
Patient & Prescribing Data
Patients diagnosed with DED, including those with severe chronic dry eye
Less than 10% of diagnosed patients receive prescription treatment; only 13% feel their condition is well-managed, highlighting need for improved therapies and holistic care
Clinical Best Practices
- Move beyond symptom checklists to understand patient-specific symptom timing and life impact
- Build trust through validating patient experiences and educating on the chronic nature of DED
- Leverage multidisciplinary team to support education, treatment adherence, and emotional wellbeing
- Individualize therapy selection from multiple FDA-approved options based on patient needs
- Maintain consistent, long-term follow-up to optimize outcomes and adjust therapy as needed
References
- TFOS lifestyle: impact of lifestyle challenges on the ocular surface
- Dry eye disease and psychiatric disorders: a systematic review and meta-analysis
- TFOS DEWS II Definition and Classification Report
- Dry eye disease: impact on quality of life and vision
- Economic burden and loss of quality of life from dry eye disease in Canada
- Long-term resolution of chronic dry eye symptoms and signs after topical cyclosporine treatment
- Development of lifitegrast: a novel T-cell inhibitor for the treatment of dry eye disease
- Real-world experience with lifitegrast ophthalmic solution (Xiidra) in the US and Canada
- Evaluating patient experiences in dry eye disease through social media listening research
- Characterization of discontinuation and switching patterns of dry eye disease medications
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