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Myths and Misconceptions in Dry Eye Disease Management
March 2019 - Scott E. Schachter, OD on ModernOptometry
There has been a slow but steady rise in interest in ocular surface disease during the past 2 decades. The FDA approved cyclosporine ophthalmic emulsion 0.005% (Restasis, Allergan) in 2002, the Tear Film & Ocular Surface Society (TFOS) released its first Dry Eye Workshop (DEWS) report in 2007,1 and the international meibomian gland dysfunction (MGD) report was released in 2011.2 It’s hard to find a monthly eye care magazine that doesn’t regularly feature articles on dry eye disease. In the past few years, we have also seen an explosion of new diagnostic and treatment options for dry eye disease.
With all of this innovation and attention, it’s easy to get lost in the weeds of the wealth of information available. Myths and misconceptions can be born from all of this noise.
Let’s clear a few of them up.
MYTH! DRY EYE IS AN OLD PERSON’S DISEASE
When we think about dry eye, the stereotypical patient is a postmenopausal woman. Although this patient is certainly at risk for dry eye disease, we need to think in much broader terms. In my practice, we look for dry eye routinely as part of comprehensive eye examinations. Risk factors such as device use; use of antihistamines, antidepressants, or oral contraceptives; and a history of refractive eye surgery can apply to patients of any age. In fact, a 2016 study showed a 6.6% prevalence of dry eye disease in pediatric patients 7 to 12 years old. In this case-control study, 30 of the participants had their smartphones taken away for 4 weeks, at which point the prevalence of dry eye disease in that intervention group dropped to zero.3
MYTH! MGD AND Aqueous TEAR-DEFICIENT DRY EYE ARE MUTUALLY EXCLUSIVE
When a patient presents with complaints of dry eye, doctors often try to determine whether it is evaporative or aqueous-insufficiency dry eye. The 2007 TFOS DEWS presented these two types of dry eye disease as mutually exclusive. However, in the 2017 TFOS DEWS II report,4 dry eye is described as a continuum between the two types, and we now recognize that there is much overlap between them (Figure).
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