IMPROVING THE SCREENING

,
DIAGNOSIS, AND TREATMENT OF

DRY EYE DISEASE
Expert Recommendations From The 2014 Dry Eye Summit

Supplement Sponsored by

0615_BioScience.indd 1 6/1/15 4:01 PM

OD.indd 1 6/1/15 4:03 PM . FAAO Scott Hauswirth. The summit participants also discussed strategies for integrating ocular surface wellness into optometric practices. and how these tools are currently being used. PhD. and treatment options. OD. the experts evaluated various screening. OD. 2014. FAAO Tom Kislan. The overall goal of the Summit was to create. OD. FAAO Art Epstein. FAAO Jim Owen. FAAO Ron Melton. more than 30 leaders in DED gathered in Dallas. FBCLA. diagnostic. PhD. OD. MBA Dell Laser Consultants Milton Hom. FAAO Gina Wesley. MEd. arriving at a consensus on baseline standards that can be used by all ECPs for clinical patient encounters. Colorado in general eye care practices. OD Jason Nichols. FABCO. OD. Alabama and medical device companies who provided invaluable industry insights into the diagnostic tools and treatments available to ECPs. OD. Joining at Birmingham the experts at this summit were representatives from 17 pharmaceutical Birmingham. FAAO translating this wealth of information into effective management strategies Eye Consultants of Colorado Conifer. FAAO Jason Miller. FAAO Joseph Shovlin. and ultimately treatment of Kelly Nichols DED. FAAO Austin. FAAO OD. Kentucky Katherine Mastrota. OD. FAAO. Texas Lyndon Jones. and treatment. AND TREATMENT OF DRY EYE DISEASE Expert Recommendations From The 2014 Dry Eye Summit Distributed by Review of Optometry PROGRAM CHAIRS EXPERT CONTRIBUTORS Marc Bloomenstein Barbara Caffery. OD. OD. FAAO Thomas Quinn. FAAO Walter Whitley. Barry Eiden. Scot Morris eye care professionals (ECPs) have encountered some challenges in OD. PhD. FAAO Kirk Smick. FAAO Koffler Vision Group ABSTRACT Lexington. OD. FAAO Scottsdale. OD. FAAO. University of Alabama Texas. DPNAP C. FAAO diagnosis. Significant gaps still exist in regard to disease prevalence and ECP awareness. OD. FAAO Dominick Opitz. OD. OD. OD Louisville. FAAO OD. on December 11–13. OD. Lisa Prokopich. MSc Derek Cunningham David Geffen. OD. 1 0615_BioScience. Over the course of the meeting. In an effort to identify opportunities for improvement in screening. OD. FAAO Jack Schaeffer. OD Randall Thomas. PhD. OD John Rumpakis. Kentucky Despite our rapidly expanding knowledge around dry eye disease (DED). OD. FAAO Doug Devries. for the inaugural Dry Eye Summit. DIAGNOSIS. through a consensus of the experts. practical recommendations that could easily be implemented and would have a substantial impact on the quality and consistency of care that patients with DED receive at the general practice level. OD. ABO William Townsend. FAAO Paul Karpecki OD. MPH. FCOptom. FAAO Ian Benjamin Gaddie Al Kabat. OD. Arizona S. OD OD. IMPROVING THE SCREENING. OD. FAAO Gaddie Eye Centers Blair Lonsberry. OD. diagnosis. FAAO Schwartz Laser Eye Center Mark Dunbar.

“Target: A Healthy Eye”). that are devoted to understanding its risk factors. Patients with dry eye of care patients receive by creating baseline DED management disease have impaired ocular recommendations that can be easily incorporated into daily health and ECPs must be able practice. Representatives of 17 pharmaceutical and medical to recognize the problem device companies. In some ways. it has see if he or she has a healthy become clear that there is a pressing need not to create another eye that is defined as being set of scientific guidelines. and that delivers clear that all ECPs can use to provide consistent. the level Target: of attention to DED by the health care community has never been greater. diagnosis.1-7 In addition. 2014. as no fewer than 7 sets of guidelines have been A Healthy Eye published. and to a failure on the part of experts to provide are minimized. as well as integrating effective diagnostic and health care deserving our treatment strategies into their practices. drawing on the available information. The summit also built on previous expert consensus work by discussing some of the concepts of ocular surface wellness and how they relate to DED (see Sidebar. with the overarching goal maintain or improve the eye’s of making a substantial impact in the quality and consistency health. over the last decade. This supplement presents the key proceedings of the Dry Eye Summit and reviews the consensus recommendations developed for ECPs by the expert attendees. with unique pathophysiologic challenges. effective DED care and consistent vision for the to the mass population that suffers from DED but is currently patient. Assessing the health not being diagnosed and treated. to their perceived disease and vision problems complexity. 2 0615_BioScience. More than 30 recommendations on how to DED leaders attended the summit. developed by DED experts. Texas. joined again sees with a healthy eye. in Dallas. are facing challenges in recognizing and utilizing published but an additional aspect of guidelines. suggesting that clinicians and treating ocular disease. ECPs should consistent education and de facto protocols to the ECPs who be assessing each patient to are seeing the majority of patients. we tend to focus on Despite this focus and available resources. their infancy and to provide held on December 11–13. As eye care practitioners (ECPs). has not gained traction taining a healthy eye so and become standard practice for ECPs. attention is ocular surface wellness. of the ocular surface gives ECPs the opportunity to catch Addressing this unmet need for minimum recommendations infections and irritations in was the primary impetus for the inaugural Dry Eye Summit. but to develop a set of consensus. with no feelings of irri- derived recommendations.indd 1 6/1/15 4:03 PM . by various groups. an influx of DED objective diagnostic tools and new treatment regimens have made it to the marketplace. INTRODUCTION Dry eye disease (DED) is an ocular and public health issue that presents a conundrum for the eye care professional (ECP). In examining this issue. What is this? It is a There are a number of potential reasons why this body of proactive program of main- research. these experts. and treatment. white. who offered their insights into the various and prescribe an appropriate treatment until the patient diagnostic and treatment resources available to ECPs. tation. there are identifiable the vision of our patients management gaps among ECPs. These range from a that the risks of developing simple lack of awareness that guidelines exist.

indd 1 6/1/15 4:04 PM .15-17 eyelid and lacrimal networks making it easier to search the Internet. with social media. despite this tests for DED. Taiwan. 21. and digital that. they are likely ability to refract correctly and The simple and straightfor. THE SCOPE OF DRY EYE DISEASE A number of groups have developed various definitions of difficult to quantify the epidemiology of DED given the DED that encompass concepts including tear dysfunction.16-17 and contact lens wear.8% of Americans in 1980.14 while more recent research has identified ad.3% in 2012) and there is no indication that this rate the relationship between is going to decline. can have belies the complexity of a device use.7%.2 multiple definitions that have been employed (reflecting the increased osmolarity. There are currently over 100 million adults in the a serious impact on functional disorder that is associated US over the age of 50. eye discomfort. computers. in the near future. if left untreated. in a multisite analysis of 344 subjects in the U. trends. with another 10 million expected by vision.8-12 skin diseases.15. surface that impacts the eye’s As high as these prevalence statistics are. meibomian 3 0615_BioScience.13 and autoimmune Digital device use is increasingly creeping into every facet mechanisms.36-38 The coming age of wearable electronic devices its impact on the evaporative and inflammatory mechanisms will certainly magnify the current problem. and other digital devices that are associ.3 disease of the tears and ocular patient quality of life.35 DED and the tear film.32.31 In the United States. if left untreated. A lack of concordance between the signs and symptoms Correlations among these and other tests—osmolarity.39 between corneal and conjunctival staining (r2 = 0. UK. these risk factors include the use of mobile phones. thyroid disease. that they are being managed appropriately. For tear break-up time (TBUT). or even plateau. evolution of how DED is defined). or watch videos anywhere and at any ported risk factors implicate our reliance on technology and time. eye discomfort.6%29. and differences in study design and is the understanding that DED is an inflammatory disease of patient populations.9%30. of DED underscores the challenge faced by ECPs. for the last 40 years (2. interact gland damage. diabetes.34. Sjogren’s Q Antidepressants Q syndrome. can have a 33.S. A multifactorial disease associated with so many risk factors is bound to have a high prevalence rate. 4. In light of these of DED. discomfort and other symptoms. varying understandings and visual disturbance.15-28 ensure that they are identifying their DED sufferers. the expert participants example. es that continue to expand. Schirmer’s test. and or more episodic manifestations of the disease. approximately 20 million serious impact on functional Americans have at least early signs or symptoms of DED DED is an inflammatory vision. countries: for example. to increase dramatically in the near future based on the ward term “dry eye disease” growing impact of 3 risk factors: age.5% in Earlier studies recognized 2000. of our waking days. arthritis) Corticosteroids Q DRY EYE DISEASE: THE MANAGEMENT CHALLENGES FOR THE ECP During the Dry Eye Summit.33 Diabetes rates have been steadily rising patient quality of life. and with a wide range of caus. and when identified. 9. the only substantial correlation found was disease being one of the leading causes of patient visits. France. with new devices and expanding Wi-Fi ditional risk factors that include age. the year 2020.18-20 The latest re. but how high? It is Table 1 Common Risk Factors for Developing Dry Eye Disease 15-28 Q Diseases Q Contact Q Medications Q Older age Q Digital Q Ocular surgery Diabetes Q lens wear Antihistamines Q device use Allergies Q Decongestants Q Autoimmune diseases (e.g.36). it is more important than ever that management of tablets. examined the myriad reasons why ECPs often face and Europe that looked at correlations between multiple difficulties in diagnosing and treating DED.3 Common to all of these definitions of disease severity. All of these have contributed to the tears and ocular surface that impacts the eye’s ability to disparities in reported prevalence rates among different refract correctly and that.. DED improves and that ECPs have the tools they need to ated with decreased blink rates (Table 1). 9.

14 0. and their half of the experts (53%) believed that these guidelines were level of complexity (Table 3).15 Conjunctival Meibomian Corneal Conjunctival Corneal OSDI Meibomian Stainingc Gland Grading Staining b Stainingc Staining b 0.09 0. tear break-up time. There are currently at least 7 sets of DED A poll of participants during the Dry Eye Summit confirmed guidelines published by various North American optometric how DED guidelines are being viewed among the larger associations.17 AVERAGE 0. newer sets of guidelines.11 OSDI.15 0.12 0.05 0.12 0.40 There was also poor reports makes them difficult to digest and incorporate agreement among these tests in terms of DED severity. such as the 2014 National Dry indicating that almost half of DED cases may be missed Eye Disease Guidelines for Canadian Optometrists.08 0. Ocular Surface Disease Index.08 0.06 0. and although each is comprehensive.08 Test a 0.indd 1 6/1/15 4:05 PM .11 0. tend to if the ECP relies solely on the patient’s reporting of be shorter and more intuitive.14 0. While of DED reported symptoms consistent with this diagnosis.14 Test a Staining b 0. c With lissamine green.12 0.14 0. their diagnostic and treatment approaches.14 Corneal Conjunctival Conjunctival OSDI TBUT TBUT Corneal Staining b Stainingc Stainingc 0.05 0.15 Staining b 0. AND TREATMENT OF DRY EYE DISEASE gland grading.05 0.05 0. DIAGNOSIS.06 OSDI OSDI OSDI TBUT Schirmer’s Corneal TBUT 0.11 TBUT Corneal TBUT Schirmer’s OSDI Conjunctival Conjunctival 0. highlighting the failure of experts to engage with Workshop on Meibomian Gland Dysfunction Report5 (2011).36 0.05 0. 4 0615_BioScience.13 0. ECPs on the information that is available (Figure 1).06 0. they vary ECP community. b With fluorescein. TBUT.17 0. easily into general practices—resulting in ECPs missing an Importantly.17 Gland Grading 0.13 0.14 Stainingc Stainingc 0.6 reading guidelines that use symptoms.13 0.05 0. and Ocular Surface Disease Index (OSDI)— The overall length and comprehensiveness of the longer were consistently low (Table 2).05 Meibomian Schirmer’s Meibomian Meibomian Meibomian Schirmer’s Schirmer’s Gland Grading Test a Gland Grading Gland Grading Gland Grading Test a Test a 0.15 0.08 0.40 different terminology and focus on varying aspects of DED makes it difficult to come away with a coherent view of how Other important reasons are the published guidelines to manage the disease.09 0.15 0. more than DED.1-7 The length of these guidelines either too complicated or difficult to implement.05 0.11 0. a Without anesthesia. only 57% of individuals with objective signs opportunity to take full advantage of these resources.06 Staining b 0. IMPROVING THE SCREENING.15 0. Table 2 Correlation Coefficients (r2) of Determination Among 344 Subjects (normal: n = 82. When asked why they think ECPs are not considerably in the terminology they use to define and classify using the various guidelines available for DED.16 0.36 0. themselves and the lack of their translation to ECP education and practice.07 0. Another ranges from 8 pages for the Delphi Dysfunctional Tear 43% said they did not believe ECPs were even aware of DED Syndrome Report2 (2006) to 169 pages for the International guidelines.09 r 2 0.13 0. dry eye disease: n = 262)40 Osmolarity TBUT Schirmer’s Corneal Conjunctival Meibomian OSDI Test a Staining b Staining c Gland Grading Schirmer’s Test a Osmolarity Osmolarity Osmolarity Osmolarity Osmolarity Osmolarity 0.

For example. as well as their treatment as opposed to any current guidelines. One notable their DED patients they recommend any treatment. A significant over their symptoms more than half the time. while ECPs are not aggressively of the experts said they recommended treatment for more treating their DED patients. The survey results revealed several other important Six hundred fifty-eight ECPs responded. while about 25% in patterns. use of diagnostic and treatment (“red eye”). In comparison. Both groups reported disconnect between the experts and the ECPs in their relying most often on personal protocols to manage DED perceptions of DED in their practices. only 29% of ECPs that their DED patients were achieving satisfactory control recommended treatment this often (Figure 2).indd 1 6/1/15 4:05 PM . Figure 2. Responses by Dry Eye Summit participants to the question: “Why Do You Think ECPs Are Not Using the Various Dry Eye Guidelines?” Simple. 82% result of the survey was that. Expert vs. community ECP responses to the question: “For What Percentage of Your Dry Eye Disease Patients Do You Recommend Any Treatment?” Experts (n = 28) OD community (n = 658) Percentage of Survey Responses 100% 80% 60% 40% 20% 0% <5% 5%-10% 11%-25% 26%-50% >50% Percentage of Patients With Dry Eye Disease 5 0615_BioScience. and these responses disparities between the 2 groups. Figure 1. but do not emphasize follow-up or early treatment Too complicated Do not emphasize the need for change from a provider's perspective Not aware Difficult to implement 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Percentage of Summit Participants WHAT ARE THE KNOWLEDGE GAPS? To better understand the specific gaps and their impact on discrepancy was also found between the experts and ECPs DED management. the ECPs were more likely to The survey responses revealed a number of key areas of identify dryness/discomfort and pain. commonly treatments that purport to relieve symptoms of inflammation reported symptoms. In contrast. when asked for what percentage of each group reported using no specific protocol. This inconsistency in prescribing asked the respondents for feedback on their perceptions of treatment has led to DED patients self-medicating with DED prevalence and risk factors in their practices. the experts were compared with those of the DED experts who attended were more than 3 times as likely as the ECPs to identify the Dry Eye Summit. 10%). For example. options. and screening strategies. and to compare the attitudes and beliefs with regard to prescription therapies—the experts were more of Dry Eye Summit participants with those of ECPs. The survey was distributed online via the Review of Optometry to all of its subscribers. fluctuating vision as their patients’ most common symptom (32% vs. a survey than 5 times as likely as the ECPs to offer these treatments was conducted prior to the summit. This 14-question survey to their patients (Figure 3). most of these providers believed than half of their patients.

diagnostic Approach to Treatment Study Group tests considered secondary in guiding therapy Recommendations 2007 Report of the Tear Film and 2007 142 Q Dry eye is a multifactorial disease of the tears and ocular surface International Dry Eye Ocular Surface Q Accompanied by increased osmolarity of tear film and inflammation WorkShop (DEWS) Society (TFOS) of the ocular surface which lead to the cascade of visual degradation. DIAGNOSIS. altered distribution of tears. or recalcitrant Guidelines for Canadian Association of Q Begins with a screening process that includes key questions. AND TREATMENT OF DRY EYE DISEASE Table Table33 Overview of Current Guidelines for Dry Eye Disease1-7 Title Sponsoring Body Publication No. chronic. and discomfort Management of University of 2009 10 Q “Dysfunctional tear syndrome” Dysfunctional Tear Ottawa Eye Q Management begins with a patient’s history. lipids. surfacing abnormalities. or tear film layer disturbances Q 5 different presentations: aqueous-deficient dry eye. and epitheliopathies 6 0615_BioScience. especially medication use Syndrome: A Canadian Institute Consensus Q Treatment focuses on underlying inflammatory process and restoring normal tear film The International Tear Film and 2011 169 Q Proposed to develop a consensus understanding of the meibomian Workshop on Meibomian Ocular Surface gland in health and disease Gland Dysfunction Society (TFOS) Q Subcommittee reports on: definition and classification. mucin-deficient dry eye. and clinical trials National Dry Eye Disease Canadian 2014 31 Q Clinical assessment defined as episodic. diagnosis and management. anatomy and pathophysiology.indd 1 6/1/15 4:06 PM . a Optometrists Optometrists full workup is recommended to confirm diagnosis and identify (CAO) comorbidities Care of the Patient With American 2015 4 Q To be used in conjunction with the AOA Optometric Clinical Practice Dry Eye Optometric Guideline on Care of the Patient With Ocular Surface Disorder (revised Association April 2003) (AOA) Q Dry eye may result from disruption of any tear film component production. epithelial cell damage. tear instability. of Key Points Year Pages Report of the National National Eye 1995 12 Q “Dry eye disorder” due to tear film deficiency or tear evaporation Eye Institute/Industry Institute (NEI) Q Tests include validated questionnaire of symptoms and demonstration Workshop on Clinical of ocular surface damage. lipid abnormality dry eye. epidemiology. IMPROVING THE SCREENING. and tear hyperosmolarity Trials in Dry Eyes Dysfunctional Tear Dysfunctional 2006 8 Q “Dysfunctional tear syndrome” Syndrome: A Delphi Tear Syndrome Q Treatment based primarily on patient symptoms and signs.

community ECP responses to the question: “For What Percentage of Your Dry Eye Disease Patients Do You Use Prescription Medications or Therapies?” Percentage of Survey Responses Experts (n = 28) OD community (n = 658) 60% 40% 20% 0% <5% 5%-10% 11%-25% 26%-50% >50% Percentage of Patients With Dry Eye Disease CLOSING THE GAPS: DRY EYE SUMMIT RECOMMENDATIONS All of this evidence points to a significant unmet need to given the key word “feel”). Industry below. will make a substantial impact in the quality and consistency of care for DED patients. contact discussion. water. given that vision difficulty is 7 0615_BioScience. and an infographic summarizing them is provided on representatives did not participate in this voting process. burning. more general term “uncomfortable” was chosen over any dations were made. Eye care providers can—and are expected 4 Do you ever use or feel the need to use drops? to—go beyond these recommendations as needed. patient with these questions to minimize the risk of a missed tives participated.” while individual scribe the symptoms using their own words. orga. and stinging were vision was considered necessary. they are 2 Are you bothered by changes in your vision throughout a set of baseline recommendations that ECPs can use in all the day? patients to screen. We also questions at each visit: emphasize that these recommendations do not represent 1 Do your eyes ever feel dry or uncomfortable? a comprehensive approach to dry eye care. and treatment—was the result of an initial in-depth key words: feel. Six concurrent workshops were held diagnosis. page 10. rather. diagnose. We anticipate that these recommendations. Figure 3. ECPs should screen every the expert summit attendees and industry representa. consis- tent with good clinical practice. Where variations of similar recommen. and lids. they were consolidated under a single specific symptom such as burning or stinging in order to be key word (for example. These recommendations are outlined reached on the top 3 or 4 choices for each category. any recommendation for a specific as inclusive as possible and to give patients a chance to de- artificial tear was given the keyword “drops. At a minimum.indd 1 6/1/15 4:06 PM . rub. RECOMMENDATIONS Recommendations It is important to emphasize that the primary focus of these 1 Screening Questions to Ask recommendations is to assist ECPs in the clinical practice setting. Each workshop developed a list of their top 5 recommendations. red. followed by individual workshops in which both lenses. vision. Discussion Each section of these DED recommendations—screening. for each category. although these recommendations will be valuable At a minimum. The resulting choices were then Considerable discussion was devoted to the specific word- compiled into a master set of recommendations. the nized by key word. ing of these screening questions. until a two-thirds consensus was DED in clinical practice. adopted into everyday practice. Expert vs. and treat DED more effectively 3 Are you ever bothered by red eyes? and consistently. every patient should be asked the following to any ECP who provides care for DED patients. The 4 screening questions were developed from the following diagnosis. These recommendations were equip ECPs with a set of easy-to-implement consensus then voted on by the group of experts via successive inter- recommendations for the diagnosis and management of active polling questions. tasks. With regard to the first. drops. The question on symptoms such as dryness.

In this question. Because of the episodic nature of DED. while a shorter follow-up interval will likely not raphy. Finally.g. orals/nutraceuticals. was by far the cyclosporine. “drops” was preferred over “artificial tears” as it encompass. meibomian gland/lid expression. and advanced. treatment compliance is likely testing. The experts importance of this symptom to patients in terms of cosmesis. such as blink analysis and meibog. We welcome feedback on b. the pass a variety of tests related to vision. but could potentially include osmolarity longer follow-up interval. not currently own this technology. and to keep raising the bar a little Treatments were considered based on the following key higher each time. the test was not recom. and photography. For patients new to recommend to ECPs. Nutrition. it was felt that these tests were too provide sufficient time to show improvement. and treat DED external. volume. more complex well as red eye relievers) that are available. words: lubrication. including TBUT and recommendation for follow-up was 3 to 4 weeks. 8 0615_BioScience. Conclusions especially for ECPs motivated to move beyond the baseline recommendations. with a minority voting for a shorter (3 mended as a top 3 choice given that most optometrists do months) or longer (1 year) interval. most participants would wait no was mentioned a number of times. Lid hygiene these recommendations as you begin to incorporate them c. interval. including diagnose. “Tear film instability” was selected to encom. which 2 Diagnostic Tools to Use includes oral nutraceuti- cals and dietary interven- At a minimum. This is just the beginning of the discussion 2 Topical anti-inflammatories regarding the complex diagnosis and treatment algorithms that exist around DED. anism of action.indd 1 6/1/15 4:06 PM . was selected based considered in each patient for primary dry eye disease on its benefits in terms of do not represent a 1 Eyelid examination overall health and the fact comprehensive approach 2 Staining that patients should be to dry eye care.. forms of lid hygiene. “Eyelid examina. With regard to over “fluctuate. anti-inflammatories. left it up to the individual ECP to choose the right class of as well as comfort. Basic lid hygiene measures (e. it is likely that most DED patients are already by patients. separate out meibomian glands Additional discussion was as a separate item. inflammation. and help raise the overall standard of care. ifying any particular type. rather than spec- the word “ever” was incorporated where appropriate. words: lid. Integrating them into community practices will enable ECPs to identify 3 Basic Management Strategies those DED patients who may be going undiagnosed.” which includes the meibomian glands. however. The question on red eyes was selected given the using some type of topical lubricant before they present to high prevalence of red eye as a symptom of DED and the the ECP office. It and other advanced dry eye testing procedures were seen as a level to strive toward. Topical anti- a baseline approach inflammatories include Discussion that ECPs can use in any medication with an Diagnostic tests were considered based on the following key anti-inflammatory mech. Nutrition into practice. IMPROVING THE SCREENING. staining. such as mechanical meibomian gland expression or pulsation. lid hygiene. but ultimately did not. AND TREATMENT OF DRY EYE DISEASE a prominent sign/symptom of DED. While other tests. most popular choice for diagnosis. With regard to the initiation of treatment. 3 Tear film instability more willing to adopt this rather. These recommenda- Basic management for dry eye disease includes: tions also are an opportunity to engage patients in discus- sions on ocular surface wellness by encouraging them to be 1 For all patients aware of their overall eye health and to take an active role a. osmolarity. hot compresses and lid cleanliness measures) were consid- es the large variety of over-the-counter topical lubricants (as ered an essential part of self-care. The consensus recommendations reached during this inau- gural Dry Eye Summit represent a huge opportunity for ECPs to make an impact on DED in their practices. to wane. DIAGNOSIS. the following diagnostic options should be These recommendations tions. topical corticosteroids and more effectively and tion. It is our hope that we will continue to Discussion empower clinicians with strategies to help patients maintain a healthy ocular surface.) The more generalized term “staining” was devoted to the appro- selected to include any form of corneal staining. should be performed only in office. (The participants consid- ered. consistently. Ocular lubrication in becoming and staying healthy. they represent approach. at the ECP’s priate patient follow-up discretion. TBUT/topography. all patients to screen. the word “change” was selected part of routine care for every DED patient. Although osmolarity testing who are considered stable. most likely a vasoconstrictor.” as the latter may not be as well understood ocular lubrication. were considered. lubricant (lipid-based or aqueous-based). yet is often unrecognized It was agreed that the first 3 treatment options should be a as such. with a corneal topography. longer than 6 months.

110:1096-1101. 10 Khurana AK et al. Accessed February 27. Available at: www. 2011.census. Cornea.html.S. Texas. 25 Wolkoff P et al.253:431-438.pdf.52:2050-2064. CooperVision.S. 23 Fuerst N et al. Int Ophthalmol.122:818-824. [Epub ahead of print] 40 Sullivan BD et al. Can J Ophthalmol. Arch Ophthalmol.33:851-854. htm. Am J Ophthalmol. 15 American Optometric Association. 2014. 2015. 13 Leonard JN et al.. Available at: 11 Mathers WD et al. Invest Ophthalmol Vis Sci.org/content/dam/aarp/research/surveys_ optometrists/QRG-10B. Pain Point Medical. 9 deLuise VP et al. Alcon did not provide funding for the summit.gov/ population/age/data/2012.92:e429-e436. 2015. 1975. 2015.69:79-86. Available at: www. 2009. 9 © 2015 Novartis 05/15 MIS15086JS 0615_BioScience.org/Documents/ http://www. Dept of Labor. or imply endorsement. [Epub 38 File T et al. 2014. Ocul Immunol Inflamm. 2014. 2005. 2015. 2013.157:799-806... 4 Jackson WB. 2007 report of the 24 Fraunfelder FT et al.104 35 American Diabetes Association. 2014. Cornea. Can J Optom. TearLab Corporation.gov/history/ ahead of print] pdf/2013computeruse. Br J Ophthalmology. 19 Iskeleli G et al. J Pediatr Ophthalmol Strabismus. 27 Uchino M et al. of the editor or publisher. National Dry Eye 30 Malet F et al. 2013.6:666-670. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations.gov/diabetes/statistics/prev/national/figage. Acta Ophthalmol (Copenh). The summit upon which this supplement is based was funded by Akorn Inc.156:759-766. 21 Misra SL et al. Census Bureau. 2014 Sep 7.44:385-394.htm. J Ophthalmol.pdf. 2014. 18 Igarashi T et al.aarp.92:161-166.pdf.2012:285851. statistics/general/2014/Getting-to-Know-Americans-Age-50- Plus-Demographics-AARP-res-gen.5:61-204. release/atus.76(Suppl 1):1-32.org/diabetes-basics/statistics/. Accessed June 12. Ocul Surf. The opinions expressed in this supplied supplement to Review of Optometry® do not necessarily reflect the views. Accessed October 1. BioTissue. 2014. 12 Yokoi N et al. Report of the National Eye Institute/Industry 20 Paulsen AJ et al. Available at: http://www. 3 International Dry Eye WorkShop. Acta Ophthalmol. 2012. 2001.8:507-515. aoa.10:108-116. 2 Behrens A et al. Bausch + Lomb Inc. 1995. 7 American Optometric Association. and TearScience who provided funding at the Silver. 2014. including third party editorial support and honoraria for the program chairs. Graefes Arch Clin Exp Ophthalmol. 5 Tear Film and Ocular Surface Society.62:4-12. Available at: http://www. Essilor of America Inc. The International 28 Li Q et al. Trans Ophthalmol Soc U K.51:87-92.S.101:634-635. Am J Ophthalmol.cdc. Centers for Disease Control and Prevention. Am J Ophthalmol. 39 Sullivan DA et al. 31 Lin PY et al. Acta Ophthalmol..2014:848659.census.aoa. 2014. 2014.14:299-302. Ophthalmologica. (Part 4):467-476. 2003. 2012. Invest Ophthalmol Vis Sci.org/patients-and-public/eye-and-vision-problems/ glossary-of-eye-and-vision-conditions/dry-eye?sso=y. diabetes. 2014. Accessed April 27. Census Bureau.98:1712-1717. Accessed February 27. Available at: http://www. 22 Beckman KA. 37 U. Canadian consensus. Accessed April 27. 1983. 1991. Oculus. 2015. Santen Inc. 2007. Beaver-Visitec International. 14 Grus FH et al. J Diabetes Res. 16 Farid M et al.bls. 36 U.. Accessed April 27. Ophthalmology.S. Allergan Inc. 1996. http://www. 2013. Management of dysfunctional tear syndrome: a 26 Moon JH et al.gov/hhes/ Accessed October 1.census. Invest Ophthalmol. Available at: http://www.25:900-907. Int J Ophthalmol. Occup Environ Med. International Dry Eye WorkShop (DEWS). Gold.nr0. 1996. 2014. 2015. 17 Gipson IK. 27. Ophthalmology. 2014. 6 Canadian Association of Optometrists. Available at: Dry Eye.21:221-232. Workshop on Clinical Trials in Dry Eyes. REFERENCES 1 Lemp MA. Available at: www. computer/. 1985. Accessed on February 8 Ralph RA. Disease Guidelines for Canadian Optometrists. Shire. 33 U. or Platinum level. Clin Ophthalmol. 29 Vehof J et al. 2014 Dec 23:1-21. Care of the Patient with 32 American Association of Retired People (AARP). Funding for this supplement. CLAO J. Ocul Surf. 2006. was provided by Alcon. Workshop on Meibomian Gland Dysfunction. Disclaimer This supplement is a summary of the Dry Eye Summit proceedings held in Dallas. ScienceBased Health. Nicox. on December 11–13. 2015. 2014. 34 U.215:430-434.54(14):ORSF48-53.indd 1 6/1/15 4:07 PM .103:664-669.gov/news.

Diagnostic. computers) SCREENING QUESTIONS TO ASK Do your eyes ever feel dry or uncomfortable? 2 Are you bothered by changes in your vision throughout the day? 3 Are you ever bothered by red eyes? 4 Do you ever use or feel the need to use drops? DIAGNOSTIC TOOLS TO USE 1 Eyelid examination 2 Staining 3 Tear film instability BASIC MANAGEMENT STRATEGIES 1 For all patients: a) Ocular lubrication b) Lid hygiene c) Nutrition 2 Topical anti-inflammatories Vision begins with the tear film. Report of the TFOS/ARVO Symposium on global treatments for dry eye disease: an unmet need. have at least early signs or symptoms of this disease. 0615_BioScience.g. tablets. 2012.. *Initial recommendations were developed based on consensus reached by experts in dry eye disease at the Dry Eye Summit (December 2014).g. diabetes) 2 Medications (e. Ocul Surf. yet many cases of dry eye disease go undiagnosed or untreated.S.. KNOW THE RISK FACTORS 1 Disease (e.10:108-116. cell phones. antihistamines/ decongestants) 3 Age 4 Digital device use (e. and help protect their ocular surface health.g. and Management Recommendations* Dry eye disease is one of the leading causes of patient visits to eye care practitioners..1 Incorporating these recommendations into your practice will help you identify and treat many more patients with dry eye disease.indd 1 6/1/15 4:07 PM . An estimated 20 million individuals in the U. 1. Sullivan DA et al. DRY EYE DISEASE Screening.

Italy. Akpek EK. 2010. Blackie CA.2 of the tear film. Evaluation of extended tear stability by two emulsion based artificial tears. Christensen M.. © 2014 Novartis 05/14 SYS14005JAD-B Relief that lasts 0615_BioScience. For the 75% of dry eye patients worldwide with evaporative dry eye (MGD) symptoms 1. SYSTANE® BALANCE Lubricant Eye Drops forms Make sure your patients a protective matrix that is designed to replenish the lipid get the lasting symptom layer for long-lasting relief from the symptoms associated with relief they need by offering LIPID LAYER evaporative dry eye (MGD). September 22-25. them SYSTANE® BALANCE This unique formulation is AQU EOUS LAYER designed to work on all 3 layers Lubricant Eye Drops.19 (5 suppl):S67-S75. Overview of age-related ocular conditions. References: 1. Poster presented at: 6th International Conference on the Tear Film and Ocular Surface: Basic Science and Clinical Relevance. Meadows DL.indd 1 6/1/15 4:08 PM . This helps create GLAND L EPITHEL NE A I UM a protective environment for the C OR ocular surface. DRY EYE CAN BE RELENTLESS CALM THE STORM WITH LASTING RELIEF SYSTANE® BALANCE Lubricant Eye Drops: Protecting the Ocular Surface by Increasing Lipid Layer Thickness (LLT) Your recommendation counts. Florence. 2. Tudor M.2 SYSTANE® Brand products are formulated for the temporary relief of burning and irritation due to dryness of the eye.. Am J Manag Care. specifically IN LAYER M UC MEIBOMIAN increasing LLT. 2013. Korb DR. Smith RA.