In this episode of Interventional Mindset, Preeya K. Gupta, MD, and Cory Lappin, OD, MS, FAAO, founder of the Dry Eye Center of Ohio, discuss early pharmacologic intervention, practice challenges, and patient communication in dry eye treatment.
Dry eye management fast facts
- Early pharmacologic treatment addresses dry eye before disease progression and prolonged OTC failure.
- Artificial tears and lid hygiene are supportive therapies, not definitive treatment.
- New pharmacologic classes allow more targeted treatment of multifactorial dry eye disease.
- Effective dry eye care often requires combination therapy and procedural intervention.
- Patient education and streamlined medication access improve treatment success.
The value of early pharmacological intervention in DED
Dry eye disease (DED) is a multifactorial disease with multiple etiologies and, as such, should be treated with pharmacologic interventions with varying mechanisms of action, including immunomodulators for inflammation, neuromodulators for increased tear production, and anti-evaporatives for lipid layer issues, often requiring a multifaceted approach.1
However, there is a common "disconnect" between patient experiences and the current standard of care, in which patients often spend months trying ineffective over-the-counter (OTC) remedies. “We have so many amazing options that sometimes it can almost lead to analysis paralysis," explained Dr. Lappin. "Like, ‘Where do I start?’ and ‘What do I do?’ At the end of the day, there's only one wrong answer…and it's to do nothing.”
While OTC treatments such as artificial tears and lid hygiene provide a solid starting point, they often do not fully address the underlying causes of dry eye, such as inflammation or meibomian gland dysfunction (MGD). As a result, many patients may spend months experimenting with various OTC options when prescription treatments are actually the most effective for DED.
Dry eye management strategies
Implementing early pharmacological intervention can significantly reduce the need for more extensive treatments in mild cases of DED compared to those that are more severe. Both Drs. Gupta and Lappin stress that providing patients with a variety of treatment options promotes better compliance and improves outcomes. An early proactive approach means less reliance on demanding therapies, such as frequent artificial tears or warm compresses.
Similar to glaucoma management, it’s important to use multiple medications with different mechanisms of action simultaneously rather than just switching from one to another. In the words of Dr. Lappin, “I often say with now having multiple classes and having really, really good in-office procedures at this point, we really have to kind of shift away from the ‘or' and to the 'and' mindset… You just have to literally take your glaucoma mindset and move it to dry eye… They're both chronic diseases, and they both have to have long-term management.”
The treatment landscape for DED has evolved to include not just anti-inflammatory therapies but also anti-evaporative agents, addressing the evaporative component present in many patients. There are also neuromodulatory agents available to increase natural tear production as well. Dr. Lappin encourages colleagues who may hesitate to start with prescription medications to build their confidence by initiating treatment with one effective option.
Tacking practice management challenges
The complexities surrounding insurance coverage and prior authorizations cannot be ignored, undoubtedly these administrative tasks can be time-consuming. However, having efficient systems in place to manage these tasks can help smooth practice operations.
Dr. Gupta emphasized the importance of considering medication access for dry eye patients, “There's nothing worse than prescribing a medication that you know has a 0% chance of being covered, have them go through everything, and then come back and hear that the medicine's $850.”
To address potential challenges, they recommend using specialty pharmacies, leveraging manufacturer resources, and implementing office systems to streamline the prior authorization process.
The role of patient communication
Effective communication plays a key role in managing dry eye disease. Dr. Lappin highlights the importance of establishing trust through open dialogue, which helps patients understand the treatment roadmap. This clarity is vital for ensuring long-term compliance and instilling confidence in their treatment journey.
Dr. Lappin elaborated: “I want them to know my exact thoughts when we're in the room, but I also want them to know where my thoughts are down the road because then there's no guesswork. They know exactly what I'm thinking. They understand my thought process. And I feel like that's just helped with communication, but it's also helped the patient stick to their treatments more.”
In conclusion
As the treatment landscape for dry eye disease continues to expand, clinicians have more opportunities to intervene earlier and more effectively. Moving beyond a “wait-and-see” approach and recognizing when OTC therapies are insufficient can help prevent disease progression and improve patient outcomes.
Dry eye should be managed as a chronic disease, often requiring individualized combination therapy and ongoing patient communication to support adherence and long-term success. By adopting an interventional mindset and utilizing the growing range of pharmacologic and procedural options, optometrists and ophthalmologists can significantly improve quality of life for patients with dry eye disease.
