Long-term Natural History of Dry Eye Disease from the Patient's Perspective

Lienert, Jeffrey; Tarko, Laura; Uchino, Makoto; Christen, William G.; Schaumberg, Debra A.

doi:10.1016/j.ophtha.2015.10.011

Cited by 61 publications

(42 citation statements)

References 19 publications

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“…Improvement was reported by 44% of respondents for ocular surface symptoms, 19% for vision-related symptoms, and 19% for social impact, while worsening since diagnosis was reported by 24%, 29%, and 10%, respectively. 9 While ocular lubricants are a mainstay of DED therapy, they generally provide only temporary symptom relief and do not target the underlying pathophysiology of DED. 1 Numerous formulations are available.…”

Section: Limitations Of Current Ded Treatmentmentioning

confidence: 99%

<p>Managing Dry Eye Disease and Facilitating Realistic Patient Expectations: A Review and Appraisal of Current Therapies</p>

Lee¹,

Kabat²,

Bacharach³

et al. 2020

OPTH

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Dry eye disease (DED) is a multifactorial disease of the ocular surface characterized by loss of homeostasis of the tear film and accompanied by ocular signs and symptoms such as corneal and conjunctival damage, patient discomfort, and visual disturbance. The prevalence of DED ranges from 5%−33%. Patients with DED may have a reduced quality of life due to their discomfort and visual disturbances. The multifactorial nature of DED requires a multi-targeted treatment approach to address the signs and symptoms. Treatment for DED should follow a stepwise approach beginning with education, dietary modification, and lid and lash hygiene, and progressing to pharmacologic and nonpharmacologic interventions. Ocular lubricants, a mainstay of DED therapy, provide temporary symptomatic relief for the patient, but do not address the underlying pathophysiology. Some currently available pharmacologic treatments that address the underlying pathophysiology of DED may have a delay of 3−6 months in the onset of therapeutic effect; however, these treatment options may also have tolerability issues. These challenges highlight the need for newer pharmacologic treatments with an earlier onset of observable clinical effect and the potential for improved tolerability profile. Patient education is vital to DED management and should convey the complex and chronic nature of DED. It is important for the eye care practitioner to set realistic expectations with the patient when managing DED to help improve treatment success. This helps the patient understand the need for ongoing treatment and that results will likely not be seen immediately. This review covers the current management of DED, focusing on pharmacologic management, and offers recommendations for the practitioner to help facilitate realistic patient expectations for the treatment of DED.

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Section: Limitations Of Current Ded Treatmentmentioning

confidence: 99%

<p>Managing Dry Eye Disease and Facilitating Realistic Patient Expectations: A Review and Appraisal of Current Therapies</p>

Lee¹,

Kabat²,

Bacharach³

et al. 2020

OPTH

View full text Add to dashboard Cite

show abstract

“…This finding is in contrast to a randomized study of artificial tears vs cyclosporine, 0.05%, where 32% of 22 patients treated with artificial tears had disease progression (composite of symptoms and signs) at 1 year vs 6% of 36 patients treated with cyclosporine, 0.05%. 26 A previous study demonstrated that patients with neuropathic pain-like ocular symptoms (hot-burning ocular pain and sensitivity to light and wind) had a more persistent and severe course of dry eye symptoms. 27 A limitation of that study, however, was that these pain-specific descriptors were obtained at follow-up and not at the baseline examination.…”

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confidence: 99%

Longitudinal Examination of Frequency of and Risk Factors for Severe Dry Eye Symptoms in US Veterans

et al. 2017

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IMPORTANCE Dry eye syndrome is a common condition that affects millions of individuals. Many cross-sectional studies have evaluated risk factors for dry eye severity, but few have assessed risk factors or symptom progression over time. OBJECTIVES To assess symptom progression in dry eye syndrome and determine risk factors associated with severe symptoms at 1 year. DESIGN, SETTING, AND PARTICIPANTS A longitudinal study was conducted from October 1, 2013, to April 30, 2015, among patients at the Miami Veterans Affairs Hospital with a wide variety of dry eye symptoms and signs (ranging from none to severe). MAIN OUTCOMES AND MEASURES Change in dry eye symptom severity during 1 year, as assessed by responses to dry eye symptom questionnaires administered at the initial visit and 1 year later, as well as baseline risk factor analysis for severe dry eye symptoms at 1 year, defined as a Dry Eye Questionnaire 5 score of 12 or more. RESULTS Of the 120 patients (mean [SD] age, 64 [11] years; 109 male and 11 female), 26 of 58 (44.8%) with either no symptoms or mild or moderate symptoms at baseline progressed to more severe symptoms at 1 year, while 46 of 62 patients (74.2%) with severe symptoms at baseline reported that severe symptoms persisted at 1 year. Baseline ocular risk factors for severe dry eye symptoms at 1 year included more severe dry eye symptoms, ocular pain, and neuropathic pain-like ocular symptoms. Nonocular risk factors included sleep disturbances (eg, sleep apnea and insomnia), mental health status (eg, posttraumatic stress disorder and depression), nonocular pain, and medications (eg, anxiolytics and analgesics). In a multivariable analysis, the most significant risk factors were sleep apnea (odds ratio [OR], 3.80; 95% CI, 1.00-14.49; P = .05), Dry Eye Questionnaire 5 score (OR, 1.15; 95% CI, 1.02-1.30; P = .02), and posttraumatic stress disorder score (OR, 1.04; 95% CI, 1.01-1.08; P = .02). CONCLUSIONS AND RELEVANCE Patients with severe dry eye symptoms and ocular pain at baseline were more likely to have persistent severe dry eye symptoms on 1-year follow-up. Furthermore, nonocular risk factors that have been associated with dry eye cross-sectionally, such as psychiatric comorbidities and nonocular pain, were also associated with severe dry eye symptoms at 1 year. Although this cohort was limited to US veterans, which may not be generalizable to other populations, our results suggest that pain perception and severity are important when evaluating and managing dry eye.

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“…Clinical observations and impressions suggest that DED may be a progressive disorder. Lienert et al reported worsening of DED symptoms over time (13) and Rao et al have reported DED progression (worsening of signs and symptoms) in a proportion of patients (14). The DEWS II definition of DED does not include progression.…”

mentioning

confidence: 99%

Lifitegrast Ophthalmic Solution 5.0% for Treatment of Dry Eye Disease: Overview of Clinical Trial Program

Chan

Prokopich

2019

J Pharm Pharm Sci

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Dry eye disease (DED) is a common inflammatory disorder of the ocular surface. Millions of people are affected by DED worldwide. Lifitegrast is a novel drug designed to inhibit DED-associated ocular inflammation. Four clinical trials have shown that lifitegrast is well tolerated and effective in improving symptoms and signs of DED over 12 weeks. A fifth trial showed long-term safety over 1 year. Lifitegrast has been in clinical use for more than one year in the United States and was recently approved in Canada (in December 2017). In this review, we discuss lifitegrast’s novel mechanism of action and provide an overview of its clinical trial program.

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Long-term Natural History of Dry Eye Disease from the Patient's Perspective

Cited by 61 publications

References 19 publications

<p>Managing Dry Eye Disease and Facilitating Realistic Patient Expectations: A Review and Appraisal of Current Therapies</p>

<p>Managing Dry Eye Disease and Facilitating Realistic Patient Expectations: A Review and Appraisal of Current Therapies</p>

Longitudinal Examination of Frequency of and Risk Factors for Severe Dry Eye Symptoms in US Veterans

Lifitegrast Ophthalmic Solution 5.0% for Treatment of Dry Eye Disease: Overview of Clinical Trial Program

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