Reviews Supplements The Science of Dry Eye and Its Impact on the Patient : Page 1

Th e SCIENCE of DRY EYE and Its IMPACT on the PATIENT A roundtable of respected dry-eye experts tackles today’s most pressing issues related to the diagnosis, treatment and management of this condition. Kenneth A. Beckman, MD, (Moderator): Estimates of the prevalence of dry eye in the U.S. population range from approximately six to 43 million people. 1,2 In fact, some reports indicate that, in the 50+ age group alone, nearly fi ve million Americans are estimat-ed to have dry eye. 3,4 When you start also accounting for the patients who are not diag-nosed because they’re asymptomatic or have less noticeable signs and symptoms, these numbers can become much higher. Now, consider the drastic changes that technology has imposed. What eff ect will this have on the prevalence of dry eye? Christopher E. Starr, MD: We all spend large amounts of time on computers and mobile devices, and this has increased symptomatic dry eyes. Computer vision syndrome, as it’s been called, is multifacto-rial and aff ects blink rate by as much as 50 percent in some people. 5 When you’re not blinking, you’re not distributing tears. In-stead, the tears are evaporating. Th is vicious cycle of decreased blink and evaporation creates an unstable tear fi lm. Original Release Date: April 1, 2015 Termination Date: March 31, 2016 Acknowledgement of Commercial Support: Allergan Inc. Principal faculty and their credentials: Richard A. Adler, MD; Kenneth A. Beckman, MD; David R. Hard-ten, MD; Sheri L. Rowen, MD; Christopher E. Starr, MD Description/Goal: The Nearly fi ve million Americans 50 years of age and older are estimated to have dry eye, and off these, more than three million are women and more than one and a half million are men. Tens of millions more have less severe symptoms. Dry-eye syndrome is characterized by one or more of the following symptoms: burning; itching; foreign body sensation; soreness; dryness; photophobia; redness; and reduced visual acuity. 1,2 Additionally, the tear fi lm instability of the condition causes infl ammation and structural damage to the ocular surface. 1 This activity will cover the latest fi ndings and approaches to managing dry eye in patients, from Sheri L. Rowen, MD: Th is cycle is further damaging in patients with underlying mei-bomian gland dysfunction. When blinking is reduced, the lid margin dries out and there is keratinization of the outer layer of the meibomian orifi ces. As a result, the oil may have trouble getting out with every blink—a phenomenon that’s compounded by the in-complete blinking. When oil starts stagnating and consolidating, we begin to see plugs inside of the glands as we express them. Dr. Beckman: Computer and digital devices are indeed infl uencing the prevalence in our patients and the exact fi gures can be higher or lower, depending on where you practice. For instance, if you practice in an environment where it’s cold, the heaters are on and the hu-midity is very low, prevalence may be higher. David R. Hardten, MD: Longevity is anoth-er factor that infl uences prevalence. As people live longer, the time period that they are disabled by dry eye and the chances of dry eye progressing increase. As a result, we now need to protect against the problems acknowledging and elevating the importance of the condition in the eyes of physicians, to recognizing it in its early stages, to treating it appropriately and creating positive experiences for patients undergoing treatment. 1. Management and therapy of dry eye disease: report of the Management and Therapy Subcommittee of the Inter-national Dry Eye WorkShop. Ocul Surf. 2007; 5:163-178. 2. Opperman, M. E-Mail Surveys—Potentials and Pitfalls. Marketing Research.1995; 7:29-33. that dry eye creates and we need to be more proactive about dealing with it at a young-er age. Th is is particularly challenging in asymptomatic populations. Dr. Beckman: Prevalence statistics can easily miss asymptomatic patients and other less obvious cases. Furthermore, I’ve found that many patients are incorrectly labeled as asymptomatic. Oft en, patients have true dry-eye symptoms—they simply are not rec-ognized as such. For example, epiphora is one of the most common symptoms of dry eyes. But if you ask a patient with tearing if his eyes feel dry, he’s going to say no. What do you do in your practice to ensure that such patients don’t fall through the cracks? Dr. Hardten: I approach these patients much as I’d approach a glaucoma suspect. To begin, I try to fi gure out which of my asymptomatic patients might be developing damage in the future. For example, if I see a patient who’s asymptomatic in May or June, I start asking questions about how their eyes felt during the cold Minnesota winter, when the heaters were Physicians Accreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Institute for the Advancement of Human Behavior (IAHB) and Postgraduate Healthcare (PHE). The IAHB is accredited by the ACCME to provide continuing medical education for physicians. Credit Designation Statement: The IAHB designates this Internet enduring material activity for a maximum of 2.0 AMA PRA Category 1 Credits TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Statement of Disclosure: All faculty/speakers, planners, abstract reviewers, moderators, authors, co-authors and administrative staff participating in the continuing medical education programs jointly provided by IAHB and PHE are expected to disclose to the pro-gram audience any/all relevant fi nancial relationships Target Audience: This educational activity is intended for general ophthalmologists who manage patients with dry eye symptoms. Learning Objectives: On completion of this educational activity, participants should be able to: 1. Provide an evidence-based summary of the signifi cance of early identifi cation and treatment of dry eye. 2. Explain the relationship between computer use and dry eye. 3. Recognize the importance of communicating with dry-eye patients about the reality of their condition. 4. Describe the implications of untreated dry eye. Jointly provided by (cont’d on page 2) Supported by an Independent Educational Grant from Allergan, Inc. Review of Ophthalmology ®

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