The Change Is Coming

Some giants, such as Allergan, have been longstanding dry eye partners with products like Restasis and now new offerings in dry eye treatment with the TrueTear device (pictured).

By Dr. Jerry Robben
Journal of Dry Eye and Ocular Surface Disease

​As the new year starts I sense a change occurring in eye care that many of us have been eagerly waiting for. Dry eye disease is finally starting to get the acknowledgement and understanding that it deserves. This acknowledgement is beginning to span the eye care world, not just thought leaders and early adopters are turning on to the fact that dry eye is real and deserves treatment; but more and more, the every-day eye care provider is beginning to actively hunt for dry eye disease and treat it in more and more sophisticated ways. Intelligent discussion about dry eye is becoming more commonplace. Dry eye is not as regularly excused as just a waste-bucket diagnosis. The change is coming, where ECPs, who are not as well equipped to treat a dry eye patient, will actively refer that patient to a more specialized clinic for shared care, similar to patients with a severe corneal ulcer. The change is coming; we are not there yet, but it is starting. Take a look around the eye care world and you will see the signs.

For instance, if you look at the various publications related to eye care, you will find dry eye and ocular surface disease discussed in nearly every issue that is circulated. In many cases the dry eye content will be listed on the cover, or as the main focus of the cover itself. We even have journals devoted to this subject, such as our own Journal of Dry Eye and Ocular Surface Disease.

Next time you attend an eye care meeting and trade show, look around the exhibit hall. You will see dry eye everywhere. We see companies in the eye care and medical industry taking notice to the importance of treating this disease. Some giants, such as Allergan, have been longstanding dry eye partners with products like Restasis and now new offerings in dry eye treatment with the TrueTear device. Newer to the dry eye area is mega giant Johnson & Johnson, one of the largest companies in the world. As we all know, J&J has acquired Tear Science and their Lipiview/Lipiflow diagnostic and treatment technology. I feel this investment into Tear Science, one of the cornerstone components in dry eye diagnosis and management, by a company like J&J is validation that dry eye is not just a blip on the radar that will go away. It is validation that these companies see value in dry eye as a growing need in our industry, and that there is opportunity in this growing market. Many other smaller companies and startups are investing in dry eye and still more giants are looking into how they should enter the space (likely by gobbling up the smaller companies).

Dr. Jerry Robben standing at the exhibit floor at the 2018 AAO in Chicago, IL.

Education is at an all-time high in the area of dry eye and ocular surface disease. Nearly every CE event will have a contribution about dry eye. There are a growing number of seminars devoted totally to dry eye, such as Dry Eye Bootcamp, Dry Eye University, The Canadian Dry Eye Summit, The Twin Cities OSD Symposium, ICO OSD Congress and many more. Some are privately run, sponsored by industry or sponsored by local and state organizations. There are established and emerging web-based resources. DryEyeCoach.com has been educating online for a few years now. Newcomer, DryEyeAccess.com, just launched in the final quarter of 2018. Both, and others, offer a unique approach to web-based dry eye education and practice resources. Facebook has a wonderful dry eye community page for any eye care provider, called OSDocs. This Facebook page offers very progressive and supportive discussion from major thought leaders and every-day providers alike, all on the sole topic of dry eye. There is another Facebook page called Lipiflow Users that is a resource for practitioners using this device. Many other dry eye related Facebook groups also exist.

Diagnostic and treatment options continue to expand. Many new diagnostics with unique approaches, such as the HD Tear Film Analyzer from Visiometrics, are released regularly, as well as new options for established diagnostics, as in the case of meibography, which now we can choose from many different platforms to obtain this necessary patient information. In the treatment world, Xiidra (SHIRE, which was recently acquired by Taketda) is still relatively new and unique. The TrueTear device from Allergan is a promising newcomer that certainly is unlike anything else out there. As well, new treatments like iLux (Tear Film Innovations, which was recently acquired by Alcon) or Tear Care (Sight Science) have recently entered the space that Lipiflow has been targeting for years.
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Things are changing in the dry eye world and they are changing for the better. Those of us who have been beating the dry eye drum are finally not having to justify our reasoning as much to our colleagues. The interest is growing in the approaches that we have been developing to treat this very complex disease, instead of being ignored or deemed boring. If the eye care community can continue to advance the narrative and open more ECPs up to actively targeting and treating it, then we all win. If the majority of ECPs are recognizing and treating dry eye, it will become more accepted and ultimately applauded to proactively treat this disease, and patients will notice. It will become more commonplace and known to patients of the importance of us doing this. And, sooner rather than later, it will become easier to treat because most patients will expect it. And when this finally occurs, most important of all, our patients will win. Their ocular health will be better and more stable as a whole with correct dry eye disease diagnosis and proactive and effective treatment. This day is coming for us all. My patients, and the patients of many of our colleagues already enjoy these advantages due to our early adoption into the treatment of this disease. Soon, if we continue to advance, all patients will benefit, as they should. 

Jerry Robben, O.D.
Bowden Eye & Associates, Jacksonville FL
Dry Eye University
Dry Eye Access

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Dr. Jerry Robben is a member of the Journal of Dry Eye and Ocular Surface Disease (JDEOSD) Editorial Board. He graduated from NOVA Southeastern University College of Optometry in 2009 and is currently the Chief Optometrist and Director of Clinical Research at Bowden Eye & Associates in Jacksonville, FL. Read more about Dr. Robben and the JDEOSD editorial board here.