Optometrist Paul Karpecki

Provides you with invaluable clinical education on management strategies for a host of ocular surface disease conditions — from dry eye disease to meibomian gland dysfunction and conditions that mimic dry eye disease symptoms.

The Dry Eye Market

As we embark upon this deep dive into ocular surface disease and, in particular, dry eye management, I want to thank Shire Pharmaceuticals for its support, in the form of an unrestricted educational grant, of the upcoming series of clinical pearls.

So, just how big is the dry eye market and why should our profession wholeheartedly embrace the management of dry eye disease (DED)?

Research shows that dry eye prevalence ranges between 5% to 50% based on symptoms alone, and as high as 75% based on clinical signs.¹ Such estimates suggest that signs and symptoms don’t always correlate to dry eye disease, and that the numbers of patients with either signs or symptoms is staggering.

If we look at two broad, US-based research projects—the Beaver Dam Study and the BOSS study (which evaluates dry eye in the children or offspring of the original Beaver Dam participants)—we see that approximately 30 million Americans likely have some form of dry eye disease.²

Further, based on the BOSS study, the incidence of DED in younger adults is comparable to that of older adults.² To put that in perspective, the incidence of glaucoma in patients older than 40 in the US is about 2.2 million individuals.³ Thus, DED is at least 12 times more common than other highly prevalent ophthalmic diseases, such as glaucoma and AMD. And unfortunately, we believe that only about one million DED patients in the US are actively being managed. This may be the greatest opportunity for the optometric profession we’ve ever experienced. DED adversely affects contact lens wear, and more than 7.5 million people drop out every year.

One report suggests that spectacle remakes might be largely attributable to dry eye disease, and that the incidence of IOL miscalculations is exceedingly high in patients with DED.⁴ The authors note that 17% of patients with hyperosmolar tears, as measured via TearLab Osmolarity testing, had missed their IOL target by more than 1.00D, and as high at 5.50D.⁴ Anecdotally, some clinicians have even suggested that medication compliance for sight-threatening diseases, such as glaucoma, may be negatively impacted by the presence of dry, irritated eyes secondary to chronic drop use.

Make no mistake about it—DED is a disease of the visual system, as the tear film serves as the first anatomical point of contact for light. This series of upcoming clinical pearls will continue to focus on the pathogenesis, detection and management of dry eye in an effort to provide your patients the most optimal care possible. Thank you for being part of this.

1. Nelson D, Craig JP, Esen K, et al. TFOS DEWS II Introduction. The Ocular Surface 15 (2017) 269e275.

2. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry Eye in the Beaver Dam Offspring Study: Prevalence, Risk Factors, and Health-Related Quality of Life. Am J Ophthalmol. 2014 April; 157(4):799-806.

3. Vitale S, Cotch MF, Sperdute RD. Prevalence of visional impairment in the United States. JAMA 2006;295(18):2158-63.

4. Epitropoulos AT, Matossian C, Berdy GJ, et al. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. JCRS August 2015;41(8):1672-7.

'He who is not courageous enough to take risks will accomplish nothing in life.'
– Muhammad Ali

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