Trends in Dry Eye Disease Management Worldwide

Figures & data

Table 1 Summary of Therapies for Dry Eye Disease^22–25

Treatment Strategy	Therapies
First line therapy	Warm compresses, lid hygiene Artificial tear supplements Patient education Modification of environment Dietary modification
Second line therapy	Tea tree oil therapy for Demodex Punctal plugs Moisture chamber devices Ointment overnight Intense pulsed light therapy Topical corticosteroids Topical Antibiotics Oral secretagogues Serum eye drops Therapeutic contact lens options Non-glucocorticoid immunomodulators (cyclosporine) LFA-1 antagonist drugs (lifitegrast) Oral tetracycline antibiotics Oral and topical hyaluronic acid Purinergic P2Y2 receptor agonist (diquafosol) Amniotic membrane grafts
In office procedures	Intense pulsed light therapy Vectored thermal pulsation Meibomian gland probing BlephEx™

Table 2 Summary of Diagnostic and Therapeutic Trends Among Community Eye Care Practitioners Surveyed in the Past Two Decades

Countries	Clinical Paper (Year) Countries	Diagnostic Tools Most Frequently Used as First Choice (% of Respondents)	Mainstay of Treatment (% of Respondents)
Australia, Canada, Italy, Japan, Switzerland, United Kingdom, United States	Korb. Survey of Preferred Tests for Diagnosis of the Tear Film and Dry Eye (2000)^Citation26	Dry eye questionnaires (and/or history) (28%) Fluorescein break up time (FBUT) (19%) Ocular surface stain (13%) Schirmer test (9%)
Australia, United Kingdom	Turner et al Survey of eye practitioners’ attitudes towards diagnostic tests and therapies for dry eye disease (2005)^Citation27	History – rated 8.5/10 for diagnosis FBUT – rated 7/10 for diagnosis
Korea	Kim et al Status of diagnosis and treatment of patients with dry eye in Korea by survey (2007)^Citation28	Decreased FBUT (42.6%) Symptoms (37.1%) Schirmer test (13.2%)	Top three treatments for each level of severity: Level 1 – preserved artificial tear substitutes (35.9%); environmental management (31.3%); lid hygiene (12.5%); Level 2 - non-preserved artificial tear substitutes (19.1%); gels and ointments (17.6%); environmental management (17.5%); Level 3: non-preserved artificial tears (17.5%); gels and ointments (15.4%); anti-inflammatory agent (13.1%); Level 4: – non-preserved artificial tears (13.5%); gels and ointments (13.4%); punctal plug (12.1%)
United States	Asbell et al Ophthalmologist perceptions regarding treatment of moderate to severe dry eye: results of a physician survey (2009)^Citation29		Primarily lubrication with artificial tears For more moderate to severe use of multiple therapies
Spain	Carona et al Knowledge and Use of Tear Film Evaluation Tests by Spanish Practitioners (2011)^Citation33	Preference #1: TBUT – optometrists (56.4%) and ophthalmologist (41.8%) OR Schirmer test – optometrists (21.4%) and ophthalmologists (26.2%) Preference #2: TBUT – optometrists (39.3%) and ophthalmologists Schirmer test (35%)
Philippines	Echavez et al Survey on the Knowledge, Attitudes, and Practice Patterns of Ophthalmologists in the Philippines on the Diagnosis and Management of Dry Eye Disease (2013)^Citation34	Most valuable tests ranked: 1 TBUT (90%) 2 Fluorescein corneal stain (91%) 3 Schirmer test (70%) 4 Meibomian gland evaluation (84%) 5 Patient symptoms (99%) 12 Tear osmolarity (6%)	Most valuable treatments ranked: 1 Artificial tear substitutes (100%) 2 Lid hygiene (88%)
Australia	Downie LE, Keller PR, Vingrys AJ. An Evidence-Based Analysis of Australian Optometrists’ Dry Eye Practices (2013)^Citation30	Most valuable tests ranked: 1 Symptom assessment (62.6%) 2 FBUT (35.3%) 3 Meibomian gland evaluation (27.5%) Tear osmolarity (<10%)	Artificial tear substitutes – non-preserved Lid hygiene
United States (North Carolina)	Williamson et al Perceptions of Dry Eye Disease Management in Current Clinical Practice (2014)^Citation35	History and symptoms (69.7%) (measure of therapeutic effect) FBUT (47%) Ocular surface stain – fluorescein (39%) Tear osmolarity (2%)	Artificial tear substitutes – non-preserved (80.8%) Lid hygiene (15.2%)
Australia and the United Kingdom	Downie et al Comparing self-reported optometric dry eye clinical practices in Australia and the United Kingdom: is there scope for practice improvement? (2016)^Citation31	Results averaged across countries: Patient symptoms (61%) Meibomian gland evaluation (59.6%) FBUT (56.2%) Conjunctival stain (49.9%) Tear osmolarity (<8%)	Mild – non-preserved artificial tear substitutes (74.5%) and lid hygiene (70%) Moderate to severe – first two treatments remain non-preserved artificial tear substitutes and lid hygiene with additional non-preserved gels being the third choice
Ghana	Asiedu et al Survey of Eye Practitioners’ Preference of Diagnostic Tests and Treatment Modalities for Dry Eye in Ghana (2016)^Citation32	TBUT – optometrist (62%); ophthalmologist (65%) Patient history – optometrist (31%); ophthalmologist (35%) Tear osmolarity (0%)	Aqueous based artificial tears optometrists (66.2%) ophthalmologist (85%) and lipid based artificial tears optometrists (21.8%) and ophthalmologists (15%)
New Zealand	Xue AL, Downie LE, Ormonde SE & Craig JP. A comparison of the self-reported dry eye practices of New Zealand optometrists and ophthalmologists (2017)^Citation12	Patient symptoms Meibomian gland evaluation Corneal and conjunctival fluorescein stain FBUT Tear osmolarity (<5%)	Mild: Non-preserved artificial tear substitutes optometrists (74%) ophthalmologists (72%) and lid hygiene optometrists (74%) and ophthalmologists (62%) Moderate: eyelid hygiene optometrists (90%) ophthalmologists (76%) and non-preserved lubricant drops optometrists (86%) ophthalmologists (86%) and gels optometrists (71%) and ophthalmologists (45%). -Severe: addition of oral tetracyclines, corticosteroids, oral omega-3 fatty acid supplements
United States	Bunya et al A Survey of Ophthalmologists Regarding Practice Patterns for Dry Eye and Sjogren’s Syndrome (2018)^Citation41	Corneal stain – fluorescein (62%) TBUT (49%) Schirmer’s test (32%) Tear osmolarity (18%)

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