Impact of dry eye disease: symptom burden, patient feedback, managing the condition
In part 1 of a 5-part video series, a panel of ophthalmologists and optometrists discuss the daily impact of dry eye disease on patients.
Marjan Farid, MD:
Hello everyone. Welcome today. We’re so happy you could join us. I am Marjan Farid, MD. I’m Director of Cornea, Cataract, and Refractive Surgery at the Gavin Herbert Eye Institute at UC Irvine. Happy to be here with you today and joined by some amazing colleagues here who are just leaders in ocular surface disease and the management of dry eye disease.
Today, we’re really going to jump in and talk a little bit about something we all encounter with our patients on a day-to-day basis, which is dry eye disease or tear film dysfunction, as I like to call it. Really figuring out how to restore the ocular surface. What are the tools we have? How do we diagnose patients? I’m going to turn it over to my amazing colleagues to introduce themselves.
Nathan Lighthizer, OD:
Hey everyone. Dr. Nate Lighthizer, OD, faculty member [and] founder of the Dry Eye Service at the NSU Oklahoma College of Optometry. Now serve as dean there.
Karolinne Rocha, MD, PhD:
Great. Thank you for having me. I’m Karolinne Rocha, MD, PhD. I’m the Director of Cornea and Refractive Surgery at the Medical University of South Carolina [at] Storm Eye [Institute]. I’m also in academics, so thank you so much for having me.
Cory Lappin, OD:
I’m Dr. Corey Lappin, OD, and I’m really excited to be joining this great group. I’m the founder of the Dry Center of Ohio, which is a dedicated dry and ocular surface disease practice in Cincinnati, Ohio.
Marjan Farid, MD:
Let’s start by sort of reviewing what … We see dry eye patients every day, but really what is the impact? What is the burden of this disease on our patients? We see a wide range of patients with dry eye disease and a lot of these patients come in and they’re absolutely miserable. I have patients that ask me for disability leave because they really can’t function at this screen anymore. We’re dealing with this all the time.
Nathan, in your dry eye center, I’m sure you’re seeing the worst of the worst as well. What is your take on the impact of this disease?
Nathan Lighthizer, OD:
Well, it certainly has a big impact on our patients. Like you said, I’ve had patients wanting disability. I’ve had patients crying in my chair because they’re just so frustrated at the burning and stinging and fluctuating vision and the dryness symptoms that they have, and they’ve been battling them sometimes for 6 months. I had a patient recently said, “My eyes have fallen off a cliff. I don’t know what happened. Nine months ago I was fine. Then this has happened.” We’ve all had other patients that have been dealing with this for 20-plus years, and we know that dry eye is a progressive, chronic condition oftentimes. It’s certainly burdensome to our patients. A lot of our treatments we put in their hands. They may be doing 2, 3, 4 different things and they feel that burden as well. It impacts patients.
I am treating my accountant right now and he’s just so frustrated. He goes, “At the end of the day, especially during tax season, the 8s look like 6s and the 7s look like 1s.” He has this fluctuating vision. Regardless of what the symptom is, whether it’s burning and stinging or fluctuating vision, this impacts our patients and it hits so many of them that it’s certainly a big thing that we deal with, not on a weekly basis, not on a daily basis, it’s an hourly basis in our practice. It certainly hits home for many, many patients.
Marjan Farid, MD:
Absolutely. A lot of patients ask me, “What is the cause?” And, “How can my eyes be dry, I just put some artificial tears in? What are you talking about?” How do you explain to patients what is dry eye disease, truly? What is the impact of a normal healthy tear and when does that become dry eye disease? Is it just a tear film insufficiency? Where do you see that change and how do you explain it to patients?
Nathan Lighthizer, OD:
I tell patients we have, we call it dry eye, but really we have dysfunctional tear syndrome. Or there are many different terms that you can tell them is just our natural tears are not doing what we should. We’re not producing as many natural tears as we could. I use the term multifactorial and I tell them that means there’s just so many different causes of dry eye. I tell them from medications, either topical or systemic from contact lens wear to age to gender, there’s just so many different things. I think that’s one of the reasons why a valuable questionnaire to help pinpoint how many risk factors does this patient have is so useful whether you use a quantitative questionnaire like SPEED or OSDI. But we really use a qualitative questionnaire as well to zero in on all those different causative factors, some of which we can change, others which we can’t like age and gender.
I think it’s important to spend time with these patients. These patients have probably seen multiple doctors over the years and they want somebody that’s just going to care, that’s going to listen to them. That’s going to give them a little bit of time and explain to them that this may be related to your sleep apnea. It may be related to your autoimmune disease. It may be related to your systemic medications or your eye surgery that you had a number of years ago. But we’re going to address this in multiple different ways.
Fortunately, in 2025, we have lots of different ways to treat dry eye. I tell them, “I’m not going to cure this. We’re going to manage this, and my goal is to make you a little bit better and a little bit better and a little bit better every single visit. I don’t have a magic pill or a magic drop that’s going to cure this in a week or a month or even a year, but you and I are going to get to become friends as we see you 2, 3, 4 times a year and get this going in the right direction. You hang in there, I’m going to need a commitment from you, but you’ve got my commitment as well.”
We have found that just that level of interaction, patients buy into that, and they like that a lot. Talking about all the different causes, using a questionnaire, and really just that chair time with them is so valuable in getting their buy-in.
Marjan Farid, MD:
It really goes a long way, and I tell patients we have to find the right cocktail that works for you. I completely agree with you, Nathan.
