"Dry Eye Disease Does Not Worsen With Time in Most Patients"

[KittyCat]

Hi everyone, apologies if this article has already been discussed before, I'm new to the forum and I'm still working my way through the amazing amount of information here!

I've been diagnosed with evaporative dry eye (I presume this means MGD but my eye doctor didn't say), and due to how vague my eye doctor's response was, I've decided to do my own research on the condition.
My biggest concern was that while I'm considered a moderate case, I'm only going to get worse and worse (I'm 33 with an established career in proofreading/editing). I stumbled upon this medscape article that has given me a lot of hope! I've also noticed that the general vibe on DEZ is that a lot of people either improve or stabilise (bloody brilliant!) or do not get worse and worse over time.

What do you guys think? Accurate or wishful thinking?
Should the "chronic" and "progressive" labels be reconsidered considering all the Dry Eye Triumph stories on this forum?


https://www.medscape.com/viewarticle/856600


Cat xx

Oh, and just to mention, you have to register to read the full article. If you don't want to do that, let me know and I'll copy and paste here!

[Guest]

Hi. Thanks for your post. Would love you to cut and paste please.

[epicjinx]

Yes mgd is evaporative dry eye, things get better it varies with mgd (as I've found) one minute I'm 4 seconds tbut and then 7 thanks to IPL (intense pulse light) and then I'm back at 2/3 seconds. Yes its progressive and chronic but people share what successes they have had to manage this disease some get to a point it doesnt bother them through diet, sclerals, antiflammatory drops or steriods or a mix of different things. As long as you manage it, things will be ok hopefully. There is a dry eye forum on Facebook, dry eye talk, dry eye care. You can join and share your story there I think less people use this due to multiple reasons: some have moved on from this forum, some are still here but I dont know how active...! Just incase you wanted a quicker ish reply. And theres many more on there, it depends on you . Trying to manage this disease is what helps many. I hope this was of some help maybe?

[KittyCat]

Hi! That's really helpful thank you! I wondered why no one really posts on here now! I deleted my Facebook account a year ago as I was wasting far too much time on it so I might have to set up a new account just to use the dry eye pages!
I'm still trying to figure out what stage I have it (mild to moderate I think) and whether my eye doctor is right when he says I should be confident that it's going to get better. At the moment it's manageable, but I don't know what I'd do if it got worse. I'm not a very strong person I don't think.
Thanks ever so much for your help, and I hope you're doing well xx

[lipino]

I highly recommend finding a dry eye specialist. A good way to tell if they are a specialist is to see how many dry eye services they offer, e.g. lipiflow (I'm not a fan), IPL, punctal plugs/cautery, scleral lenses, autologous tears produced from your blood, probing. The typical eye doc is not going to help you much with this, although they do seem more knowledgeable now than 10 years ago when they basically just said "eh, just put some drops in." They might want to put you on Xiidra or Restasis, but just realize that those aren't cures, they are just an attempt to block part of the immune response and treat some of the symptoms. You should get your glands scanned and you should also get your tear film measured, not with the Schirmer's test, but with a device that measures it at different points in your eyelid.

[KittyCat]

Hi. Thanks for your post. Would love you to cut and paste please.

Hi there! Sorry, I've only just seen your reply. Here's the article in full:
Dry Eye Disease Does Not Worsen With Time in Most Patients

Diana Swift

December 30, 2015

Despite the general perception, dry eye disease does not necessarily worsen over time. Most patients report no progression, and some even report improvement, according to a retrospective survey-based study of healthcare professionals having the condition for an average of more than 10 years.

"These results, supported by review of clinical records, call into question the suggested tendency for [dry eye disease] to progress over time, but also point to possible inadequacies of current therapies," write Jeffrey P. Lienert, MS, from the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, and colleagues.

Those with a history of severe symptoms were more likely to experience worsening and to have epithelial damage such as corneal staining or superficial punctate keratopathy, the researchers report in an article published online November 21 in Ophthalmology.

In the United States, this chronic condition is estimated to affect 3.2 million women and 1.68 million men aged 50 years and older.

The investigators analyzed the medical records of 398 men and 386 women (more than 90% white) recruited from the Women's Health and Physicians' Health I and II studies who also responded to a questionnaire about their experience of disease change since time of diagnosis. Male participants ranged in age from 60.2 to 97.3 years and had the disease an average of 10.5 years; women ranged in age from 61.2 to 89.9 years, with an average disease duration of 14.5 years. A history of severe symptoms was reported by 68.1% of women vs 34.7% of men (P < .0001).

Thirty-six percent of patients were using level 2 treatments, and 64% were using level 1 agents or no treatments.

"At least 75% were on some form of treatment, if only artificial tears, although these are not thought to affect the disease process," coauthor Debra A. Schaumberg, ScD, OD, MPH, a professor of ophthalmology and visual sciences at the University of Utah Moran Center for Translational Medicine in Salt Lake City, told Medscape Medical News.

Subscale indicators of progression included worsening of ocular surface symptoms, vision-related symptoms, and social impact, as well as clinical signs from medical records.

Less than a quarter (24.1%) of respondents reported change in ocular surface symptoms, 28.7% in vision-related symptoms, and just 9.7% in social impact.

Women were not significantly more likely to experience worsening, but female sex was linked to past severe symptoms, which was a risk factor. Women also had more frequent corneal damage and more frequently underwent clinical tests for dry eye. "We don't know why women are more affected, but my hypothesis is that it has to do with the age-related balance between androgens and estrogens," Dr Schaumberg said.

For ocular surface symptoms, 27.7% of women vs 20.4% of men reported at least some worsening; 30.9% of women and 26.5% of men reported at least some worsening of vision-related symptoms. More men (11.3%) than women (8.0%) reported worsening of social impact that interfered with activities.

"This is in line with studies in pain that show men tend to be more impacted than women and that women are able to tolerate more pain," Dr Schaumberg said.

Overall, however, patients of both sexes recalled minimal or no change in ocular surface symptoms, vision-related symptoms, or social impact since diagnosis, and about the same number of patients reported improvement as reported worsening.

The most common response was that things had not changed in 10 years. Dr Debra A. Schaumberg

"The most common response was that things had not changed in 10 years," Dr Schaumberg said. This was corroborated by chart review for 263 patients. "I was a little surprised that patients' medical records showed no evidence of progression, that their probability of having corneal damage was the same at the beginning as up to 23 years later," she said.

Progression on at least two of the three subscales was associated with a history of severe symptoms: for example, for ocular surface symptoms, this conferred an odds ratio of 2.17 (95% confidence interval [CI], 1.49 - 3.18) and of 2.35 (95% CI, 1.63 - 3.37) for vision-related symptoms. "We see this pattern in undifferentiated autoimmune disease," Dr Schaumberg said. "It may wax and wane at the mild end of the spectrum, but in those with severe symptoms, it may progress to a serious autoimmune disease such as lupus."

Interestingly, for untreated depression, the odds ratio was 2.33 (95% CI, 1.21 - 4.49) for vision-related symptoms. Blepharitis or meibomian gland dysfunction had an odds ratio of 1.57 (95% CI, 1.05 - 2.40) for visual symptoms and 2.12 (95% CI, 1.22 - 3.68) for social impact.

Spending more than $20 a month on treatments was also an indicator, conferring an odds ratio of 1.80 (95% CI, 1.07 - 3.01) for ocular surface symptoms and 1.99 (95% CI, 1.20 - 3.31) for vision-related symptoms.

Any use of systemic beta-blockers translated to patient-reported worsening on all three subscales: odds ratio 1.62 (95% CI, 1.10 - 2.39) for ocular surface symptoms, 1.84 (95% CI, 1.27 - 2.66) for visual-related symptoms, and 1.86 (95% CI, 1.10 - 3.17) for social impact. This finding is "supported by prior research linking use of systemic beta-blockers and hypertension to risk of [dry eye disease], and other work suggesting an association with topical beta-blockers," the investigators write.

They urge clinicians "to not only investigate potential causes of corneal epitheliopathy but also inquire routinely in a more standardized fashion about symptoms of [dry eye disease]." Short questionnaires such as the Symptom Assessment in Dry Eye may be helpful.

“We’ve been studying the epidemiology of dry eye disease for the past 20 years and there has been a lot of concern about progression but very little information in the peer-reviewed literature on it. Now we have a piece of the missing information,” Dr Schaumberg said.

A large study underway within the Vitamin D and Omega-3 Fatty Acid Trial should provide clarifying prospective data within the next few years on the prevention and natural history of dry eye disease, Dr Schaumberg said. "We'll have about 2000 patients separately randomized in two-by-two factorial fashion to some combination of vitamin D, omega-3, and placebo with 5 or 6 years' follow-up," she said.

This study was funded by the National Institutes of Health, Research to Prevent Blindness, and Pfizer Inc, none of which had any role in the design or conduct of this research. Dr Schaumberg disclosed receiving personal fees from SARcode/Shire, Mimetogen, Kala Pharmaceuticals, and Auven and being an employee of Shire. The other authors have disclosed no relevant financial relationships.

[KittyCat]

I highly recommend finding a dry eye specialist. A good way to tell if they are a specialist is to see how many dry eye services they offer, e.g. lipiflow (I'm not a fan), IPL, punctal plugs/cautery, scleral lenses, autologous tears produced from your blood, probing. The typical eye doc is not going to help you much with this, although they do seem more knowledgeable now than 10 years ago when they basically just said "eh, just put some drops in." They might want to put you on Xiidra or Restasis, but just realize that those aren't cures, they are just an attempt to block part of the immune response and treat some of the symptoms. You should get your glands scanned and you should also get your tear film measured, not with the Schirmer's test, but with a device that measures it at different points in your eyelid.

Hi lipino, thank you so much for your helpful reply! I'm going to see a dry eye specialist a week today, who's going to scan my glands and measure my tear osmolality, hopefully then I can start to get treated!
I have definitely started to see an improvement with warm compresses and lid massage (going from 15 OTC eye drops per day to maybe 2-6), so I'm hoping I still have enough functional glands to become comfortable and get things under control and it's just a case of unblocking them.

[deep_dry_eye]

That's a good sign warm compress is helping you. I would suggest get in LipiFlow, IPl, Xiidra and Restasis.

[Teresa longacre]

Does anyone know of a Dr in Texas , with good results in probing… I live in Oklahoma, but close to Texas line…. Thanks

[Canuck]

Perhaps this is the full text version of the study being referred to: https://www.aaojournal.org/article/S...188-4/fulltext

What struck me was there's no mention of the impact of women's makeup likely influencing the impact of dry eye being greater with women than men.