About 30 million Americans suffer from dry eye disease.¹ That means whether we see routine cases or specialize in the anterior segment, retina disease, or glaucoma, we all are seeing dry eye patients virtually every day. In our clinic, my colleagues and I tracked patients who presented for cataract evaluation and found that a staggering 80% had some form of ocular surface disease.

Diagnosing a Complex Disease

In the past, we were taught that most dry eye patients were aqueous-deficient, but now we know most patients have evaporative dry eye due to meibomian gland dysfunction or mixed-mechanism dry eye (both evaporative and aqueous-deficient disease). When we look deeper, we see the many contributing factors that make up this complex disease. Anatomically, it involves multiple structures, including the meibomian glands, lacrimal glands, corneal surface, conjunctival surface, and goblet cells. Risk factors include autoimmune disease, smoking, use of certain medications, prior eye surgery, and environmental factors, among others.

The full analysis can be overwhelming to clinicians, but diagnosis is generally straightforward. A good history and dry eye questionnaire, point-of-care testing, and a careful exam offer a detailed picture—one that is absolutely essential for patient care because, whether we see a patient for new eyeglasses or surgery, we must treat dry eye.

The Importance of Treatment

To my mind, the most important reason to treat dry eye aggressively is that the disease impacts visual quality. Many dry eye patients report that their vision fluctuates between blinks. Of course, dry eye symptoms also affect patients’ quality of life and ability to engage in important tasks.

We have to treat dry eye in surgical patients prior to surgery because dry eyes produce inaccurate biometry and keratometry, which makes targeted visual outcomes and patient satisfaction difficult. Nevertheless, some surgeons still do not address dry eye before surgery. In fact, I find that the number one reason for patient dissatisfaction after cataract surgery with a premium lens (such as toric or multifocal) is related to untreated preoperative dry eye.

Choosing an Artificial Tear

We offer the full range of dry eye treatments in our clinic, including traditional hygiene, nutraceuticals, punctal plugs, prescription topical medications, thermal pulsation, intense pulsed light therapy, amniotic membrane treatment, and others. We also ensure patients are treated for systemic disease, change medication use when necessary, and alter detrimental environmental factors. No matter what treatment we select, all patients are instructed to use artificial tears when needed.

For several months, I have been advising all of my patients, including preoperative LASIK or cataract patients and patients who see me strictly for dry eye, to use SYSTANE COMPLETE (Alcon) artificial tears. The drops have been wonderful. They are BAK free, which I love because the preservative can be so toxic to the ocular surface that it is actually counterproductive to prescribe a dry eye drop that contains BAK. SYSTANE COMPLETE contains an emulsion of tiny lipid nano-droplets that spread quickly across the ocular surface—resulting in better coverage compared to SYSTANE BALANCE Lubricant Eye Drops, fast-acting hydration, and long-lasting relief (Figure 1).^2-7

United States National Nanotechnology Initiative. https://www.nano.gov/nanotech-101/special. Accessed April 5, 2018.

Figure 1. Illustration depicting the increased surface area of nano-sized materials.

SYSTANE COMPLETE also takes the guesswork out of choosing an artificial tear because it’s designed to provide symptom relief for every major type of dry eye—aqueous-deficient, evaporative/MGD, and mixed dry eye—the drop has everything patients need to increase tear volume and restore the lipid layer.

I have patients use artificial tears as needed, rather than follow a prescribed schedule. They tell me that SYSTANE COMPLETE is comfortable to use, lasts a long time, and feels less sticky and cakey than some other drops. They also don’t perceive a period of blurring after they instill the drops.

Patient Education and Compliance

When I recommend SYSTANE COMPLETE to my patients, I explain the unique properties that I like about these drops. We discuss the tear film’s aqueous and lipid layers, and I tell them that SYSTANE COMPLETE supplements the deficient oil layer and provides hydrating molecules as well. They intuitively understand that this will work for all aspects of dry eye disease.

My staff helps ensure that patients actually purchase SYSTANE COMPLETE (Figure 2) when faced with the mind-boggling number of artificial tears in the drugstore, some of which are of suboptimal quality. We give patients coupons as both an incentive and a reminder. However, once my patients have used SYSTANE COMPLETE, they seem to appreciate the value of the drops enough to make compliance a minor concern.

Figure 2. Dr. Gupta’s staff helps ensure that patients actually purchase SYSTANE COMPLETE when faced with the mind-boggling number of artificial tears in the drugstore.

SYSTANE is a trademark of Alcon.
© Alcon 2018. All other brand/product names are the trademarks of their respective owners.

Preeya K. Gupta, MD

• Associate Professor of Ophthalmology, Cornea & Refractive Surgery at Duke University Eye Center and Clinical Director of Duke Eye Center at Page Road in Durham, North Carolina
• gupta@duke.edu
• Financial disclosure: Consultant (Alcon)