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We all need to practice based on science and medical literature, not on commercial marketing; it is really pretty evident, but one has to read in order to be able to separate acquisition of knowledge from salesmanship. • Although there is controversy over the impact of omega-3 essential fatty acids in the care of patients with dry eye disease, the vast majority of optometrists (as surveyed in our lecture audiences) subscribe to their benefit, and so do we. We start all of our patients on fish oil at about 2000mg/ day. By the way, this dosing is well below the levels that affect blood coagulation based on conversations we have had with cardiologists. • We have laid out a rational, costeffective, patient-centric and literature-supported approach to diagnosing and managing patients with dry eye disease. Beware of industry-driven “education,” and adhere to timehonored, scientifically sound patient care. It is very straightforward. • A recent literature review comes to the following conclusions: 5 –“Recognition of the role of inflammation in dry eye has been a crucial factor in facilitating dry eye treatment. Inflammation plays a significant role in dry eye, promoting ocular surface disruption and symptoms of irritation.” –“Pretreatment with Lotemax induction two weeks before the initiation of cyclosporine-A can provide more rapid relief of dry eye signs and symptoms and greater efficacy than cyclosporine-A and artificial tears alone.” –“The inflammatory nature of dry eye has been widely accepted; thus, the direction for treatment research is geared toward the reduction of inflammatory cytokines.” Our take: Let’s take a moment here to engage logical thought. When treating inflammatory eye conditions, we never use an NSAID, cyclosporine or lifitegrast; we use a steroid! Studies have shown that loteprednol QID for four weeks eliminates this inflammatory component, so any eyedrop following this course of therapy will do just fine, because the targeted inflammation has been conquered. So, the intelligent, cost-effective, scientifically sound approach is to prescribe Lotemax SM (with a coupon) QID for two weeks, then BID for two more weeks (or a similar ANTERIOR SEGMENT CARE STEROIDS AND DRY EYE DISEASE • “Because chronic inflammation at the ocular surface plays an essential role in the pathogenesis of DED, topical steroids have been commonly used in these patients.” • “Although the pathogenesis of DED is multifactorial and not fully understood, inflammation has been recognized as a key mechanism in its development and propagation.” —Ophthalmology, June 2018 (see ref. 9) • “Once DED is diagnosed, the ASCRS protocol encourages aggressive, rapid-acting treatment that includes the use of steroids on the ocular surface.
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