Ophthalmologist perceptions regarding treatment of moderate-to-severe dry eye: Results of a physician survey

Purpose: To understand ophthalmologists' current perceptions and treatment of patients with moderate-to-severe dry eye disease (DED). Setting: Online survey. Methods: The online survey was sent to 7,882 ophthalmologists, including 51 corneal specialists, throughout the United States from October 9 to 21, 2008. The response rate was 3.1% (n = 245), typical for this type of survey. Only ophthalmologists who treated four or more moderate-to-severe DED patients per month (235 of 245 [96%]) were asked to complete the survey. Results: Ninety-four percent of respondents agreed that more treatment options are needed for moderate-to-severe DED. Corneal specialists were more likely to strongly agree (63%) than general ophthalmologists (54%). Only 33% overall felt that current therapies were extremely or very effective for moderate DED and only 5% for severe disease. Ninety-two percent agreed that multiple therapeutic agents are needed to manage moderate-to-severe DED. The respondents prescribed or recommended a mean of 3.2 different treatments (standard deviation = 1.2) for moderate DED patients over the course of a year and 4.9 (standard deviation = 2.2) for patients with severe DED. The most highly ranked goals for treatment of moderate-to-severe DED patients were maintaining and protecting the ocular surface (ranked 1 or 2 × 74%) and lubricating and hydrating the ocular surface (ranked 1 or 2 × 67%). Corneal specialists ranked maintaining and protecting the ocular surface even more highly (ranked 1 or 2 × 82%). Conclusions: Results reflected the difficulty of treating moderate-to-severe DED, the importance of using multiple treatment approaches, the limitations of current treatment options, and the need for additional treatment options.