It used to be when I was a resident and young attending at Harvard, we only had about 4 treatments for dry eyes:
1. Warm compresses & cleaning
2. Artificial tears: I remember when Refresh was the only kid on the block (came out in 1986 but Refresh Plus–non preserved variety–came out about 2006)
3. Steroid drops (which have a real risk of inducing cataract & glaucoma when used extensively)
4. Punctal Plugs (came out around 1991): a silicone cover over the puncta (the drain from eye corner lower & upper lid area near nose that drains into nose.)
Then we started using
5. Autologous Serum
At Harvard we would harvest our own
6. Amniotic Membrane (from the placenta of recently born babies at MGH)
Then came in 2002.
7. Restasis® cyclosporin
Then in 2003
8. Omega 3 became a mainstay of dry eye treatment. A recent study in 2018 says Omega 3 does not help dry eyes but eye surgeons question those results for many reasons.
Then in 2004
9. Doxycycline started to be used more for Dry Eye Syndrome
Then in 2007
10. Prokera: Amniotic membrane in a contact lens: but did not take off until about 2010.
Then in 2010
11. Meibomian Gland Probing (but most surgeons did not believe it would work (including me) until about 2015.
Then in 2011
12. Lipiflow (was about $2000+ when it first came out)
Then in 2015
13. IPL: Intense Pulse Light: Dr. Rolando Toyos noted IPL liquifies the meibomian gland oil to help it come out with expression more easily which leads to dry eye pain relief in many.
14. Tea Tree Oil: data showed Demodex was a real culprit in meibomian gland loss & TTO was excellent at keeping these mites under control.
15. Cliradex: TTO wipes came to market
Then came in 2016
16. Xiidra® Lifitegrast
Avenova Spray came to market to keep Demodex mites under control
Then in 2017
17. Testosterone cream
18. Platelet Rich Plasma drops
Then in 2018
19. Cord Blood Serum (experimental: publications pending)
20. Platelet Rich Plasma insertion into meibomian glands and lacrimal glands (experimental: publications pending)
21. Stem Cell insertion into meibomian glands (experimental: publications pending)
22. Gabapentin, PreGaba, Naltrexone for chronic dry eye pain
23. Pain pumps, pain pills, pain specialist: theses are becoming more familiar to eyeMDs now. This was not even mentioned once in my entire residency program and post grad days.
24. True Tear: the nasolacrimal gland stimulator: just launced in April 2018; FDA approved 2017.
And yet to come maybe in 2019
Either way 2019 will be a year of new innovations for treating dry eyes as this international epidemic will demand more attention of all eye surgeons and doctors.
Thus many patients have been overwhelmed by all the options.
As a result a dear, generous, patient who is an executive brought in the below.
He calls it the “Layered Cake Approach.” He said once he processed the first three steps, he felt better fast.
His sheet is very helpful. He generously gave me permission to show you his thought process in trying to understand all the options and where he stands with treatment. Thank you, Mr. H!
He says he fells much better. Hopefully creating such an excel document will help you to –to keep things straight.
Fast Dry Eye Treatments: The Step Ladder Approach Made “Easy” or should I say “Easier”