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EW SHOW DAILY 28 ASCRS Symposia Monday, May 8, 2017 by Lauren Lipuma EyeWorld Contributing Writer think we've done too good of a job educating them," Dr. Shamie said. She thinks physicians should pay more attention to the quality of the meibum before considering serum tears. "We're forgetting that inflam- mation is a key player by moderate dry eye by this stage, so anti-inflam- matories and topical steroids need to be higher on this list," Dr. Farid said. For severe dry eye, most survey respondents chose punctal occlusion as their primary treatment, followed by cyclosporine and topical corti- costeroids. Dr. Farid was surprised that thermal lid express was the least-used primary treatment on the list. "Thermal lid expression works so much better in mild to moderate dry eye disease," she said. "When they're very severe, chances are many of these glands have atro- phied, so I offer this much earlier." "It's interesting that so many of the answers relate to meibomian gland disease, and we don't begin to think about it until it's severe disease," Dr. Hovanesian said. "But meibomian gland disease is often the first form of dry eye the patients have, so many of these might be appropriate at an earlier stage." Dr. Chan said she was surprised by punctal occlusion being the number one go-to treatment for severe dry eye. "It's so important that the inflammation is dealt with first, otherwise you've blocked the drainage channel and all the sewage just backs up, meaning that all the inflammatory mediators sitting on the eye surface will worsen your patient's symptoms and they'll think you made them worse," she said. "Punctal occlusion is a last, down- the-line treatment. You want to treat the tear quality, quantity, inflam- mation, and then consider punctal occlusion." "This highlights the fact that we're now understanding a lot about dry eyes but not enough," Dr. Shamie concluded. "We don't have a protocol that is standardized across the board. The onus is on us to create a protocol that's very easy to follow." EW Editors' note: The physicians have financial interests related to their comments. T wo teams of cornea special- ists competed to find out how ASCRS members re- sponded to questions about ocular surface disease in the 2016 ASCRS Clinical Survey during the "Cornea Family Feud" session. Marjan Farid, MD, Irvine, California; Christopher Starr, MD, New York; Neda Shamie, MD, Los Angeles; and Preeya Gupta, MD, Durham, North Carolina, competed against John Hovanesian, MD, La- guna Hills, California; Clara Chan, MD, Toronto; Richard Davidson, MD, Denver; and Thomas John, MD, Chicago, in the game show- style session moderated by Francis Mah, MD, La Jolla, California. One set of questions addressed what physicians choose as the primary therapy for mild, moder- ate, and severe dry eye. For mild dry eye, most survey respondents chose artificial tears as their primary therapy, followed by serum tears and oral omega-3 supplements. It was surprising that lid hygiene and warm compresses were not among the answers given, Dr. Farid said. "It's typical for us to move to artificial tears as a treatment for mild dry eye, but it's important to remember that artificial tears aren't necessarily a treatment," she said. "If patients are presenting and they're having symptoms, I actually move to the anti-inflammatory topical drops because if patients are com- ing in already using artificial tears, they're beyond that stage." The participants were also sur- prised that serum tears were placed so highly on the list of therapies. "Serum tears are not a very cost effective therapy for mild patients," Dr. Gupta said. She said she doubts her mild dry eye patients would be willing to have their blood drawn monthly and spend $200 a month on a serum tear treatment. "But I think what we're missing is that a lot of these therapies aren't focused on meibomian gland dys- function, and that is a huge area of things we can improve in a dry eye patient," she said. For moderate dry eye patients, most survey respondents chose serum tears as their primary therapy, followed by cyclosporine, artificial tears, and punctal occlusion. The participants were again surprised how many survey respondents chose serum tears as their primary therapy. "A couple of years ago, we were trying to educate our peers about serum tears, and the fact that it's ended up on mild and moderate, I Cornea specialists face off in 'Family Feud' Dr. Shamie and Dr. Davidson compete in Cornea Family Feud, moderated by Dr. Mah. Drs. Gupta, Shamie, Starr, and Farid try to guess how ASCRS members responded to questions about ocular surface disease on the 2016 ASCRS Clinical Survey.

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