Controversies and Considerations
So far I have presented universally endorsed and accepted facts and opinions related to the diagnosis and treatment of dry eye, Meibomian gland disease [MGD] and ocular surface disorders. In this section, I have included presentations of respected experts in the field who have different opinions on the value of both diagnostic and treatment regimens for different forms of dry eye. I have included this section because patients should be aware that even experts on dry eye can and do disagree. Consequently, patients should question their physicians or me on issues in dealing with dry eye so that they are comfortable with treatment options. I have personally spent time at the most respected dry centers across the country and was surprised that one highly regarded center uses a therapy that other centers have found to be of little or no benefit. This does not mean a given treatment may be of no value but could easily represent ethnic differences in patient population and climate. A facility that offers a wide variety of treatment option is less likely to favor one treatment over another. At the Inland Empire Dry Center, we have invested in virtually every FDA approved diagnostic and treatment modality and we are happy to discuss alternate treatment modalities simply because patients with similar conditions do not always respond as expected.
Remember the most common presenting symptom of dry eye with patients is not dryness but fluctuation in vision. At first that may seem unlikely but any change in the shape or content of the tear film will profoundly effect visual acuity. Many of these patients opt for LASIK surgery. However, if the the surgeon does not check for dry eye, the patient almost invariably will develop dry eye after LASIK and other types of eye surgery, since the nerves that stimulate tear secretion are disrupted and may take many months to recover. Treating dry eye before any form of eye surgery is critical to a good postoperative outcome.