Purpose: Based on the fluorescein break-up pattern classification (FBUP), the concept of tear film oriented diagnosis (TFOD) that classifies dry eye (DE) into subtypes was born. With the advent of mucin/fluid secretion promoter eye drops and mucin production enhancers, tear film oriented therapy (TFOT), as proposed by TFOD, has become possible. In this study, the current status of DE therapy with TFOT and treatment outcomes was evaluated.
Subjects and methods: A total of 133 eyes from 133 patients (mean age=63.8 years) with DE who were treated with TFOT between May 2013 and June 2016 and followed up for at least 1 year were included in the evaluation. Based on the FBUP, each DE was classified into three types: aqueous tear deficient DE (ATDDE) ［distinguishing between severe (s) and moderate (m)］, decreased wettability DE (DWDE), and evaporative DE (EDE). TFOT was initiated with basic treatments such as punctal plugs and artificial tears (AT) for sATDDE, diquafosol sodium (DQS) ophthalmic solutions for mATDDE and DWDE, and AT for EDE. If no improvement was obtained with TFOT, other drugs［e. g., rebamipide (RBM) ophthalmic suspension］were concomitantly used. In patients who did not show improvements in (1) response rates,(2) rates of concomitant use of other drugs, or (3) either symptoms and findings (non-responders), the factors for non-response were investigated.
Results: The response rates were 89.2%, 69.0%, 67.2%, and 50.0% and the rates of concomitant use of other drugs were 62.2%, 48.3%, 60.7%, and 83.3% in sATDDE, mATDDE, DWDE, and EDE, respectively. Both conjunctivochalasis and blepharospasm were considered to be the causes of non-response.
Conclusion: TFOT produced favorable treatment results (72.9% improvement in the overall response rate compared to that before TFOT).
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 407-414, 2021.