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Dry Eye Study – The Dream Study

Transcript of discussion on the DREAM Study

Dr. Chris Rapuano and Dr. Beeran Meghpara of the Wills Eye Hospital Cornea Service discuss the recent DREAM Study on Dry Eye Syndrome

Hello, I’m Dr. Chris Rapuano, and I’m here with my associate, Dr. Beeran Meghpara. We are from the Cornea Service at Wills Eye Hospital. We are coming to you from the Wills Eye Alumni Society newsroom at Wills Eye in Philadelphia.

Dr. Rapuano: So we are here to talk about dry eye and a new study that came out on dry eye. Beeran do you see a lot of dry eye patients?

Dr. Meghpara: Definitely, Chris. I would say it is the most common complaint when they come in to see us now. We are cornea specialists, so it is a little self-selected. Fifty to 75 percent of the patients that come through the door have some sort of dry eye symptom.

Dr. R: I agree, and even if they have other problems they often have some dry symptoms. Just briefly: what’s your kind of step wise approach to the treatment of dry eye? I know it depends on mild dry eye and severe dry eye, but just kind of summarize.

Dr. M: Like you said, I do tend to have a step wise approach. The first thing I start with is artificial tears - maybe preserve tears first if patients have to use it more frequently - then preservative-free tears. Next would be something prescription like Lifitegrast or Cyclosporin. Sometimes we use low-dose steroids in a limited capacity. Definitely want to treat the eyelids. Treat blepharitis with warm compresses. Sometimes ointments at night. Punctual plugs are little stoppers that you put in the eyelids that help retain tears that you have.

Then there are more advanced options for patients with very severe dry eye. There are other things that we do. Now Omega-3s have been part of the treatment of dry eye and a recent study came out looking at Omega-3s for dry eye called the DREAM Study, published in The New England Journal of Medicine. I always joke with the residents and fellows when an ophthalmology study is published in The New England Journal of Medicine. We should pretty much know about it.

Dr. R: So tell us a little bit about that study, and it was good or bad and what the findings were.

Dr. M: One of the greatest things about this study is that is was so big. It was a large randomize double blinded study where they compared the use of Omega-3 supplementation with the placebo. The placebo that was used here is another type of oil; it was basically olive oil. What these researchers did is they compared the two groups as far as were there differences in the symptoms of dry and the signs of dry eye. By signs we mean staining of the cornea - something called the Schemers test - and how the tears break up. And the interesting thing in this study is when you look at the two groups, both groups actually had an improvement in symptoms, a pretty significant improvement in symptoms, as well as their improvement in their signs of dry eye.

Dr. R.: Were these patients super selected or were they kind of relatively real life patients?

Dr. M: They were screened and found to have moderate to severe dry eye. But the neat thing about this study, and some may consider it a positive and some may consider it a negative, is all patients were allowed to continue any pre-existing dry eye treatments they were doing. So if they were on artificial tears or Restasis they were allowed to continue that to simulate more of a real life situation.

Dr. R: Right, because a lot of studies, when they’re done you have to stop all medications, can’t do anything else, and just use the study medication.

Dr. M: So I do think that was a really great aspect of the study, plus the size of it. And I think it was a one year trial if I remember, so it was a long term trial.

Dr. R: So if this study didn’t show Omega-3s being helpful, why is that? And are Omega-3s helpful or not?

Dr. M: That is a good question, and I don’t think we know exactly. Omega-3s are helpful in that they lower inflammation, but we’re not really sure exactly what in these oils is actually the active component or what is actually lowering the inflammation. Is it the Omega-3? Is it something that is found in fish oil? Is it something found in other oils? For example, olive oil has Omega-9s - is that component involved? Both of these groups also had vitamin E and that has shown to have anti-inflammatory effects. So the key here is treating the inflammation. Whether it is Omega-3 or some other oil, we don’t really know.

Dr. R: In my practice I would still recommend Omega-3 supplement to patients. It is something that’s easy to do, it’s easily accessible, you can go to the drug store and get it. It’s relatively inexpensive and relatively minor side effects, and it comes in both naturally, especially in a fish diet. It comes in certain seeds and nuts. I think salmon has high Omega-3 and fish oil content and lots of different pills, and it has other health benefits. Yes, it has cardiovascular benefits. Some say it decreases symptoms from arthritis, joint pains, aches. Right, help with memory loss. There are other benefits to it.

Dr. M: I agree. I prescribe whether it’s a Mediterranean diet type that is high in Omega-3 and fish oil and things like that. I think it’s helpful not only probably for dry eye and maybe even some blepharitis eye lid inflammation symptoms but also maybe other health aspects in the body.

Dr. R: Who are the people who shouldn’t get high doses of these medications?

Dr. M: It is a very safe medication. There is maybe one group that they should be avoided in, and those patients that are on blood thinners. A high dose Omega-3 has been shown to increase bleeding, so I would avoid it in those sorts of patients. So like patients on Coumadin or high dose aspirin, or things like that.

Dr. R: Thank you very much! I am Chris Rapuano, and I am here with Dr. Beeran Meghpara from the Cornea Service at Wills Eye Hospital. Thank you very much. Thank you.