COOKIE 22 - The Dry Eye Issue by Media MICE

Nothing Dry

ABOUT DRY EYE CARE

Schirmer’s strips had a good run—but dry eye care has officially entered its glow-up era. From app-based diagnostics and tear film analytics to IPL, nutrition and phenotype-driven treatment plans, today’s approach is smarter, sharper and unapologetically multimodal. If your dry eye playbook hasn’t changed lately, this is your nudge to turn the page.

A mentor of mine at the University of Waterloo once joked, “If you want a patient to hate you and never return, use Schirmer’s as your primary dry eye test.” Humor aside, the point stands: our approach to dry eye must evolve with the evidence and tools now available.

DIAGNOSIS AND ASSESSMENT

We’ve moved beyond Schirmer’s and ad hoc symptom checks. Validated instruments like the OSDI have transitioned from paper forms to app-based workflows, streamlining intake and scoring while emphasizing the condition’s prevalence and impact.

Contemporary imaging and metrics matter. Many corneal topographers now include tear film analysis—quantifying tear

meniscus height, noninvasive break-up time and meibomian gland structure—with standardized grading that supports patient education and shared decision-making.

LID DISEASE AND DEMODEX

Demodex blepharitis, severe anterior/posterior blepharitis and conjunctival inflammation—often influenced by environment, lifestyle and systemic disease—are increasingly recognized contributors.

In-office lid hygiene technologies and thermal pulsation/ heat-massage systems (e.g., devices targeting meibomian gland obstruction) improve biofilm control and meibum quality when paired with ongoing home care.

ENERGY-BASED THERAPIES

Intense pulsed light (IPL) is gaining adoption in dedicated dry eye clinics for refractory evaporative disease associated with MGD and ocular rosacea, with protocols that integrate meibomian expression and photothermal effects on periocular vasculature.

NUTRITION AND ADJUNCTS

Nutritional supplementation—endorsed by organizations such as the Ocular Wellness & Nutrition Society (OWNS)— has growing clinical uptake, particularly re: omega-3 quality, anti-inflammatory profiles and lifestyle counseling as part of a multimodal plan.

DROPS AND DRUG DELIVERY

Advances in drop formulation, osmolarity, viscosity and lipid content, alongside improved vehicles and delivery systems, are extending retention time and comfort. Tailoring to phenotype (aqueous-deficient vs evaporative or mixed) remains key.

CONTACT LENS STRATEGIES

Scleral lenses provide reliable relief and surface protection in severe dry eye and exposure cases, while modern daily disposables with moisture-retention technologies can improve comfort in milder disease and in contact lens-intolerant patients.

TAKEAWAY

Dry eye management has matured into a nuanced, technologyenabled, patient-centered discipline. When we match diagnostics to phenotype and combine in-office procedures, home maintenance and lifestyle/nutritional strategies, outcomes—and patient satisfaction—improve.

In short, there’s nothing “dry” about the current state of dry eye care

Best, Dr. Carmen Abesamis-Dichoso OD, MAT, FPCO, FIACLE, FBCLA, FAAO

Image created with assistance from Midjourney AI, © Media MICE Pte Ltd, 2026.

ADVISORY BOARD MEMBERS

DR. CARMEN ABESAMIS-DICHOSO

Abesamis Eye Care & Contact Lens Center Manila, Philippines carmen.dichoso@gmail.com

DR. PURVI THOMSON

OCL Vision London, United Kingdom purvi@oclvision.com

DR. KRISTIE NGUYEN

Dr. Feenstra and Associates

Dr. Kristie Nguyen PLLC, Floria, USA kristie817@gmail.com

DR. LI LIAN FOO

Singapore National Eye Centre (SNEC) Singapore drfoolilian@gmail.com

DR. MONICA CHAUDHRY

Learn Beyond Vision

New Delhi, India monica.rchaudhry@gmail.com

DR. MARIA SAMPALIS

Society Friends

Sampalis Eyecare Cranston, Rhode Island, USA msampalis@hotmail.com

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When Love is Not in the Air

Valentine’s Day is all about connections: shared glances, lingering eye contact and candlelit dinners. But when dry eye symptoms strike, those same romantic moments can feel less like love at first sight and more like irritation at first blink.

It’s worth considering how some classic Valentine’s Day rituals quietly conspire against the ocular surface. Low lighting and prolonged eye contact reduce blink rate. Planning the date and sending those romantic text messages increase screen time, further destabilizing tear film. Then there’s the candlelight itself, adding smoke and ambient air pollution to an already vulnerable ocular environment.

When we think about air pollution, a candlelit dinner rarely comes to mind. Instead, we picture factories, congested highways or forest fire smoke. Discussions of air pollution typically focus on particulate matter, nitrogen oxides, ozone, sulfur dioxide and volatile organic compounds because of their links to asthma, chronic obstructive pulmonary disease (COPD) and heart disease. Our instinctive response is to protect the

HOW AIR POLLUTION FUELS DRY EYE DISEASE

From candlelit dinners to indoor humidity, the air around patients may be quietly undermining the tear film. Emerging research is pushing air quality and environmental exposures onto the dry eye radar and urging clinicians to think beyond drops when managing the ocular surface.

By April Ingram

lungs and cardiovascular system, often by wearing a mask.

Yet the impact of air pollution on the eyes, particularly its role in dry eye disease (DED), is receiving growing scientific and clinical attention. The ocular surface—cornea, conjunctiva and tear film included—is directly exposed to the environment with minimal physical barriers, making it especially susceptible to airborne insults.

Studies consistently show that individuals living in areas with higher levels of fine particulate matter (PM) and ozone report increased dry eye symptoms.1 Unlike the lungs, which benefit from robust mucociliary clearance, the eye relies primarily on the tear film and blinking to remove irritants. These protective mechanisms can be overwhelmed by persistent pollutant exposure.

WHEN PARTICLES MEET THE TEAR FILM

At the molecular level, air pollutants interact directly with the tear film and ocular surface epithelium. Particulate matter can deposit on the tear film, disrupting its delicate balance of lipids, aqueous fluid and mucins. These particles are far from inert, carrying adsorbed organic compounds and metals that catalyze chemical reactions at the ocular surface.

One key mechanism is oxidative stress. Pollutants generate reactive oxygen species on contact with biological tissues, modifying proteins within the tear film and on epithelial cell surfaces. When tear film proteins such as mucins and lysozyme are structurally altered, their ability to stabilize the tear film and protect the ocular surface diminishes. The result is tear film instability, faster evaporation and increased exposure of underlying corneal cells. 2 In romance and in eye health, stability matters.

Another emerging area of research examines how airborne chemicals bind to extracellular matrix proteins and receptor sites on epithelial cells, triggering inflammatory signaling pathways. Interaction with toll-like receptors on surface cells can initiate a cascade of inflammatory cytokine release. This inflammation further destabilizes the tear film, impairs neural feedback for tear production, and perpetuates the chronic cycle characteristic of dry eye disease.3

LOOKING INWARD, LITERALLY

Dr. Kumar emphasizes the importance of indoor environments. As he notes in his

educational material, Improve and Protect your Health by Improving Your Indoor Air Quality, “We take 8,640 breaths each day and we spend 90% of our time indoors,” underscoring the need to recognize indoor pollutant sources and their health impacts.

In his collaborative research with Dr. Galor4 , the ocular implications are clear. “In the home, a high microbial concentration, such as airborne mold and microbes, are associated with epithelial disruption. Our research also suggests that both low < 45% and high > 55% relative humidity affect dry eye, but the mechanisms of their effects are different. High humidity facilitates indoor microbial growth and concentration of PM, increasing exposure to indoor air pollutants. Low humidity results in excess tear evaporation.”

So, is there a Goldilocks zone for indoor air? Dr. Kumar continues, “Importantly, our findings also suggest that modifying the home environment can lead to clinically meaningful improvements. In a cohort of U.S. veterans, targeted home interventions, such as controlling indoor humidity between 45-55%, improving ventilation and indoor plants not only improved indoor air quality but also reduced DED symptoms and favorable changes in ocular surface signs over time. While these results highlight the potential of environmental optimization as a therapeutic strategy for DED, and potentially other ocular diseases, they also underscore the need for larger and more detailed longitudinal studies to identify which specific environmental modifications provide the greatest benefit and for whom.”

The findings even offer a timely Valentine’s Day takeaway. Gifting a plant benefits both home air quality and eye health, making it a thoughtful gesture that quite literally shows you care.

A CLEAR-EYED CONCLUSION

Understanding and addressing the ocular effects of air pollution enhances patient care while revealing how deeply the environment shapes health. For clinicians,

this means adopting a more holistic, environmentally informed approach to dry eye management. For public health professionals, it reinforces the need to include eye health in air quality policy and community health planning.

Sometimes, protecting vision starts with looking beyond the exam chair and into the air patients breathe every day.

REFERENCES

1. Onyeze NS, Jacob J. Climate change and its impact on ocular health: A systematic review. Cureus. 2025;17(9):e91614.

2. Bohm EW, Buonfiglio F, Voigt AM, et al. Oxidative stress in the eye and its role in the pathophysiology of ocular disease. Redox Biol. 2023;68:102967.

3. Pflugfelder SC, de Paiva CS. The pathophysiology of dry eye disease: What we know and future directions for research. Ophthalmology. 2017;124(11 Suppl):S4-S13.

4. Rock S, Galor A, Kumar N. Indoor airborne microbial concentrations and dry eye. Am J Ophthalmol. 2020;223:193-204.

CONTRIBUTORS

Dr. Anat Galor Professor of ophthalmology at the Bascom Palmer Eye Institute and a staff physician at the Miami VA Hospital. She directs the Ocular Surface Pain Program at both institutions. agalor@med.miami.edu

Dr. Naresh Kumar Professor of environmental health and biostatistics at the Miller School of Medicine, University of Miami. His research focuses on the adverse health effects of environmental pollutants and their management. nkumar@med.miami.edu

CONTACT COMPATIBILITY

MAKING DRY EYES AND CONTACT LENSES A MATCH MADE IN HEAVEN

Millions try to make contact lenses and dry eyes coexist, but as many as half bow out by year three. From mucin loss to blink mechanics to the role of Demodex, the signs of strain are everywhere. Luckily, smart counseling, smarter materials and a few strategic interventions can turn this messy romance into a long-term success story.

By Diana Truong

There are relationships that take work, and then there are relationships that involve a hydrogel disc sitting on a delicate, multilayered ecosystem all day while blinking repeatedly rubs it like sandpaper. Soft contact lenses and dry eyes fall squarely into the latter. Yet millions of people still try to make the match work.

According to Dr. Kaleb Abbott (United States), optometrist and assistant professor of ophthalmology at the University of Colorado School of Medicine, this is not a niche problem. “There are roughly 140 to 150 million contact lens wearers worldwide, and as many as half discontinue lens wear by the three-year mark.” The number-one culprit is discomfort—a relationship killer if ever there was one.

THE RELATIONSHIP PROBLEM

If the tear film were a rom-com protagonist, the contact lens would be the disruptive roommate: always in the way, constantly requiring attention and causing friction in every sense of the word.

“We’re taking something that’s supposed to be in its natural state—the tear film—and we’re putting something on it that

separates the tears into a pre-lens tear film and a post-lens tear film,” Dr. Abbott explained.

This division alone destabilizes the tears, but the plot thickens. Lenses rub the conjunctiva with every blink, gradually reducing goblet cell density and mucin production. Dr. Abbott described mucin as “extremely hydrophilic…It likes water, and its job is to help the tear film stay anchored to the ocular surface.” Lose mucin and tear stability starts slipping.

Then comes the blink mechanics. Put a lens on the eye and the lids can’t make proper contact. The result, he said, is reduced meibum expressibility, and over time, “you start to see evidence of atrophy of those meibomian glands.” Less meibum means more tear film evaporation, more friction between the eyelids and the globe, and more patients giving up.

And, as if the tear film didn’t have enough drama already, osmolarity rises with contact lens wear. “We know that increased tear osmolarity is a big driver of dry eye, inflammation and damage to the ocular surface,” Dr. Abbott added.

Even the microbiome joins the chaos, with lens wearers showing higher rates of Demodex mite infestation. “Ninety-three percent of patients that report contact lens discomfort also have Demodex blepharitis,” he noted.

SIGNS THE RELATIONSHIP IS IN TROUBLE

Patients rarely announce dry eye or lens intolerance with grand declarations. More often, they drop hints. A midday blink pause. A casual mention of “scratchiness.” An offhand confession that they took their lenses out at 4 PM yesterday “just because.”

A little probing often uncovers the truth. The end-of-day stinging. The vague sense that one eye is “just tired.” The makeup removal ritual that has become a nightly blink torture test.

In-office diagnostics help clinicians catch problems early, monitor tear stability, assess gland structure and personalize treatment. Follow-ups transform the experience from reactive troubleshooting to proactive relationship coaching.

RELATIONSHIP COUNSELING

Luckily, modern contact lens care offers ways to salvage this romance…or at least renegotiate the terms. The first step is picking the right partner. Dr. Abbott is clear about material choice. “Hydrogel lenses contain a lot of water, and as they dry out, they draw water from the tear film,” he said. “But silicone hydrogel lenses don’t create the same drying effects.”

Replacement schedule matters just as much. “Monthly lenses tend to cause more dryness than two-week lenses, and two-week lenses more than daily disposables,” he noted.

Contact lens solutions can even be part of the problem. Dr. Abbott often sees discomfort vanish simply by switching bottles. “Sometimes it’s as simple as the patient using a contact lens solution that is irritating to the eyes,” he said.

Fit matters too. Too tight and it’s immovable; too loose and it’s a tiny plastic slip-n-slide. Lubricants can help, with hyaluronic acid earning praise. “There is good data showing the benefits

CONTRIBUTOR

Dr.

Kaleb Abbott

Optometrist and

Assistant Professor of Ophthalmology

at the University of Colorado School of Medicine. He specializes in complex ocular surface diseases, corneal nerve dysfunction and ocular pain perception. kaleb.abbott@cuanshutz.edu

of hyaluronic acid in treating contact lens discomfort. It can even reduce friction from associated conditions like lid wiper epitheliopathy,” Dr. Abbott explained.

Oil-based drops may support the compromised lipid layer, while stronger cyclosporines or lifitegrast can quiet the underlying inflammation. And if Demodex is in the mix? Treat it. “I’ve found that treating Demodex blepharitis often dramatically improves contact lens discomfort,” he said.

Simply put, managing underlying dry eye is essential for long-term contact lens wear. Heat, hygiene and meibomian gland support remain foundational. Dr. Abbott also noted the promise of newer therapies, including an upcoming Azura Ophthalmics (Tel Aviv, Israel) ointment for meibomian gland dysfunction and contact lens discomfort.

THE HAPPY ENDING

At the heart of successful contact lens wear is communication; the kind that starts before the patient ever opens their first blister pack. Dr. Abbott believes clinicians should prepare patients for the possibility of discomfort rather than hope for the best.

“After all, we’re placing an artificial device onto a very delicate ocular surface, so some degree of initial discomfort is expected,” he said. “Sometimes all it takes is telling patients that a certain level of discomfort with lens wear is normal. Without that context, many assume the discomfort means they’re simply not candidates for contact lenses.”

When comfort improves, satisfaction naturally follows. So does loyalty. A patient who feels cared for—who understands why dryness happens and what their clinician is doing about it—is far more likely to stick around, both in lenses and in your practice.

Because when managed well, the relationship between contact lenses and dry eyes doesn’t have to be a tragic romance. With the right counseling, the right treatment and the right expectations, it can become exactly what every patient wants: comfortable and stable.

THE NEW OF FACE

DRY EYE

THE SHIFTING DEMOGRAPHIC

While dry eye disease (DED) has long worn the badge of an age-related condition, clinics are now seeing a different demographic blinking back at them. Millennials, teenagers and even children are presenting with dry eye symptoms in growing numbers.

According to Scientia Professor Fiona Stapleton (Australia) from the School of Optometry and Vision Science, University of New South Wales, Sydney, the shift is real—and it demands a rethink in how optometrists detect, assess and manage dry eye in younger patients.

“Historically, we just assumed that dry eye disease was a disease of adults, particularly older adults”

- Prof. Fiona Stapleton

Over the past 10 to 15 years, she noted, research has increasingly explored dry eye symptoms and signs in children and adolescents. The results have been sobering. “We were a little bit surprised at the rate of particularly dry eye symptoms being reported in children,” she said. Importantly, this is not just a symptom story. Clinical

signs and formal diagnoses are also being reported “at a not insubstantial rate.”

WHAT’S DRIVING THE RISE IN YOUNG DRY EYE?

While the data is still emerging, Prof Stapleton sees the trend as the product of intersecting lifestyle, environmental and ocular surface factors. “It’s sort of a combination of lifestyle factors and some other pieces around changes to the environment,” she said.

Digital device use is one of the most discussed contributors. Small studies in younger populations have consistently flagged prolonged screen time, especially device use before bed, as a risk factor. Reduced time outdoors has also been associated with dry eye symptoms in children.*

Blink behavior is central to the discussion. “We know that when blink completeness as well as blink rate changes with concentrated tasks, those kinds of things can drive increased instability of the tear film and dry eye symptoms,” Prof. Stapleton explained. Children often work at very close viewing distances, with suppressed blinking, creating a different risk profile compared with adults.

Contact lens wear adds another layer, particularly as myopia control drives increased lens use among younger patients. “We also know that contact lens wear has an association with dry eye disease,” she said, noting that this behavior was far less common in children a decade or so ago.

From screens and blinking habits to contact lenses and acne meds, a new generation is arriving in practice with surprisingly “adult” ocular surface problems, challenging optometrists to spot, question and manage dry eye earlier, smarter and with fresh tools in hand.

By Tan Sher Lynn

ENVIRONMENT AND THE PEDIATRIC OCULAR SURFACE

Environmental factors—both indoor and out—may further exacerbate symptoms. “We know that things like pollution, indoor and outdoor pollution can make a difference to the ocular surface. We know that low humidity can make a difference,” Prof. Stapleton said.

Crucially, children cannot be viewed as “small adults” when it comes to the ocular surface. “They’re not the same as adults…and they interact with the digital environment in a different way,” she emphasized.

Allergies, anterior blepharitis and potentially a distinct ocular microbiome are more common in younger patients and may all shape how dry eye presents.

One risk factor that often flies under the radar in teenagers and young adults is isotretinoin, commonly prescribed for acne. Prof. Stapleton cautioned that isotretinoin use has a real impact on the Meibomian glands, even over relatively short courses.

“We’ve certainly seen 19 to 20-year-olds who’ve been using it for quite a short period of time, and they are quite symptomatic. Their Meibomian glands do seem to be changing with use,” she reported.

SILENT SUFFERS AND SMARTER DETECTION

Underreporting remains one of the biggest clinical challenges in this age group. “Children tend not to verbalize it unless

you ask,” Prof. Stapleton said, noting that many shrug off discomfort as normal.

To overcome this, she suggested the use of questionnaires, noting that while pediatricspecific tools are still limited, adult dry eye questionnaires have been used with reasonable success in children and teens.

“We know that children and teens respond very well to questionnaires. That at least gives you a baseline to know whether things are getting worse or getting better with intervention,” she noted.

Symptoms alone, however, are not enough.

A careful ocular surface assessment is essential, including evaluation for lid disease, allergy, Demodex, blink completeness and blink rate during tasks.

“Those kinds of things really give a very good pointer to what’s going on,” she said.

MANAGING YOUNG DRY EYE

In broad terms, treatment approaches for children resemble those used in adults, particularly the use of preservativefree lubricants. There is, however, an important caveat. “Many of these treatments are not actually registered for use with children, so they’re often used off-label,” Prof. Stapleton noted.

Lifestyle modification remains foundational, with attention to screen

habits (especially before bed), outdoor exposure, contact lens practices and systemic medications. Compliance, however, can be difficult. This is where digital tools may help.

Online questionnaires allow young patients to complete symptom assessments on their phones, track changes in their scores over time, and engage more actively with their eye health—effectively “gamifying” dry eye monitoring and management.

Blink training is another underutilized intervention. “Getting appropriate blinking is one of those things that can cure a lot of dry eye,” Prof Stapleton said. “I have many patients who sort their blinking out and their dry eye improves considerably.” Apps and reminder systems may make this more achievable for younger patients, she added.

WHAT’S NEXT IN DRY EYE INNOVATION?

Fortunately, new treatment approaches may soon make dry eye management easier for young patients. Prof. Stapleton points to emerging lid ointment therapies that only need to be used twice a week, reducing the reliance on daily eye drops and making treatment more manageable for children and teenagers.

While physical therapies for meibomian gland dysfunction continue to grow, evidence supporting their use in younger patients is still limited, highlighting the need for further research. What is already clear, however, is the importance of early detection and individualized care.

For optometrists, recognizing that dry eye is no longer confined to older age groups is a crucial step in safeguarding the long-term ocular surface health of the next generation.

REFERENCE

*Stapleton F, Velez FG, Lau C, et al. Dry eye disease in the young: A narrative review. The Ocular Surface. 2024;31:11-20.

CONTRIBUTOR

Dr. Fiona Stapleton Scientia professor and clinical teaching director at the School of Optometry and Vision Science, UNSW Sydney. She co-authored the TFOS DEWS III report and specializes in ocular disease. f.stapleton@unsw.edu.au

THE BLINK LINK

WHEN INCOMPLETE BLINKS BECOME A TREATABLE DRY EYE SIGNAL

Blink rate gets the spotlight, but blink quality may be the real culprit. Incomplete blinks are common in screen-heavy lives, strongly predictive of dry eye, surprisingly easy to spot in clinic and relatively simple to retrain.

By Kendra Bruning

Blinking may be the most underappreciated “treatment” in the room. It’s not glamorous, it’s not billable and it’s usually happening right under our noses. Yet it remains one of the few practical, lowcost, modifiable factors clinicians can explain and train in clinic, particularly when screens, evaporation and meibomian gland dysfunction start stacking the odds against patients.

Dr. Cory Lappin, an optometrist and founder of the Dry Eye Center of Ohio, describes dry eye as “tear film dysfunction,” where tears either are not produced in sufficient quantity or “are just evaporating too quickly.” In those scenarios, blink mechanics move from background physiology to frontline disease management.

OPTICS

THE BLINK BREAKDOWN

A normal blink is more than a lid closing. It’s a coordinated reset that renews the tear film, spreads it across the ocular surface, and helps express and distribute meibum.1 When the lids fail to meet, the system does not fully reset, leaving the tear film patchy and unstable.

Large real-world datasets back what many clinicians have long suspected. Incomplete blinking tracks dry eye disease more reliably than blink rate itself. In a prospective registry study of 453 community residents, higher rates of incomplete blinking were linked to higher odds of dry eye, with a practical threshold emerging at 40% or more incomplete blinking. Blink rate alone showed no meaningful association with ocular surface findings.2

In clinical terms, blink frequency matters less than blink quality.

In young adults with dry eye symptoms, controlled blinking at 20 blinks per minute performed similarly to natural blinking for tear breakup measures, while dropping to 10 blinks per minute performed worse. It’s not a universal target, but it suggests there is a practical “too low” zone for tear film stability in some screenheavy patients.3

THE DIGITAL AGE BLINK TAX

Screen work changes how people blink, making blinks fewer and “shallower.” Clinical reviews and experimental studies consistently describe task-related shifts in blink patterns during digital use, including higher rates of incomplete blinks.4-6

Dr. Lappin tells patients that distance viewing averages around 15 to 20 blinks per minute, while screen work can drop this down to four to six, with the proportion of incomplete blinks rising at the same time. The exact numbers vary across studies, but the direction of change is remarkably consistent during reading and digital tasks.4,6

The irony is that people are not choosing discomfort. They are choosing screen visibility. When patients concentrate, they subconsciously avoid fully interrupting their view and the blink degrades into a half-complete habit.

THE BIOMECHANICS OF A “BAD BLINK”

Incomplete blinking is not just “less lubrication.” It can push the tear film toward evaporative instability and meibomian gland dysfunction. Wang and colleagues found higher rates of incomplete blinking associated not only with worse symptoms and tear film stability, but also with lid margin staining, meibography changes, poorer meibum quality and differences in lipid layer thickness. 2

Dr. Lappin explains this to patients in plain terms they can quickly grasp. A full blink is not just a lid closure. It’s a squeeze that exerts pressure on the meibomian glands and expresses oil into the tear film. When blinks stop halfway, that compression never happens. The oil stays put, the glands clog and evaporation wins.

Prof. Charles McMonnies, honorary professor at the University of New South Wales (UNSW), points to a familiar clinical pattern: symptoms flare during visually demanding tasks and staining appears inferiorly. When the story and the staining line up, the diagnosis usually does, too.

THE HEISENBERG PROBLEM OF BLINK QUALITY

Assessing blink quality comes with a paradox. The moment patients realize blinking is under scrutiny, behavior changes. They begin to “perform” a good blink.

Prof. Jennifer Craig at the University of Auckland recommends watching blink patterns before patients are alerted to what is being assessed, such as during history-taking or while they complete a symptom questionnaire. If possible, video capture allows frame-byframe review and more accurate quantification of incompleteness.

Dr. Lappin uses an ocular surface analyzer that reports blink completeness and rate, but he emphasizes an old-fashioned alternative that every clinic already has: talk to the patient and watch what their eyelids actually do in conversation.

According to Prof. Craig, spontaneous blink quality during history or questionnaires can then be followed by confirmation—ideally under infrared illumination—but otherwise simply at the slit lamp, assessing lid position, including inferior scleral show, lid seal and laxity using snapback-type maneuvers. Device metrics or short video clips, when available, can help standardize documentation and track change over time.

RETRAINING THE BLINK

Blink retraining is less about perfection and more about motor memory. Prof. McMonnies recommends “full, quick, relaxed blinks” that mimic everyday blinking. Overdoing it with forceful or prolonged closures can backfire, disrupting motor memory and potentially raising intraocular pressure (IOP).4

Prof. Craig describes this as “blink hygiene” and is refreshingly honest about where the evidence stands. There is no single routine that has been proven to outperform the rest, which makes personalization the real clinical key. For some patients, that means formal exercises to help improve blink habits. For others, it’s as simple as consciously linking better blinking to something they already do every day.

Digital reinforcement is also entering the chat. A smartphonebased blink-training application has also shown short-term improvements.7 In clinic, Dr. Lappin often anchors blink retraining to a variation of the familiar 20-20-20 break, using it as a cue for a brief reset focused on full, relaxed lid closure. The key is the tone of coaching. Not a hard squeeze drill or eyelid CrossFit, just a repeatable motion patients can actually stick with.

PAIRING BLINK TRAINING WITH MEIBOMIAN GLAND CARE

Blink training is rarely the only lever, but it is often the missing one. Prof. Craig notes that meibomian gland-focused therapies alone may not restore tear film homeostasis if blinking does not adequately spread the tear film across the ocular surface.

Exercise trials add an important caveat. Because effective meibum expression often requires more pressure than a normal blink, and because lipid layer thickness did not change meaningfully, blink exercises alone may not fix every lipid metric. 8 In practice, this supports pairing blink retraining with lid therapies when indicated.

This is where blink retraining stops being a wellness suggestion, and becomes a systems fix. You’re not just telling patients to blink more. You’re enabling other therapies to work on an ocular surface that can finally support them.

TURNING BLINKS INTO BONDS

Dr. Lappin finds adherence improves when patients understand the “why,” because it’s hard to follow a routine that feels random.

Prof. McMonnies has published patient-facing educational material on incomplete blinking, intended to make the concept concrete and repeatable at home.9 For busy clinics, that kind of handout-style education can turn blink coaching into something offered consistently across all practice staff, rather than being dependent on how much time the doctor has that day.

This is also where rapport can improve. Blinks are easy to see and easy to explain, and patients often walk out feeling like you identified a mechanical reason for their symptoms, not just a name for them.

A PRACTICAL BLINK PROTOCOL

When you start looking for incomplete blinks and lid laxity, you’ll see them everywhere. Build the blink check into your history and slit-lamp routine, quantify it when you can and coach proper blinking to become automatic when suboptimal blinking is identified. Tie the habit to the patient’s real day, not an ideal one. Then plan follow up periods that are just long enough to reinforce the win before screen life quietly retrains them back to old habits.

CONTRIBUTORS

Dr. Cory Lappin Dry eye and ocular surface specialist based in Cincinnati. He is the founder of The Dry Eye Center of Ohio, a specialty clinic focused on comprehensive, patient-centered care. corylappinod@gmail.com

REFERENCES

1. Kim J, Shirriff A, Cornwell JN, et al. Human eyelid behavior is driven by segmental neural control of the orbicularis oculi. Proc Natl Acad Sci U S A. 2025;122(32):e2508058122.

2. Wang MTM, Power B, Xue AL, et al. Blink completeness and rate in dry eye disease: An investigator-masked, prospective registry-based, cross-sectional, prognostic study. Cont Lens Anterior Eye. 2025;48(3):102369.

3. Chai Y, Cheng M, Liu X, et al. Identification of a blink frequency threshold for maintaining tear film stability in young adults with dry eye symptoms. Sci Rep. 2025;15(1):42321.

4. McMonnies CW. Diagnosis and remediation of blink inefficiency. Cont Lens Anterior Eye. 2021;44(3):101331.

5. McMonnies CW. The pervasive contributions of blink inefficiency to dry eye disease and computer vision syndromes. Expert Rev Ophthalmol. 2025;20(1):41-54.

6. Argilés M, Cardona G, Valentino M. Characterization of eye blink parameters during high- and low-dynamic scenes in different video game genres. J Optom. 2025;:100584.

7. Xu Z, Shen J, Jiang M, et al. A smartphonebased blink training application for alleviating dry eye signs and symptoms. NPJ Digit Med. 2025;8(1):703.

8. Kim AD, Muntz A, Lee J, et al. Therapeutic benefits of blinking exercises in dry eye disease. Cont Lens Anterior Eye. 2021;44(3):101329.

9. McMonnies CW. Incomplete blinking: exposure keratopathy, lid wiper epitheliopathy, dry eye, refractive surgery, and dry contact lenses. Cont Lens Anterior Eye. 2007;30(1):37-51.

Prof. Jennifer Craig Therapeutic research optometrist and the head of the Ocular Surface Laboratory at the University of Auckland, New Zealand. She also serves as the chair of the Board of Directors of TFOS.

jp.craig@auckland.ac.nz

Prof. Charles McMonnies Honorary professor at the University of New South Wales (UNSW) and a highly distinguished figure in optometry and vision science. He specializes in contact lenses and dry eye syndromes. c.mcmonnies@unsw.edu.au

Dry eye disease (DED) has never been a casual fling. It is chronic, complex, often frustrating and, like any long-term relationship, requires understanding, communication and commitment from both sides.

Yet for years, clinicians have been navigating this relationship with guidance that, while valuable, was starting to feel a little…dated.

Enter the Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) III: the long-awaited sequel to the 2017 DEWS II, and the most comprehensive reexamination of dry eye disease in nearly a decade. If DEWS II was about defining the relationship, DEWS III is about learning how to make it last.

ATTRACTION

FROM BINARY CATEGORIES TO INDIVIDUALIZED DRIVERS

Dry eye care has moved from rigid labels and onesize-fits-all fixes. TFOS DEWS III rewrites the rulebook with a sharper focus on drivers, diagnosis and lived experience, offering clinicians a smarter, more nuanced way to build trust, tailor treatment and keep long-term comfort alive.

By Hazlin Hassan

This article unpacks some of the scientific and clinical updates in DEWS III, translating them into practical, patient-centered care. Think of it as a modern relationship guide, one that helps clinicians and patients stay aligned through every phase of the dry eye journey.

A LONG-AWAITED SEQUEL

Eight years is a long time in medicine. Since DEWS II was published, dry eye research has accelerated dramatically. New diagnostic tools have emerged, digital device use has exploded, our understanding of ocular surface biology has deepened, and dry eye has revealed itself as far more than an age-related inconvenience.

As Dr. Fiona Stapleton (Australia), co-author of the DEWS III report and clinical teaching director at the School of Optometry and Vision Science, University of New South Wales Sydney, explained, “It is an enormous report. There were changes in the diagnosis and the management. What do we know about this sort of pathophysiology? What has changed in the last eight years?”

The answer, as it turns out, is quite a lot.

DED is now recognized as a condition that:

• Is increasing in prevalence worldwide

• Affects younger adults and even children

• Has diverse biological “drivers” rather than a single cause

• Does not always involve inflammation

• Impacts quality of life, productivity and emotional wellbeing

DEWS III was needed not just to update definitions, but to realign clinical practice with how dry eye actually behaves in real life: messy, multifactorial and deeply personal.

WHAT’S NEW IN DEWS III

From tear film homeostasis to ocular surface homeostasis. One of the most important conceptual shifts in DEWS III is the move beyond tear film homeostasis alone. Dry eye is no longer framed as simply a problem of tears, but of the entire ocular surface system.

“It’s not just about homeostasis of the tear film, it’s also homeostasis of the ocular surface. This concept of drivers of disease—how different patients may have different drivers—and all of those need to be addressed to get a really good outcome,” Dr. Stapleton noted.

This reframing matters. It explains why two patients with similar symptoms may respond very differently to the same treatment. It also legitimizes what clinicians have long observed, that there is no single “dry eye patient.”

Goodbye binaries, hello nuance. DEWS II leaned heavily on the aqueous-deficient versus evaporative framework. DEWS III steps away from rigid categories and embraces overlap and variability.

“We recognize that inflammation is not present in every form of the disease and that is a really important shift, because that tells us that we need to be thinking about managing patients a little bit differently,” said Dr. Stapleton.

This acknowledges the frustration of patients who don’t respond to anti-inflammatory treatments and gives clinicians permission to stop using the wrong solutions on the wrong problems.

Drivers of disease. Rather than asking “What type of dry eye is this?”, DEWS III asks a better question: what is driving this Drivers may include:

• Lid and meibomian gland abnormalities

• Incomplete or infrequent blinking

• Tear film instability or hyperosmolarity

• Ocular surface damage

• Neurological contributions to symptoms

• Environmental and lifestyle stressors

Understanding these drivers is the foundation of personalized care and the key to building trust.

DIAGNOSIS IN DEWS III

Diagnosis has long been a sticking point in dry eye care. Too many tests, inconsistent thresholds and limited access to technology have made it unnecessarily complicated.

DEWS III streamlines this process.

Dry eye is, by definition, a symptomatic disease. DEWS III reinforces this by recommending a single, simple questionnaire. “DEWS III has kind of landed on one, very simple one, the OSDI6, which is really quick to administer, very easy to score, and is able to be answered by probably all patients,” said Dr. Stapleton. This ensures symptoms are not an afterthought, but the starting point of the conversation.

Not every test is needed. Another major update is the acknowledgement that clinicians do not need to perform every possible diagnostic test. “You do not need to do both breakup time and osmolarity,” noted Dr. Stapleton. “One of those is sufficient.”

For practices without access to non-invasive break-up time instruments, DEWS III provides practical guidance. “If you’re using a fluorescein breakup time, it now gives you a cutoff of five seconds,” she said. “So it’s helping make the diagnostics a little bit more accessible.”

Seeing the whole surface. DEWS III places renewed emphasis on ocular surface staining. “Corneal staining, conjunctival staining and staining of the lid wiper,” Dr. Stapleton reported. “It’s not just about the cornea.”

This broader view aligns perfectly with the shift toward ocular surface homeostasis and helps ensure clinicians aren’t missing critical clues.

FROM PAPER TO PRACTICE

Once dry eye is diagnosed, DEWS III provides a clear pathway forward. “Do they have dry eye? What are their drivers, and how does that suggest a management plan?” This three-step logic of diagnosis, drivers and targeted management runs throughout the report and is one of its greatest strengths.

Lifestyle. Management now starts with a conversation, not a prescription. “The management piece starts with a discussion around lifestyle, recognizing some of the new risk factors we know about,” said Dr Stapleton.

These include, and are not limited to:

• Screen use

• Air-conditioned or low-humidity environments

• Cosmetic products

• Contact lens use

• Deficiencies of vitamins A and C, fatty acids

This holistic approach sends a powerful message to patients. “You are treating them as a whole body and a whole person, rather than just treating their eyes,” said Dr Stapleton. That feeling of being seen and understood is the foundation of loyalty.

THE BLINK LINK

One of the most practical and surprisingly effective updates in DEWS III is the renewed focus on blinking. “When we start thinking about drivers of disease, what is the blinking like? Is there complete blinking? Is there inadequate blinking?” noted Dr Stapleton.

Incomplete or infrequent blinking can:

• Leave areas of the ocular surface exposed

• Prevent proper distribution of meibomian lipids

• Destabilize the tear film

“A lot of people, particularly when they are doing a concentrated task, the eyelids don’t come together. They may have a wide aperture, and the eyelids don’t meet,” Dr. Stapleton explained, “You get a band of exposed surface of the eye, which can dry out.”

Because the oil glands open along the eyelid margins, incomplete blinking also prevents the oil from spreading evenly across the eye. This leads to tear film instability and drying of the ocular surface

And importantly: “We do have patients who sort the blinking out, and the dry eye disappears.”

Sometimes, the smallest behavioral changes, such as blink awareness, screen breaks and environmental adjustments, can dramatically reduce symptoms. These interventions may sound simple, but they work.

Dry eye does not exist in a vacuum; it exists in offices, airplanes and bedrooms with screens glowing late into the night. For patients who cannot avoid air-conditioned environments: “Turn the fan down, perhaps have a humidifier in the office,” suggested Dr Stapleton.

LOVE, LOYALTY AND QUALITY OF LIFE

Dry eye is not just uncomfortable. It’s disruptive. “We are beginning to understand the impact of dry eye disease on life in terms of quality of life and functioning daily activities,” said Dr Stapleton.

“[DED] negatively affects quality of life, including physical, psychological and emotional well-being, social functioning, daily living activities and independence. General and mental health, social functioning, physical and emotional states, bodily pain and vitality are significantly poorer in those with DED compared with those without, said the DEWS III report. “And that health status worsens in those with more severe disease.”

DEWS III encourages clinicians to listen and to truly hear the patient’s story. “It’s hearing their story and their journey, and being able to offer advice to remediate that,” said Dr Stapleton.

These conversations do more than guide treatment. They strengthen the doctor-patient relationship. When patients feel heard, they stay engaged, even when improvement is gradual.

Top Three Takeaways Clinicians Can Fall in Love With

Some of the most actionable insights from DEWS III include:

• Diagnosis grounded in symptoms and homeostasis

• Look at tear film and ocular surface homeostasis. Both matter.

• Identify the drivers

• Lid anomalies, blinking issues, tear film instability and surface damage each points to a different strategy.

• Let drivers guide management

• Testing should inform treatment, not exist for its own sake.

• THE FUTURE OF DRY EYE RELATIONSHIPS

“There is a lot of work going on in terms of the development of biomarkers to support the diagnosis of disease, also disease subtyping and response to treatment,” said Dr Stapleton. Emerging areas include:

• Tear film diagnostics and biomarkers

• Micro RNAs

• Lipid composition and saturation analysis

• Oxidative stress markers

• Nerve-related biomarkers for pain

There’s also growing momentum toward mechanism-based therapies. Dr. Stapleton said her team has been involved in developing a selenium sulfide ointment that focuses on the mechanisms driving dry eye in meibomian gland dysfunction, particularly disruptions in keratinisation and lipid production.

“Better understanding of the pathophysiology of disease drives better treatments for patients,” said Dr Stapleton.

These advances promise a future where treatments are precisely matched to patient needs.

THE HEART OF DEWS III

At its heart, TFOS DEWS III is not just about data and definitions. It’s about how clinicians care for people with dry eye, day in and day out. It recognizes that dry eye:

• Evolves over time

• Requires ongoing communication

• Demands empathy as much as expertise

By shifting the focus from rigid categories to individual drivers, from isolated eyes to whole lives, DEWS III invites clinicians to build lasting partnerships with their patients.

STAYING ALIGNED OVER TIME

As DEWS III makes clear, there is uncertainty and variability in dry eye care. Not every patient will improve quickly. Not every intervention will work the first time. By recognizing dry eye as a condition driven by multiple, shifting factors, DEWS III gives clinicians permission to set realistic expectations early and to revisit them often.

This is critical for long-term engagement. When patients understand that dry eye management is iterative rather than instantaneous, they’re more likely to stay committed, report changes accurately and participate actively in their care. Followup becomes a continuation of the conversation rather than a reassessment of failure.

In many ways, DEWS III supports a model of care built on transparency and trust. It encourages clinicians to explain not only what they are doing, but why, and how management may evolve as drivers change over time. That shared understanding helps prevent frustration, strengthens adherence, and reinforces the sense that clinician and patient are working toward the same goal.

In the spirit of Valentine’s Day, perhaps that is the most important lesson of all. Lasting comfort, like lasting love, comes from understanding, flexibility and showing up, consistently, thoughtfully and with care.

CONTRIBUTOR

Dr. Fiona Stapleton Scientia professor and clinical teaching director at the School of Optometry and Vision Science, UNSW Sydney. She coauthored the TFOS DEWS III report and specializes in ocular disease. f.stapleton@unsw.edu.au

ILLUMINATING DRY EYE

THE VISIONARY WORK OF DR. ANTOINETTE ANTWI ON LOW-LEVEL LIGHT THERAPY

A clinician-turned-scientist with a global lens, Dr. Antoinette Antwi is helping decode dry eye’s trickiest questions and shining new light— low-level, of course—on the future of MGD management.

By Ee-Tan Chow

When Dr. Antoinette Antwi (United States) speaks about dry eye disease, she does so with the calm precision of a clinician and the bright curiosity of a scientist.

A PhD candidate at the University of Houston College of Optometry, this Ghana-born optometrist is emerging as one of the most promising young voices in ocular surface research, with her work on low-level light therapy (LLLT) already earning her international recognition.

“I’ve always wanted to help people in a meaningful way,” she said. “With dry eye, even small improvements can be life-changing. That is what motivates me.”

Dry eye may look deceptively simple to those outside the field, but Dr. Antwi sees the opposite: a complex, chronic, deeply personal disease that touches millions. For her, studying it is not just an academic pursuit but a mission rooted in compassion, curiosity and the quest for accessible innovation.

FROM GHANA TO HOUSTON

Dr. Antwi’s journey began in Kumasi, Ghana, where she grew up with her mother and two sisters. A fascination in health care—and a family nickname, “Dr. Antoo”—nudged her toward optometry. Her admission to the Kwame Nkrumah University of Science and Technology became the first defining chapter of her scientific path.

“In my final year, I worked on a clinical research project investigating patient-reported outcomes after LASIK surgery in a Ghanaian cohort. I was honored to present my findings at the 2019 American Academy of Optometry meeting in Orlando, Florida,” she recalled. “That experience was transformative and opened my eyes to how research can answer real clinical questions. I wanted to be part of that world.”

This momentum carried her toward one of vision science’s most challenging and rapidly evolving areas as she embarked on her PhD in Houston: dry eye disease.

A CLINICIAN MEETS DRY EYE

During clinical practice, Dr. Antwi noticed a constant theme. Every day, a significant number of patients walked into the clinic with familiar complaints: burning, irritation, fluctuating vision, screen-related discomfort, difficulty driving.

“It was impossible to ignore,” she said. “Dry eye disease was everywhere. And it affects quality of life in ways many people don’t realize .”

Dry eye’s chronic, multifactorial nature—shaped by environment, medications, systemic disease, ageing and contact lens wear— makes management incredibly challenging. On top of that, not every therapy works for every patient, which often leaves them discouraged.

“Seeing that struggle first-hand made me determined to contribute to solutions,” said Dr. Antwi. “I wanted to study therapies that could really make a difference to those suffering from dry eye diseaset.”

Her focus soon gravitated toward meibomian gland dysfunction (MGD). Understanding its mechanisms, and how therapies influence them, became a central focus of her academic journey.

DISCOVERING THE POTENTIAL OF LLLT

Dr. Antwi’s breakthrough moment arrived when she encountered low-level light therapy, a treatment gaining traction in ocular surface care. The first thing that caught her attention was surprisingly simple: a warming sensation around the eyelids during treatment.

“Warming the eyelids has always been important for treating meibomian gland dysfunction”

Dr. Antoinette Antwi

“So I wondered—could LLLT be doing something similar?” That question sparked her doctoral research. She designed a study comparing warm compresses, LLLT and sham treatment, examining eyelid temperature and tear film stability.

“We found that both warm compress and LLLT raised eyelid temperature above the melting point of meibum. That was an exciting moment because it suggested LLLT may contribute directly to improving gland function,” she said, adding that these findings provided early evidence that LLLT could play a meaningful role in dry eye management.

Building on this, Dr. Antwi expanded her work to the cellular level, exploring LLLT’s effects on inflammation, oxidative stress and mitochondrial activity—mechanisms that underpin ocular surface health.

“LLLT has been studied in dermatology and neurology, but its mechanism in vision science remains incomplete,” she said. “I wanted to validate how it actually works for dry eye.” Her findings suggest that LLLT may regulate inflammatory proteins in tear fluid and improve cellular energy production, which could explain the clinical improvements observed.

“When you combine clinical and basic science approaches, you get a clearer picture of the ‘why’ behind treatment outcomes,” she explained. Her work has been presented at major scientific

meetings including AAO and ARVO, reinforcing her reputation as a rising leader in dry eye research.

CRACKING DRY EYE’S BIGGEST CHALLENGE

Dr. Antwi noted that one of the biggest obstacles in dry eye care is inconsistency. Patients respond differently to the same therapy, which leads to confusion and treatment fatigue.

“Dry eye is multifactorial and chronic. When the first treatment doesn’t work, people often lose confidence”, she noted This unpredictability fuels her commitment to mechanismbased research.

She stressed that understanding the mechanisms of action behind available therapies helps clinicians make informed choices and match treatments more effectively to patient needs.

“When clinicians know how a treatment works, they can pick the right therapy sooner. This reduces trial and error and ultimately supports patient confidence,” she said. Dr. Antwi hopes her findings bring greater clarity to clinical decision-making and more assurance for patients navigating the frustrations of dry eye.

INNOVATION, BUT MAKE IT ACCESSIBLE

As her work gained visibility, Dr. Antwi’s perspective on innovation deepened. “Innovation is most meaningful when its outcomes are truly impactful,” she said.

Her own path—from Ghana to international research stages— reinforced her belief that eye-care technologies must be accessible to everyone. “The eye is a precious sensory organ,” she said. “Technologies that preserve eye health should not be limited to certain communities.”

This conviction drives her advocacy. Through programs like Prevent Blindness ASPECT and the ARVO Science Communication Training Fellowship, she has engaged policymakers on improving access to eye care and research funding.

“True innovation requires collaboration among researchers, clinicians, policymakers and patients,” she said.“We all play a role in the patient’s journey.”

RESILIENCE, ROOTED IN CULTURE AND CHARACTER

As a woman of color in vision science, Dr. Antwi has had to navigate cultural, academic and social transitions. Moving to the United States brought both opportunities and challenges.

“I have always believed that embracing challenges helps us grow,” she said. Much of her resilience is deeply tied to her mother’s example. “After we lost my father, my mother raised my sisters and me with incredible determination. Watching her wake up every morning with purpose taught me that hard work can overcome any obstacle,” she shared.

These lessons have shaped her approach to leadership and collaboration. Dr. Antwi values integrity, honesty, respect and community in all aspects of her work. These principles have helped her secure prestigious grants and fellowships, serve in leadership roles and earn recognition across the field, whether she is moderating scientific sessions, mentoring younger students, or serving in roles such as President of the Physiological Optics Graduate Student Association and Associate Program Coordinator for Africa STEM Network.

MENTORSHIP WITH PURPOSE

These same values guide her commitment to mentorship. Dr. Antwi hopes to open doors for more young women— particularly women of color—who want to pursue optometry and vision science.

“I want them to know that their perspectives are needed,” she said. “Dry eye research thrives on diverse ideas, diverse backgrounds and diverse experiences.”

At the same time, she encourages young women to lean into challenges, trust their abilities and stay rooted in their values.

A FUTURE IN FOCUS

Looking ahead, Dr. Antwi hopes to blend her clinical research expertise with roles in innovation, medical technology and scientific communication. She envisions dry eye care becoming more evidence-based, personalized and globally accessible.

Her work is already helping shape that future—one that feels brighter, clearer and grounded in both scientific rigor and human experience.

CONTRIBUTOR

Dr. Antoinette Antwi

Optometrist and Vision Science

PhD candidate at the University of Houston College of Optometry. Her current doctoral research centers on the use of LLLT for managing dry eye disease. aantwi@uh.edu

ON ONE-SIZE-FITS-ALL SWIPE LEFT

MODERNIZING DRY EYE WITH BETTER CLINICAL MATCHES

Today’s dry eye care looks less like guesswork and more like matchmaking, using a structured workup to properly pair the problem with the therapy that actually fits.

By Kendra Bruning

Dry eye had its long season of “just try some drops and see how it goes.” Artificial tears still help, yet many patients stall when the real issues sit deeper: a thin lipid layer, surface inflammation or poor tear retention.

Reviews of real-world care and clinical data keep pointing to the same conclusion: progress comes faster when you find the right pairing, not when you hand out another bottle and hope for chemistry.1,2

DIAGNOSTICS THAT MATTER

The Tear Film and Ocular Surface Society Dry Eye Workshop III (TFOS DEWS III) gave the field a needed reset by moving away from loose staging toward a framework that starts with the primary driver.

It organizes therapies into ten sections, supported by three algorithms that sort care based on what actually fails first, whether tear production, lid function or the ocular surface itself. Most patients arrive with more than one issue, so combination therapy is expected rather than exceptional. 2

In day-to-day practice, a streamlined intake gets clinicians most of the way to a solid match. Evidence shows that pairing symptom triage with slit-lamp findings sets a reliable foundation.

Adding targeted tests like fluorescein tear breakup time, corneal and conjunctival staining, tear meniscus height, osmolarity, MMP-9 for surface inflammation and meibography for gland health helps move

from impressions to clarity. 2,3 Pairing fluorescein with lissamine green ensures conjunctival staining does not slip under the radar.

Dr. Cynthia Matossian (United States), founder of Matossian Eye Associates and chief medical officer of Freya Ophthalmics, likes to start with three questions that reveal whether a deeper workup is needed:

1. How many times a day do you use artificial tears?

2. Does your vision change through the day and sharpen with a blink?

3. Do your eyes feel tired by evening?

A “yes” to any of the three is enough for Dr. Matossian to order MMP-9, osmolarity and meibography before discussing treatment. The goal is not to overwhelm the patient on the firstvisit, but to ensure the initial plan is built on real information rather than vibes.

FINDING THE RIGHT PAIRING

Most patients have several things going sideways at once, but one or two issues usually rise to the top. Start with the dominant driver and adjust from there.

When inflammation leads. If MMP-9 is strongly positive, Dr. Matossian favors a short induction steroid for two to three weeks to settle the surface. That window buys comfort while a maintenance immunomodulator ramps up.

TFOS DEWS III places anti-inflammatories alongside environmental and behavioral drivers because any break in homeostasis can nudge the surface into flare. 2 Matching the plan to the pattern matters.

When evaporative stress takes the wheel. If the lipid layer looks thin or meibomian glands look compromised, Dr. Matossian opts for a perfluorohexyloctane ophthalmic drop to decrease evaporation in addition to heated moisture masks as the first match. Home masks need to hold around 42°C for about ten minutes to soften meibum. A warm washcloth for half a minute rarely moves things forward.

In clinic, options range from vectored thermal pulsation to microblepharo-exfoliation, low-level light therapy, plasma therapy and related tools. 2

Intense pulsed light (IPL) followed by expression is a staple for moderate meibomian gland dysfunction with rosacea features, which mirrors how Dr. Marissa Heary, a clinical assistant professor at the University of Pittsburgh Medical Center, structures her own workflow.

New therapies are also entering this space, including topical selenium sulfide for gland disease and lipid-layer stabilizers for evaporative loss. 2

Dr. Heary keeps first-line home routines simple so they stick. Electric warm compresses live by the bed. Dietary omega-3s come first, with supplements for those who need the boost. Pull the cool-mist humidifier out when heaters start drying out the air. And on screen-heavy days, the 20-20-20 routine supports the system: every twenty minutes, look far for twenty seconds and finish with twenty deliberate blinks.

When the issue is tear conservation. Aqueous deficiency still responds to traditional plugs once inflammation settles, according to Dr. Matossian. Canalicular gel fillers such as Lacrifill (Nordic Pharma; Hoofddorp, The Netherlands) add reversible, longerlasting options. Moisture chamber eyewear and, in more severe cases, specialty lenses that vault the cornea can stabilize the surface by protecting what moisture remains. 2

When patients want to stay in contact lenses. Modality adjustments often bring the biggest gains. Dr. Heary tends to favor daily disposables for comfort and wear time, paired with the same lid care, diet and hydration habits that support the full tear film.

COACHING THAT PATIENTS ACTUALLY FOLLOW

Treatment plans succeed when instructions feel like something a patient can actually live with. Dr. Matossian sets expectations early by framing dry eye as a chronic, progressive condition, which shifts the dynamic toward shared responsibility.

Both Dr. Matossian and Dr. Heary agree that small lifestyle notes matter: keep electric masks within reach, use mascara free of lashlengthening fibers, aim car vents down at the floor and keep a water bottle on hand to stay hydrated. These are the kinds of details patients remember and repeat.

IMPLEMENTATION MEANS AN HONEST CONVERSATION

Before starting a new regimen, Dr. Matossian is upfront about cost. IPL, thermal evacuation and some point-of-care tests often fall outside insurance coverage in the United States. Plus, prior authorizations for prescription anti-inflammatories take time. Explaining this at the start protects trust and helps keep the plan intact through the first month, which is usually when measurable change begins.

CHECKING BACK TO CONFIRM THE MATCH

Follow-up is where the real validation happens. Dr. Matossian likes to repeat a small set of baseline tests to show progress as a trend rather than a single snapshot.

Dr. Heary checks symptom scores and staining patterns, then notes whether comfort is improving even before the ocular surface looks fully calm. As long as the cornea is healing and the patient feels better, progress is underway.

PLANNING A FUTURE TOGETHER

Short-term comfort is one thing, long-term stability is another. The pipeline continues to grow with treatments aimed at sustaining the match beyond the first few visits.

CONTRIBUTORS

Dr. Cynthia Matossian Board-certified ophthalmologist, founder of Matossian Eye Associates, CMO of Freya Ophthalmics, and a consultant in refractive cataract surgery and dry eye. cmatossianmd@icloud.com

Tryptyr (acoltremon ophthalmic solution 0.003%), a newly FDA-approved neuromodulation therapy from Alcon (Geneva, Switzerland), stimulates tear secretion through corneal nerve pathways and falls within DEWS III’s neuromodulation section. 2 New retention tools, biologics and refined device workflows are writing the next chapter of the relationship. 2 The rule of thumb is to use DEWS III as the compass, then match therapy to biology instead of forcing a pairing that will not last. 2

A

BETTER MATCH, BUILT

TO LAST Today’s dry eye workup behaves less like speed dating and more like a thoughtful match that starts with the right questions

The work now begins with an intentional look at what is genuinely breaking homeostasis and a treatment that fits the biology instead of relying on a hopeful swipe.

Keep plans simple enough to live with and specific enough to matter. When the surface calms and the patient feels heard, the care shifts from trial and error to a relationship that actually works.

Dr. Marissa Heary Clinical assistant professor of ophthalmology in the Optometry Division at the University of Pittsburgh Medical Center. She specializes in ocular surface disease. hearyma@upmc.edu

REFERENCES

1. Matossian C, Crowley M, Periman L, et al. Personalized management of dry eye disease: Beyond artificial tears. Clin Ophthalmol. 2022;16:3911-3918.

2. Jones L, Craig JP, Markoulli M, et al. TFOS DEWS III: Management and therapy. Am J Ophthalmol. 2025;279:289-286.

3. Lam D, Chong K, Shih K, et al. Optimizing diagnosis and management of dry eye disease: A practical framework for Hong Kong. Ophthalmol Ther. 2025;14(5):815-833.

Dry eye has moved on from the mild-moderate-severe era, and it’s bringing baggage. Meet the phenotypes, decode their love languages and learn why the future of DED care looks a lot like couples therapy.

By Diana Truong

The ocular surface doesn’t ask for much in life, just to be seen, understood and cared for in the way it needs. Yet for decades, clinicians have treated dry eye like a one-size-fits-all situationship: mild, moderate, severe.

That old approach, according to OCL Vision’s Head of Optometry Mrs. Purvi Thomson (United Kingdom), is “like saying all headaches are the same; a migraine, tension headache and sinus headache are treated very differently.”

In today’s era of phenotyping, the ocular surface finally gets to show its full personality: dramatic tendencies, quiet requests, love languages and all. Because at its heart, dry eye disease is more than a clinical condition. It’s a relationship. And some partners communicate better than others.

Welcome to the dry eye dating game. Let’s meet the contenders.

THE AQUEOUS-DEFICIENT PARTNER

This is the partner who wakes up hopeful, looks fine at lunch and is falling apart by mid-afternoon. The one always insisting they’re “fine,” while clutching a half-empty bottle of artificial tears that did absolutely nothing for them.

Many aqueous-deficient patients “consume half a bottle with minimal relief, highlighting that surface lubrication alone rarely addresses the underlying problem,” Mrs. Thomson explained.

Clinically, the story is clear: reduced tear volume, elevated osmolarity, staining, a shrinking tear meniscus…the ocular equivalent of a plant that’s been watered once since last spring. And at the core, the lacrimal gland simply isn’t producing enough aqueous tears. That low volume “leads to hyperosmolarity, triggering inflammation that further damages the ocular surface,” she said.

Their love language is acts of service. They blossom with the dependable, thoughtful gestures: preservative-free lubricants, plugs, anti-inflammatories, ciclosporin, even serum drops if the relationship has reached its emotionally fragile era. And don’t forget environmental changes: humidity and screen breaks speak volumes.

Trust with this partner is rebuilt by restoring volume and quelling inflammation. No fancy gifts, no grand gestures. Just consistency and care.

THE EVAPORATIVE TYPE

Evaporative dry eye, driven largely by meibomian gland dysfunction (MGD), is the one with commitment issues: plenty of tears, but no lipid stability to hold things together. Tear breakup is too quick. The lid margins tell a story. The glands give you… cottage-cheese energy.

Many practitioners miss it, Mrs. Thomson noted, because “eyelid and meibomian gland evaluations are often insufficient.” Clinicians often check the cornea, maybe even a lid if they’re feeling ambitious, but fail to “truly examine the quality and expressibility of the meibum.”

Mechanistically, it’s simple: the glands aren’t producing usable oil. Without the lipid layer, aqueous tears evaporate too fast and the relationship destabilizes.

Their love language is physical touch. Warmth. Massage. Gentle but firm expression. Thermal pulsation. Lid hygiene. Even intense

pulsed light (IPL) if things are really on the rocks. And— big misconception alert—warm compresses are not the cure. “They don’t cure and serve as maintenance therapy only,” Mrs. Thomson emphasized.

This partner needs daily rituals, stability and reassurance. Consistency keeps the flame alive.

THE MIXED RELATIONSHIP

You know this one. A bit of dryness here, some lipid drama there. Unpredictable. Complex. Occasionally confusing. But with the right approach, it’s deeply rewarding.

“Most dry eye patients have multiple contributing factors,” Mrs. Thomson reminded us. The clinical challenge is identifying the dominant driver—who’s calling the shots at any given moment.

Their love language? Quality time. They thrive under a care plan that’s layered, thoughtful and revisited regularly. You start by targeting the biggest offender—aqueous deficiency, severe MGD, inflammation—while supporting secondary issues.

“Layer therapies strategically rather than overwhelming patients with everything at once,” Mrs. Thomson advised.

Improvement isn’t instant. It’s a slow dance. Small wins. Mutual understanding. And lots of follow-up.

THE ASYMPTOMATIC ONE

Ah yes, the partner who insists they’re totally okay while quietly breaking apart inside.

Here, symptoms and signs just…don’t match. Maybe it’s neuropathic pain—burning, hyperalgesia, but almost no staining. Maybe it’s neurotrophic keratitis—reduced corneal sensation so profound the cornea can’t signal for help.

“Normal tear breakup time, minimal staining; you’re examining at the slit lamp thinking the findings don’t correlate with their reported suffering,” Mrs. Thomson explained.

Their love language is words of affirmation. Validation. Education. A clinician who listens carefully and treats their experience as real—which it absolutely is. And crucially, recognizing when the problem is neural so they aren’t stuck in months of ineffective therapies. “Artificial tears or lid therapies alone are insufficient,” Mrs. Thomson warned.

These are the patients who need you to read between the lines.

THE HAPPY ENDING

The most successful relationships in eye care are built on understanding. Not assumptions. Not generic treatments. True, thoughtful phenotyping.

Early in Mrs. Thomson’s career, she “would jump straight into looking at the tear film” and treat what she saw first. Now, she starts with history because “the most valuable diagnostic information often comes before you ever turn on the slit lamp.” And even when Mrs. Thomson finds a clear abnormality, she keeps going.

“Always complete the evaluation even if an obvious abnormality is present,” she advised.

Because every ocular surface has a love language. Every phenotype has emotional needs. And every patient becomes more engaged, compliant and trusting when you speak in the dialect their eyes understand.

Whether it craves acts of service, physical touch, quality time or gentle words of affirmation, the dry eye relationship thrives with tailored care. When clinicians communicate in the ocular surface’s love language, adherence improves, outcomes strengthen and even the most difficult dry eye partnerships find their version of happily-ever-after.

In the end, dry eye isn’t just a disease. It’s a relationship. One that’s ready to work as long as you are.

CONTRIBUTOR

Mrs. Purvi Thomson Head of Optometry at OCL Vision. She has a keen interest in ocular surface disease and established a successful dry eye clinic at her current workplace. purvi@oclvision.com

FIRST VISIT ATLOVE

HOW TO BUILD LOYAL RELATIONSHIPS WITH DRY EYE PATIENTS

In a condition defined by chronicity, frustration and déjà vu, Dr. Cory Lappin argues that trust, timing and tone may matter as much as tear film metrics. Here’s how the first visit, and everything after it, can turn exhausted DED patients into longterm partners in care.

By Marhiel Garrote

Dry eye patients rarely walk into a clinic feeling neutral. Many arrive frustrated, emotionally worn down and unsure whether this visit will be any different from the last. By the time they settle into the exam chair, they’re not only hoping for symptom relief. They’re asking something quieter, but more consequential: Will this doctor really listen to me?

For dry eye specialist Dr. Cory. Lappin (United States), the answer to that question shapes everything that follows. “A big thing for a dry eye patient is they just wanna be heard,” he says. “Many of them have often

LOVE AT FIRST VISIT

(OR AT LEAST TRUST)

The first dry eye consultation sets the tone for everything that follows. For Dr. Lappin, that visit begins not with diagnostics, but with silence.

“One of the first things you can do is just listen,” he advises. “I keep it very openended…‘You tell me what’s going on with your eyes. You tell me how it’s affecting you, and I’m just going to listen.’”

been to multiple doctors. I’m normally the third or fourth doctor that they’ve seen.”

This reality is not uncommon. Dry eye disease (DED) is widespread, affecting a significant portion of the population. A study in JAMA Ophthalmology1 reported that “dry eye symptoms were present in 14.4% of the population examined,” underscoring just how frequently clinicians encounter patients who are already exhausted from telling their story.

What keeps those patients coming back, Dr. Lappin argues, isn’t technology alone. It’s how the relationship is built, starting with the very first visit.

That pause does more than build rapport. It often guides diagnosis. “My mentor, Dr. Epstein, used to say that patients are the most sensitive instrument we have,” Dr. Lappin recalls. “So just let them talk, and they’ll often lead you to exactly what’s going wrong.”

Just as important is acknowledging the emotional context the patient brings with them. Many arrive anxious, worried that they’ve already exhausted their options. For Dr. Lappin, acknowledging that experience is also important and normal. “This is normal,” he tells his patients. “That alone brings the stress level down.”

By normalizing their journey, patients stop feeling like outliers and start feeling understood. “They realize they’re finally in the right place,” adds Dr. Lappin.

COMMUNICATION THAT ACTUALLY COMMUNICATES

Listening opens the door, but communication keeps it open. Dr. Lappin is intentional about understanding what matters most to each patient, not just clinically but personally. He asks how dry eye has disrupted daily life, whether that means wearing contact lens wear, long hours on screens or simply getting through the day comfortably.

“I want to know what activities—what daily parts of their lives—are struggling now, because I’m concerned [about] what I see going on in their eyes,” he says. “But I need to see the bigger picture. Because when it comes to dry eye, you want to take care of the entire patient…Those eyes are attached to a whole person.”

Once those priorities are clear, he reflects them back to the patient, reinforcing that their concerns are central to the treatment plan. “What’s most important to them is what should be most important to me,” says Dr. Lappin.

Education plays a key role in that process. Dr. Lappin takes time to explain dry eye in

simple, relatable terms, often using visuals to describe the tear film and its layers.

The goal is not to overwhelm patients with medical language, but to help them understand what is happening and why their symptoms make sense.

Language also shapes expectations, particularly for chronic conditions. Rather than framing dry eyes as a dead end, Dr. Lappin emphasizes manageability and progress over time.

This approach is especially relevant given research showing that dry eye disease often intersects with mental health. A review in Internal Journal of Molecular Science 2 described “a strong and bidirectional association between DED and psychiatric disorders, particularly depression, anxiety, post-traumatic stress disorder (PTSD) and sleep disturbances,” reinforcing the need for communication in empathy and reassurance.

“Dry eye is often viewed as a chronic pain condition, and pain—especially chronic pain—has a strong emotional element to it,” Dr. Lappin shares. “So I let them know that that is a normal thing and that is something that they’re likely experiencing.”

THE SMALL STUFF THAT ISN’T SMALL

Loyalty often grows in moments that seem minor but feel very personal. One of Dr. Lappin’s simplest practices is removing pressure from the visit itself. Patients are reassured that instructions and recommendations will be provided in writing, allowing them to stay present during the conversation.

“I will have everything written down for you, so don’t worry,” he tells his patients. “I want you to just be able to relax, sit, and listen and talk.”

That reassurance changes the dynamic of the visit. Patients no longer feel compelled to capture every detail, which allows clinicians to better understand what patients actually need from treatment through conversation.

Consistency across the practice matters just as much. From front desk interactions to follow-up calls, patients should experience the same tone of empathy and care. For Dr. Lappin, a well-trained staff is essential. “Making it an office-wide effort is a big thing,” he says.

Even small touches of calm, warmth and appropriate humor can help ease

the emotional weight dry eye patients often carry.

PLAYING THE LONG GAME, TOGETHER

Dry eye care is not a one-time fix, and patient loyalty is no different. Dr. Lappin structures care with continuity in mind, maintaining regular follow-ups even for patients who are doing well.

Early in treatment, visits may be more frequent to build momentum and adjust plans. Over time, consistent check-ins help patients to feel supported rather than forgotten. “I don’t cut patients loose,” he says. “Even the ones who are doing best, I like to see them at least twice a year”

Setbacks are expected. Treatments lapse, routines slip and life intervenes. Dr. Lappin approaches these moments without judgement, encouraging honestly and reinforcing that restarting is always an option. “As long as they don’t give up…I’m not going to give up.” notes Dr. Lappin. That flexibility preserves trust and keeps patients engaged even when progress isn’t linear.

EMOTIONAL ROI, MEASURED CAREFULLY

Patients who feel heard and supported are more likely to adhere to treatment plans, attend follow-ups and return for care. Dr. Lappin relies on objective data to reinforce progress, especially when symptoms lag behind measurable improvement.

“A lot of times patients’ signs will improve before their symptoms do,” he explains. “But then I could show them that their numbers have gotten better, and [they’ll] sometimes say, ‘Oh, so I am getting better.’”

Certain phrases, however, signal deeper fatigue. When patients say they have “tried everything,” Dr. Lappin hears hesitation rather than resignation. Often, it reflects fear of being disappointed again. Recognizing these moments allow clinicians to slow down, reset expectations and rebuild partnership.

In some cases, emotional distress extends well beyond frustration. Dr. Lappin notes that clinicians committed to dry eye care must be prepared for conversation outside traditional clinical boundaries. “I’ve had many patients who have discussed suicidal ideation, self harm,” he reports. “You have to be prepared for how you’re going to address that.”

For Dr. Lappin, preparation is a responsibility. He stresses the importance of understanding professional and legal obligations, and having a clear plan in place long before such moments arise.

“If that ever happens, I discuss with the patient, ‘When you mention this, I think we really need to get other specialists involved,’” he says, with a list of professionals to refer to ready. “You have to be prepared ahead of time because that is one of the most challenging things you can deal with.”

Handled thoughtfully, these moments do not weaken the clinician-patient relationship. They strengthen it. Emotional ROI, in this sense, is not just about loyalty or outcomes. It reflects a clinician’s readiness to care for the whole person, to recognize limits and to collaborate when a patient’s needs extend beyond the ocular surface.

In dry eye care, trust is built not only through treatments that work, but through presence in moments of vulnerability. For patients who have spent years feeling unseen, untreated and hopeless, that presence may be the most meaningful outcome of all.

REFERENCES

1. Moss SE, Klein R, Klein BEK. Prevalence of and risk factors for dry eye syndrome. JAMA Ophthalmol. 2000;118(9):12641268.

2. Kastelan S, Kozina L, Tomic Z, et al. Dry eye disease and psychiatric disorders: Neuroimmune mechanisms and therapeutic perspectives. Int J Mol Sci. 2025;26(21):10699.

CONTRIBUTOR

THE COLLABORATIVE VISION BEHIND WORLD OPTOMETRY WEEK 2026

By Marhiel Garrote

RETHINKING GLOBAL EYE CARE COMPATIBILITY

At some point in life, nearly everyone will need eye care–whether for refractive error, age-related changes, chronic disease or an unexpected condition that affects vision. And yet, despite how universal that need is, access to eye care remains deeply uneven across the world. Millions of people still go without even the most basic eye care services.

That gap is exactly what World Optometry Week 2026 is asking the global eye-care community to confront. This year’s theme places collaboration front and center–not as a buzzword, but as a practical response to a challenge that has outgrown siloed solutions.

As President Dr. Cindy Tromans of the World Council of Optometry outlines in the organization’s materials, the scale of need makes collaboration unavoidable. “Almost everyone will experience impaired vision or an eye condition during their lifetime and will need access to eye care services and sadly, there are millions of people worldwide lacking access to essential eye care.”

To put it simply, challenges this widespread can’t be met by one profession working alone.

For Dr. Tromans and the WCO, this reality points to a bigger shift, one that moves eye care away from fragmented services and toward systems designed to work together, across disciplines and borders.

WHAT COLLABORATION LOOKS LIKE IN PRACTICE

In healthcare conversations, collaboration is often spoken about in broad, aspirational terms. But for World Optometry

Week 2026, the focus is firmly on what collaboration looks like on the ground.

“For WCO, effective collaboration means action, not just intent,” Dr. Tromans explains. “It requires coordinated, team-based care organized around people’s needs rather than professional boundaries—reflecting WHO’s call for integrated people-centered eye care (IPEC).”

That definition matters. It reframes collaboration not as a professional courtesy, but as infrastructure. According to Dr. Tromans, meaningful collaboration depends on “mutual respect between professions, clear roles, standardized education and competencies, and systems that enable communication and continuity of care.” Just as critically, it ensures that “optometry is embedded within health systems rather than operating in isolation.”

This framing aligns closely with the World Health Organization’s World Report on Vision, which calls for an integrated, people-centered eye care as the foundation for universal eye health care.

WHY SILOS NO LONGER WORK

From a public-health perspective, the case against siloed care is already clear. In a virtual interview conducted for this article, Dr. Rajeev Prasad described why collaboration has become essential rather than optional.

“From a public health standpoint, I can say collaboration is really essential because the burden of visual impairment is too large and too complex and I would say too unevenly distributed to be addressed by any single profession or sector,” he said.

Eye health, Dr. Prasad emphasized, is closely tied to much broader forces. “Health is deeply connected to broader health, social and economical determinants, and effective solutions require coordinated action across primary health care specialist service and community delivery and policy.”

In day-to-day clinical practice, that coordination often shows up through co-management. “Optometrists working alongside with ophthalmologists ensures safe, timely and comprehensive care,”’ he explained—whether that involves managing corneal disease, keratoconus with scleral lenses, anisometropic amblyopia or supporting low-vision rehabilitation when other treatment options are limited.

When those connections are in place, he added, “Integrated teamwork transforms fragmented care into better outcomes at both individual and population levels.”

COLLABORATION IN ACTION: LESSONS FROM COMMUNITIES

While collaboration is sometimes discussed in abstract terms, Dr. Prasad pointed to community-based and regional programs as proof that it works–especially in underserved populations.

According to him, community bases and regional eye care programs clearly talk about how collaboration works. Delivering care “Through primary eye health services, outreach programs and task sharing can significantly improve access to early detection and long-term outcomes particularly in the underserved population.”

These models highlight the role optometrists often play at the front lines of care. “These programs also show how optometrists can identify patients in a community who need further investigation, medical treatment or surgery and ensure appropriate referral and followup,” Dr. Prasad noted.

Importantly, these local wins don’t stay local. Under the WCO’s leadership, collaboration “uses this local success to inform global guidance promoting adaptable evidence-based approaches rather than one-size fits all solutions.”

OPTOMETRISTS AS THE COORDINATORS OF EYE CARE

In many health systems, optometrists are the first eye care professionals patients encounter when something goes wrong with their vision. That position places them at the center of collaborative care models.

“Optometrists’ contributions in positioning themselves as primary eye care providers and care coordinators will be within their communities,” Dr. Prasad said, stressing that this role works best when paired with a strong relationship with ophthalmologists.

He described optometrists as a crucial point person in identifying individuals with cataract, glaucoma, retinal disease and corneal pathology, particularly in community outreach and primary care settings. Early detection, however, must be matched with “timely referral comanagement and follow-up.”

“If a proper referral pathway is there, that really improves the health system and strengthens what optometrists can

deliver. That’s when you can really say that an optometrist can help deliver people centered eye care when it is needed the most,” Dr. Prasad said.

TURNING A GLOBAL VISION INTO LOCAL ACTION

While World Optometry Week 2026 sets a global direction, its real impact depends on what happens at the regional and national levels. According to Dr. Prasad, professional organizations play a pivotal role here.

“The role is really vital in translating the global vision into local action,” he said. “Because if there is a global vision and local action is not being taken I think you know that will fail.”

During Optometry Week, national and regional groups can bring the theme to life by “highlighting local partnerships promoting integrated and collaboration models of care and advocating for optometry roles within primary eye health and public health system.”

Engaging ophthalmological societies, policymakers and other community organizations helps demonstrate “how optometry can contribute meaningfully to universal health coverage, ensuring that world optometry week drives with real impact and not just creating awareness.”

A WEEK THAT SPARKS EVERYDAY COLLABORATION

Rather than treating World Optometry Week as a symbolic moment, both WCO leaders frame it as a starting point. Dr. Prasad emphasized that collaboration doesn’t have to begin with large-scale reforms.

“The practical action optometrists can take during the world optometry week is to intentionally connect with the colleagues or partners outside their immediate practice,” he said–whether that means ophthalmologists, primary health providers, public-health programs or nongovernmental organizations.

“Even a single collaborative initiative such as joint screening…co-managing patient pathways or maybe shared community education programs,” he added, “reinforces a powerful message that optometrists are essential partners in delivering collaboration, comprehensive and sustainable eye care not only nationally but also globally.”

A SHARED VISION, SUSTAINED

At its core, World Optometry Week 2026 carries a clear message. As Dr. Tromans states plainly, “The future of eye care depends on collaboration.”

Moving beyond silos and toward shared responsibility is not a one-week exercise. It is an ongoing shift in how eye care is delivered, coordinated and sustained. By working together—across professions, systems and communities—the global eye care community moves close to a future where, as the WCO envisions, “everyone, everywhere, has access to the eye care they need and deserve.”

CONTRIBUTORS

Dr. Cindy Tromans is a Consultant Optometrist at Manchester Royal Eye Hospital and Honorary Clinical Lecturer at the University of Manchester, President of the World Council of Optometry (2025–2027). cindy.tromans@college-optometrists.org

Dr. Rajeev Prasad is a senior clinical optometrist from Delhi NCR, India. Secretary General of the Indian Optometry Association, President of the Asia Pacific Council of Optometry and President-Elect of the World Council of Optometry (2025–2027). rajeev@visualeyezindia.com

COOKIE 22 - The Dry Eye Issue

Nothing Dry

ABOUT DRY EYE CARE

ADVISORY BOARD MEMBERS

When Love is Not in the Air

HOW AIR POLLUTION FUELS DRY EYE DISEASE

MORE THAN A LOCAL PROBLEM

WHEN PARTICLES MEET THE TEAR FILM

LOOKING INWARD, LITERALLY

A CLEAR-EYED CONCLUSION

REFERENCES

CONTRIBUTORS

CONTACT COMPATIBILITY

MAKING DRY EYES AND CONTACT LENSES A MATCH MADE IN HEAVEN

THE RELATIONSHIP PROBLEM

CONTRIBUTOR

THE HAPPY ENDING

THE NEW OF FACE

DRY EYE

ENVIRONMENT AND THE PEDIATRIC OCULAR SURFACE

SILENT SUFFERS AND SMARTER DETECTION

MANAGING YOUNG DRY EYE

WHAT’S NEXT IN DRY EYE INNOVATION?

REFERENCE

CONTRIBUTOR

THE BLINK LINK

WHEN INCOMPLETE BLINKS BECOME A TREATABLE DRY EYE SIGNAL

OPTICS

THE BLINK BREAKDOWN

THE DIGITAL AGE BLINK TAX

THE BIOMECHANICS OF A “BAD BLINK”

THE HEISENBERG PROBLEM OF BLINK QUALITY

RETRAINING THE BLINK

PAIRING BLINK TRAINING WITH MEIBOMIAN GLAND CARE

TURNING BLINKS INTO BONDS

A PRACTICAL BLINK PROTOCOL

CONTRIBUTORS

REFERENCES

ATTRACTION

ATTRACTION

FROM BINARY CATEGORIES TO INDIVIDUALIZED DRIVERS

A LONG-AWAITED SEQUEL

WHAT’S NEW IN DEWS III

FROM PAPER TO PRACTICE

THE BLINK LINK

LOVE, LOYALTY AND QUALITY OF LIFE

Top Three Takeaways Clinicians Can Fall in Love With

THE HEART OF DEWS III

STAYING ALIGNED OVER TIME

CONTRIBUTOR

ILLUMINATING DRY EYE

FROM GHANA TO HOUSTON

A CLINICIAN MEETS DRY EYE

DISCOVERING THE POTENTIAL OF LLLT

CRACKING DRY EYE’S BIGGEST CHALLENGE

INNOVATION, BUT MAKE IT ACCESSIBLE

A FUTURE IN FOCUS

ON ONE-SIZE-FITS-ALL SWIPE LEFT

DIAGNOSTICS THAT MATTER

3. Do your eyes feel tired by evening?

FINDING THE RIGHT PAIRING

COACHING THAT PATIENTS ACTUALLY FOLLOW

IMPLEMENTATION MEANS AN HONEST CONVERSATION

CHECKING BACK TO CONFIRM THE MATCH

PLANNING A FUTURE TOGETHER

BETTER MATCH, BUILT

REFERENCES

THE EVAPORATIVE TYPE

THE ASYMPTOMATIC ONE

THE HAPPY ENDING

FIRST VISIT ATLOVE

HOW TO BUILD LOYAL RELATIONSHIPS WITH DRY EYE PATIENTS

LOVE AT FIRST VISIT

(OR AT LEAST TRUST)

COMMUNICATION THAT ACTUALLY COMMUNICATES

THE SMALL STUFF THAT ISN’T SMALL

PLAYING THE LONG GAME, TOGETHER

EMOTIONAL ROI, MEASURED CAREFULLY

REFERENCES

CONTRIBUTOR