CRU 2025: The ABCs of DED and OSD

Optometric and ophthalmic perspectives collided when Cecelia Koetting, OD, FAAO, DipABO, and Madeline Yung, MD, compared and contrasted their observations and practices regarding ocular surface disease (OSD) and dry eye disease (DED) during a presentation given at CRU 2025 in Napa, California. The presentation “The ABCs of DED and OSD” was given on March 29 and detailed the prevalence of the conditions, diagnostic tools, and treatment options.

As far as prevalence, Koetting and Yung cited that an estimate of over 16 million patients have been diagnosed with DED, with about 33 million patients estimated to be suffering from dry eye symptoms, with the condition known to be underdiagnosed and undertreated.² MGD affects approximately 100 million patients in the US, and has a near-term market opportunity of 30 to 40 million patients.³ Both Koetting and Yung agree with these estimates.

“The world that we live in today is very different from how we evolved biologically, and so I don't think our biology has had that time yet to catch up to these things,” Yung said. “And if you own some sort of screen, you are altering your own physiology beyond what might have been expected by evolution.”

Koetting noting that a majority of her patients sleep with their eyes partially open, which also contributes to the prevalence of dry eye. “Maybe 50 to 60% of my patients sleep with their eyes partially open … It is just a poor seal that leads to air being able to make its way in and being able to the drying out of the cornea,” she said.

Additionally, Demodex mite prevalence has been found to have no correlation with overall hygiene, with Koetting noting that the treatment of Demodex is as much as treating the face as it is treating the eyes. “Sometimes you do have to create a partnership with dermatologists,” Yung said.

For diagnostic techniques, slit lamp examination the use of fluorescein and lissamine green for staining, checking meibomian gland function and expression, examining lid position and blinking patterns, and looking for conjunctival inflammation all crucial for determining a diagnosis.

To start, basic treatments like warm compresses and lid hygiene can provide dry eye relief, with advanced therapies available if needed. Said therapy options include OTC lubricants, nutraceuticals, topical steroids, cyclosporine, intense pulse light therapy, and in-office lid cleaning devices. Some emerging treatments include RASP inhibitors for inflammation control and tryptamine receptor agonists to stimulate tear production.

References:

1. Koetting C, Yung M. The ABCs of DED and OSD. Presented at: CRU 2025; March 28-30; Napa, California.

2. Farrand KF, Fridman M, Stillman IO, Schaumberg DA. Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. Am J Ophthalmol. 2017;182:90-98. doi:10.1016/j.ajo.2017.06.033

3. Blackie CA, Folly E, Ruppenkamp J, Holly C. Prevalence of meibomian gland dysfunction – a systematic review and analysis of published analysis. Invest Ophthalmol & Vis Sci. 2019;60(9):2736.