SECO 2025: The nuanced challenge of treating dry eye and ocular surface disease

At SECO 2025 in Atlanta, Georgia, Ian Ben Gaddie, OD, FAAO, participated in a dry eye symposium, where he highlighted the clinical benefits of Vevye ophthalmic solution. During the discussion, he explained the unique formulation of Vevye, which consists of a semifluorinated alkane combined with cyclosporine. This innovative composition acts as an effective drug delivery system, allowing for significantly improved penetration of cyclosporine—approximately 22 times greater than traditional formulations. This enhanced drug delivery mechanism provides a promising new treatment approach for patients with ocular surface disease, including dry eye, meibomian gland disease, and blepharitis.

When assessing patients with symptoms or signs of ocular surface disease, Dr. Gaddie follows a structured diagnostic process. His first step is symptom evaluation, for which he relies on the Standard Patient Evaluation of Eye Dryness (SPEED) survey. Patients complete this survey while waiting, providing a quantifiable score that helps assess symptom severity. After establishing symptoms, he performs a clinical examination, focusing on the lid margin for Demodex blepharitis, signs of ocular rosacea, and corneal and conjunctival staining, which is a key indicator of ocular surface disease. Gaddie emphasizes the importance of identifying and documenting corneal staining, often using photography to show patients their condition, which aids in treatment acceptance.

Regarding treatment, Gaddie typically turns to two main approaches. For blepharitis, he prefers *lotaliner*, a treatment that works quickly over a six-week period. When corneal staining is present, he prescribes *Vevye*, which has demonstrated both clinical and statistical effectiveness within two weeks. This allows him to reassess within a month and determine whether to continue the treatment or explore alternative options. He acknowledges that no single treatment works for every patient and that many individuals historically struggle with existing dry eye therapies.

Gaddie also notes a critical challenge in dry eye treatment: patient dissatisfaction. Traditional therapies for dry eye and ocular surface disease have seen high discontinuation rates, with nearly 70% of patients stopping cyclosporine-based treatments within the first year due to side effects, lack of efficacy, or access issues. He stresses the importance of patient education, stating that individuals cannot fully understand their condition unless they see visual evidence of their disease. Tools such as photography and meibography play a crucial role in improving compliance and acceptance of treatment.

In summary, Gaddie advocates for a systematic approach to diagnosing and managing ocular surface disease. He emphasizes the advantages of *Vevye* as a groundbreaking treatment, highlights the need for individualized care, and underscores the importance of patient education in achieving better treatment outcomes.