Newer paradigms in dry eye disease research.

Abstract

Dry eye disease (DED) is a chronic ocular surface condition that affects millions of people and has a worldwide prevalence of over 50%. Morbidities associated with DED include pain, discomfort, and blurring of vision. DED has evolved into a pressing public health concern due to the economic and psychosocial burden it imparts on affected individuals. A multitude of etiological or risk factors has been identified, ranging from aging, surgery, and malnutrition to occupational environment. These factors contribute to ocular surface inflammation, epitheliopathy, hyperosmolarity, tear film instability, and neurosensory abnormalities that culminate in the presentation of signs and symptoms of DED. Aberrant and chronic ocular surface inflammation emerged as a key modifiable contributor in DED pathobiology due to its direct association with signs and symptoms of DED, and resolution of disease following the use of anti-inflammatory agents. Despite being one of the most successful therapeutic strategies in DED management, there is a substantial number of patients who are refractory to anti-inflammatory regimen and other current forms of treatment. In addition, complexity in the management of DED increases with the presence of discordance between signs and symptoms in some patients. Hence, there is an urgent and constant need to identify additional disease mechanisms and contributors that can be targeted to resolve the morbidities associated with DED. The current special issue DED is designed to report and highlight the various translational investigations that have been directed towards improving DED management in clinical practice. These include (i) disease-specific and biomarker-based stratification of patients for personalized treatment and prevention of disease progression; (ii) newer therapeutic strategies that include both pharmacological and non-pharmacological (such as thermal pulsation therapy) approaches; (iii) novel molecular factors and mechanisms including novel proteins, interferon imbalance and ionic imbalances; (iv) physiological variations, such as hormonal and nutritional changes; (iv) newer disease models, including animal models that can be used to understand newer mechanisms and to test emerging and novel therapeutic agents. In summary, the contributors to this special issue have provided critical additions to the DED knowledgebase, with reference to both pathological mechanisms and clinical management. About the AuthorDr. Rohit Shetty Dr. Rohit Shetty is the Vice Chairman of Narayana Nethralaya, Bangalore, a cornea-refractive surgeon and a clinician scientist with a keen interest in keratoconus, corneal ectatic disorders and dry eye disease. He has been practicing high volume refractive surgery for 15 years now. Dr Shetty obtained his FRCS Glasgow in 2006 and is currently an FRCS examiner. He is the Chief Mentor for the Dual Academic Program (PhD & Clinical Fellowship) at Narayana Nethralaya Eye Institute, Bangalore and Maastricht University. He was recently awarded the Fellowship of the American College of Surgeons. Dr Shetty has close to 350 publications in peer-reviewed journals and is a reviewer for many indexed journals in the specialty. He is also on the editorial board of the Journal of Refractive Surgery. With a keen interest in imaging, some of his research includes, waveform analysis of deformation and deflection amplitude in keratoconus, influence of ocular spherical aberration on near and intermediate visual acuity in presbyopic eyes, biomechanics of LASIK Flap and SMILE Cap and corneal tomography in post-refractive surgery ectasia. In the 2015 annual conference of the All India Ophthalmological Society, Dr Shetty won the prestigious Col. Rangachari Award for his work on “Is Inflammation Driving Keratoconus? A Holistic Study of Molecular Pathways”. The American Academy of Ophthalmology recently conferred the Achievement Award to Dr Rohit Shetty for distinguished services rendered over the years to the programs of the society. Besides being conferred the Casebeer Award for outstanding contribution to refractive surgery, he was recently awarded the Achievement Award by the Asia-Pacific Academy of Ophthalmology.