Ocular Surface Disease: Look how far we’ve come… and how far we have yet to go…

Medicine is a journey. The advances in science and technology throughout history often travel over years and between continents. Ophthalmology has contributed to this dynamic process with its myriad breakthroughs, as our nobel profession writes its own path of optimizing care for those who wish to improve vision and quality of life. The dramatic changes which have occurred in cataract surgery, for example, came from leaps in technology such as phacoemulsification and foldable intraocular lens materials, to the small steps of adding drapes and povidone-iodine to prevent devastating complications. It seems no area in ophthalmology is satisfied with the status quo.
The history of ocular surface disease is as old and well travelled as the history of our specialty itself. “Dry eye” was described even in the 1880’s, while Henrik Sjogren described the triad of symptoms which would bear his name in 1933, even then the journey of ocular surface disease was well travelled as a French author also described the syndrome independently. In fact, the efforts surrounding ocular surface disease are the perfect example of how several factors can come together to push the advances faster and bring the issues to a wider appeal within our specialty, and even to the general population.
While ocular surface disease experts toiled trying to identify the “Holy Grail” of corneal stem cells, keratorefractive surgery was a burgeoning area with seemingly nothing in common. A strange thing happened on the way to the laser, “simple” dry eye was a relatively common occurrence, and it was the most common reason for patient dissatisfaction. Suddenly, refractive surgeons were taking notice of the first refracting surface, the ocular surface. Together, clinicians, scientists and industry started working together down the path to try to (1) define ocular surface disease, (2) describe the changes that occur, (3) identify areas to attack the problem, and finally (4) design new treatment paradigms. This collaboration led to the first medication approved for the treatment of ocular surface disease, cyclosporin, in 2002, over 120 years after the first description of “dry eye.” As our specialty has taken notice, it seems every subspecialty can play a role in improving the ocular surface, from the glaucoma medications decreasing or eliminating harsh preservatives, to the experimentation of anti-VEGF pharmaceuticals to affect the ocular surface.
In this edition of EyeWorld, take note of the phenomenal work being done in all aspects of ocular surface science, and more importantly for our patients, how we can use our current knowledge to improve patient experiences and optimize surgical outcomes. Review the latest commercial products which have amazing properties much more desirable than the saline which was the sole agent before. Read about the simple steps we can take in our preparation for cataract and refractive surgery which could mean the difference between a happy patient, and a devastating complication. Journey down the story of inflammation and its role in ocular surface disease, we seem to be seeing the light at the end of the tunnel for more specific targets and therefore, more specific treatments, hopefully the second approved medication for dysfunctional tear syndrome. Explore the current state of the art in ocular surface reconstruction surgery, which is evidence of how far we have come, and yet how far we are from all of the solutions for ocular surface disease.
We hope that this forum will stimulate your interest in these topics and that you will share your ideas with us.

Francis S. Mah, M.D.