Dry Eye Disease Therapy: who are the non‐responders?

Purpose To investigate the parameters that characterize the patients that responds or do not respond to dry eye disease ( DED ) therapy as recommended by the International Dry Eye WorkShop 2007. Methods 217 DED patients were consecutively included at the Norwegian Dry Eye Disease Clinic in Oslo, Norway. All patients underwent a comprehensive ophthalmological examination. The patients’ symptoms were reported by means of three self‐questionnaires (Ocular Surface Disease Index [ OSDI ], McMonnies Dry Eye Inventory [ MDEIS ] and the Sjögren's syndrome [ SS ] questionnaire [ SSQ ]). Patients were defined as treatment‐responders if their dry eye severity level ( DESL ) score had improved following 6 months of treatment, and non‐responders if their DESL score was unchanged or worse. Results Non‐responders were older ( P  =   0.019), had lower baseline DESL score ( P  <   0.001), had less pathological tear meniscus height ( P  =   0.007) and used fewer systemic prescription drugs ( P  =   0.046). Linear regression analysis showed that age, DESL and number of systemic prescription drugs used were independently associated with treatment response ( P  <   0.05). Furthermore, patients were more likely to respond to therapy if it was initiated during winter, which suggests a seasonal effect. Females and males, as well as meibomian gland dysfunction ( MGD ) patients and non‐ MGD patients, were equally likely to respond to treatment. Conclusions As the recommended therapy for DED is based on the DESL score of the patient our results may either indicate that the therapy recommended for the higher levels of DESL are more effective than that recommended for the lower levels of DESL or that effect is easier to detect in patients with more pronounced DED . Future studies should investigate whether patients with mild DED should be treated more aggressively.