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Optometry Simplified Newsletter: Dry Eye 3.0 - What the New DEWS III Reports Mean for You
Published over 1 year ago • 4 min read
Welcome to Optometry Simplified.
In this biweekly newsletter, I've curated the best resources to help you grow personally and professionally.
My mission is to find what's best for my patients and my practice.
Here's what I've found...
My Favorite Links
What Do You Do When You Are Downcoded by an Insurance Company?
If you’ve ever felt blindsided by a denied or downcoded claim, this article by Peter Cass, OD, offers a step-by-step guide to responding effectively. Save it, bookmark it, share it with your biller—it’s your playbook for when insurance doesn’t play fair. Review of Optometric Business
Refractive Surgery: Real Talk for Your Patients
Cecelia Koetting, OD, gives a well-written clinical overview that helps ODs frame refractive surgery options clearly, especially helpful when managing patient expectations or explaining why LASIK isn’t always the “best” option. Optometry Times
We Have a New Dry Eye Drug to Prescribe
Alcon’s Tryptyr (acoltremon) is the first FDA-approved TRPM8 agonist—a new class that boosts basal tear production by stimulating corneal nerves. In Phase III trials, up to 53.2% of patients achieved ≥10mm Schirmer improvement vs. 14.4% on vehicle, yielding an impressive NNT of 3. Results were seen as early as Day 1. With BID dosing and preservative-free vials, Tryptyr offers a rapid, non-immunosuppressive option for volume-deficient dry eye. Review of Optometry
Journal Articles I'm Applying to Practice
Ocular Rosacea: The Hidden Culprit Behind Refractory Lid Disease
This new Canadian study reminds us how often ocular rosacea flies under the radar—nearly one-third of patients with facial rosacea had moderate to severe meibomian gland dysfunction. This deserves a second look if you’re treating chronic lid margin inflammation that doesn’t respond as expected. Canadian Journal of Ophthalmology
How the French Manage Myopia: A Clinical Protocol Worth Stealing
Published in Nature, this structured protocol from the French Myopia Institute outlines clear clinical pathways for monitoring and managing high myopia. It’s a model we can adapt in our practices to bring more clarity to follow-ups, imaging, and progression control. Journal of Nature graphic
Catching OCT Changes Early May Prevent Permanent HCQ Damage
AJO reports that if hydroxychloroquine is discontinued at the first sign of ellipsoid zone (EZ) disruption on OCT, further progression of retinopathy is unlikely. This study helps us make clearer, earlier decisions with co-managing providers and protects patients from long-term damage. American Journal of Ophthalmology
Deep Dive
The DEWS III updates mark a significant inflection point in diagnosing and managing dry eye disease. These aren’t just academic tweaks; they offer a smarter, more targeted approach that fits squarely into a busy comprehensive optometry clinic. Here’s what you need to know:
Diagnosis: Shift from Severity to Subtypes
The traditional mild/moderate/severe scale is out. DEWS III moves us toward identifying etiologic drivers, a more nuanced subclassification that includes tear deficiency, evaporative dysfunction, neurosensory anomalies, and inflammatory pathways. It recognizes that most DED cases are multifactorial and fluctuating, and provides updated diagnostic protocols accordingly.
Practical changes include:
OSDI-6 is now the preferred screening tool (score ≥ 4).
Diagnosis requires ≥1 sign of tear film or ocular surface loss of homeostasis: NIBUT < 10s, osmolarity ≥ 308 mOsm/L or ≥ 8 mOsm/L inter-eye difference, or ocular surface staining thresholds.
New emphasis on lid wiper epitheliopathy, meibum quality, and meibography to identify MGD-driven disease.
This subclassification enables smarter treatment decisions and better conversations with patients around cause, not just symptoms.
Management: Etiology-Based Prescribing
DEWS III offers a prescribing algorithm that ties specific treatments to the dominant disease driver, bringing new clinical clarity to management.
Highlights:
Lifestyle is first-line: Improve blinking, reduce screen time, optimize diet (think omega-3s), and control environment (e.g., humidity).
Tear film support: Aqueous deficiency? Artificial tears and punctal plugs. Evaporative loss? Address meibomian gland dysfunction with warm compresses, in-office thermal pulsation, or IPL.
Inflammation-targeted therapy: Use corticosteroids, lifitegrast, or cyclosporine for inflammatory subtypes; consider biologics (PRP, serum tears) for chronic or recalcitrant cases.
Neurosensory abnormalities: Consider newer neuromodulatory options (e.g., varenicline nasal spray) and collaborative management for neuropathic pain syndromes.
Importantly, DEWS III reinforces that multi-modal therapy is the rule, not the exception. Most patients will need a customized blend of interventions based on fluctuating drivers and symptoms.
How to Apply This in Your Practice:
Update your intake with the OSDI-6 as a routine screening tool.
Refine your clinical protocols to include subclassification workups—NIBUT, osmolarity (if available), meibomian assessment, and targeted staining.
Use the algorithm: Start with lifestyle, move to driver-specific treatments, and escalate to advanced therapies if needed.
Educate your team: Ensure your techs and front desk understand dry eye as a chronic, multifactorial disease. Better staff buy-in improves patient adherence.
Track outcomes: Build in re-evals at 6–8 weeks post-treatment initiation, using the same diagnostic markers to assess improvement.
Why You Dread Certain Tasks—and What to Do About It
In the latest Aaron Werner podcast episode, Aaron and Sophie Thune break down the Working Genius model by Patrick Lencioni.
This simple but powerful tool helps you understand why some parts of your work energize you while others exhaust you. (Spoiler: It’s not about effort. It’s about alignment.)
And if you’re ready to go even deeper, explore the full Practice Culture Builder Program to overhaul your leadership clarity, team roles, and culture foundations.
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