Purpose: To survey ophthalmologists regarding their current therapy preferences and desires for future treatment to help guide providers in choosing treatments and pharmaceutical startups in developing future therapies. Methods: A prospective survey developed internally and sent twice to ophthalmologists. Results: There were 76 responses. Approximately 30% of respondents stated they examined a few cases of dry eye disease (DED) patients a day and 20% noted DED was a majority of their practice. Almost all physicians recommended tear replacement drops (95%) for their patients while 80% prescribed cyclosporine. Importantly, 40% started prescribing lifitegrast and the same percent prescribe tetracycline. When asked what new mechanisms of action physicians preferred, about 70% indicated improved tear film stability, while 50% desired greater lacrimal gland tear production. Further, 70% of physicians noted they would prescribe a product that increased tear film stability as first line. With two anti-inflammatory DED products currently available 55% of participants noted a third product should have a different mechanism of action while 25% desired better anti-inflammatory activity. In evaluating the available DED medications specifically, participants believed cyclosporine and lifitegrast had similar moderate levels of efficacy; with lifitegrast being slightly better tolerated than cyclosporine. Conclusions: The survey showed that DED patients are an important part of the ophthalmic practice. Multiple different therapeutic techniques are used and there is desire for new products that especially would treat tear film stability and corneal surface disease.

Dry eye disease (DED) continues to be an important part of ophthalmic related pathology as well as a target for new treatment products. DED DfflLcts a sLJnLficDnt part of the adult population (6%-34%) [1-4]. Symptoms can be irritating, causing reduced quality of life, visual disturbance and pain [5]. Treatment modalities are multiple with no precise standard of care although helpful guidelines are available [5]. Two DntL-LnflDmmDtor\ topical medications, cyclosporine (Restasis™) and lLfiteJrDst (Xiidra™), as well as tear replacement drops are eوٴectLve and commonly used. However, none of the available treatments are completely curative or prevent symptoms. Accordingly, at least 77 DED related products have been under development over the last number of years that have publicly available information including 12 active compounds with new mechanisms of action that is not currently available as well as a variety of tear replacement formulations and delivery systems [6]. Despite so many DED patients in the population, and diverse treatments available, little information exists on physician attitudes in treating DED both in terms of current practices and future treatment. Нe purpose of this study was to survey ophthalmologists regarding their current therapy preferences and desires for future treatment. It is hoped this information would help guide providers in choosing

Нe design was a prospective survey of ophthalmologists. We used an existing internal, proprietary diverse database of ophthalmic physicians (n=1837). Нe survey was sent to each physician in the database. Invitations were sent October 25, 2016 and reminders were sent November 10, 2016. Survey questions were developed internally, and the survey was linked through Survey Monkey (www.surveymonkey.com). A copy of the survey questions can be found online (supplemental).

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