Expert Perspectives on the Management of Moderate to Severe Dry Eye Disease in Indian Settings

Abstract

Objective: To assess ophthalmologists’ clinical perspectives on the burden, diagnosis, and management of moderate to severe dry eye disease (DED), with a particular focus on the use of trehalose-based formulations in Indian settings. Methods: The cross-sectional study was conducted among 192 ophthalmology experts across India using a 23-item questionnaire to evaluate their perspectives on DED, including its prevalence, demographics, diagnostic approaches, treatment preferences, management challenges, and use of therapies such as trehalose. Data were analyzed using descriptive statistics, with categorical variables presented as percentages. Results: Nearly half of the clinicians (46.88%) preferred trehalose as a lubricant for managing moderate to severe DED, particularly after cataract surgery. The majority (42.71%) had been using trehalose eye drops for 3–5 years, and approximately 68% reported switching to trehalose when patients showed an inadequate response to carboxymethylcellulose 0.5%. About 45% of the experts noted that the most common dosing regimen was four times daily. Improvement in Schirmer’s values and tear breakup time (TBUT) by week eight was observed by around 46% of clinicians. A large majority of respondents (80.73%) stated that trehalose acts through multiple mechanisms, including induction of autophagy, protection against oxidative stress, and preservation of labile proteins.  Conclusion: The study highlights the growing preference for trehalose-based eye drops in managing moderate to severe DED, especially post-cataract surgery, among Indian clinicians. Consistent clinical improvements and recognition of trehalose’s multifaceted mechanisms support its use, particularly when conventional lubricants are ineffective.