Dry eye care has changed dramatically over the past decade—but with more diagnostics, pharmaceuticals, in-office treatments, and technology than ever before, it can also feel increasingly complicated. In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Dr. Etty Bitton, Professor at the Université de Montréal, Head of its Dry Eye Clinic, and a Canadian ambassador for the Tear Film & Ocular Surface Society (TFOS), to discuss how optometrists can simplify their approach while staying aligned with the latest evidence in dry eye disease.

Dr. Bitton explains why clinicians should start with diagnosis before investing in treatment technology, including the importance of standardized symptom assessment with the OSDI-6 and a systematic approach to evaluating tear-film stability, osmolarity, ocular-surface staining, eyelid disease, inflammation, and other anatomical contributors. She also discusses how the evolving TFOS DEWS III framework moves beyond simply categorizing dry eye as evaporative versus aqueous deficient and instead encourages clinicians to identify the specific structures and mechanisms involved.

The conversation also explores several issues increasingly relevant to everyday optometric practice: screen time, incomplete blinking and meibomian gland dysfunction in younger patients; Demodex and its connection with dermatological conditions; cosmetics, retinoids and products used around the ocular surface; and the value of building referral relationships with other optometrists, dermatologists, rheumatologists and specialists. Dr. Bitton's message is ultimately a practical one: before building an advanced dry eye clinic around expensive equipment, make sure you understand the disease, use evidence-based diagnostic tools, and speak the same diagnostic language as your colleagues.

3 Key Takeaways

1. Get the diagnosis right before worrying about the technology.

Dry eye management can become overwhelming when clinicians start with IPL, RF, meibography, pharmaceuticals or other treatments. Dr. Bitton argues that the first priority should be a consistent, evidence-based diagnostic process—including standardized symptom assessment such as the OSDI-6.

2. Screen time may be affecting the ocular surface much earlier than we think.

Screen use is associated with more frequent partial blinking, which can interfere with normal meibomian gland function. Dr. Bitton discusses seeing significant gland changes even among optometry students in their early twenties and emphasizes the opportunity for earlier patient and parent education.

3. Dry eye history-taking needs to extend beyond the eyes.

Cosmetics, skin-care products, retinoids, dermatological conditions and systemic disease can all provide important clues. Asking patients about what they put around their eyes—and developing collaborative relationships with other healthcare professionals—can become an important part of comprehensive dry eye care.

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