Dry Eye Treatment Gaps Persist, Whereas Comorbid DED Does Not Affect Glaucoma Adherence

Gaps in both treatment initiation and adherence continue to limit the management of ophthalmic therapies among Medicare populations, according to 2 posters presented at the Academy of Managed Care Pharmacy (AMCP) 2026 meeting in Nashville, Tennessee.^1,2

Together, the findings highlight real-world challenges in ophthalmic medication use among older adults, with low initiation and frequent discontinuation in dry eye disease (DED), whereas glaucoma therapy adherence remained stable regardless of comorbid DED.

Low Prescription Uptake, Early Discontinuation in DED

Investigators of the first poster, “Treatment Patterns for Dry Eye Disease Among Medicare Advantage Beneficiaries,” noted that the global prevalence of DED is about 5% with increased occurrence among older adults, contact lens wearers, postmenopausal women, and those with autoimmune diseases.¹ However, real-world treatment patterns among patients with DED enrolled in Medicare Advantage (MA) remain poorly understood.

To address this gap, the researchers conducted a descriptive retrospective cohort study using the Humana Research Database to evaluate treatment patterns among treatment-naive patients with newly diagnosed DED. The analysis included MA enrollees from January 1, 2020, through June 30, 2025, with eligible patients identified between January 1, 2021, and March 31, 2024. They were required to have at least 2 DED diagnoses 30 to 365 days apart, be aged 18 to 89 years, and have continuous enrollment for 12 months before and 6 months after the index date, defined as the first related claim.

The investigators assessed first- and second-line treatment patterns from the index date through variable follow-up, defined as disenrollment, the end of the study period, or death, whichever came first.

Among 192,793 patients newly diagnosed with DED, 12.4% (n = 24,002) received a prescription treatment and were included in the final cohort. The mean (SD) age was 72.0 (8.5), and most (79.1%) were female, with a mean follow-up time of 1059 (358) days.

The mean time to initiation of first-line therapy from the index date was 285 (348) days, with a mean treatment duration of 220 (167) days. The most common first-line agent was cyclosporine (88.5%), followed by loteprednol (4.2%) and lifitegrast (3.4%).

A total of 39.9% of patients also received second-line therapy, with a mean duration of 192 (130) days. By contrast, 49.2% of patients discontinued first-line treatment without initiating subsequent therapy.

The findings demonstrate early treatment drop-off and suggest substantial reliance on nonprescription options. Because of this, the investigators highlighted the need for future research comparing health care resource use and costs between patients with and without prescription treatment for DED, as it would provide more insights into the benefits of prescription medications in managing DED.

"Our research shows that many older adults with dry eye disease are turning to over-the-counter products first, while prescription treatments often come later,” primary author and presenter Lindsey Fronizer, PharmD, said in a statement to The American Journal of Managed Care^®. “This underscores the importance of helping patients get all the information they need to be fully aware of their available options."

Comorbid DED Does Not Impact Glaucoma Therapy Adherence

Latanoprostene bunod (LBN) 0.024% ophthalmic solution is indicated for reducing intraocular pressure in patients with open-angle glaucoma (OAG) and ocular hypertension.² However, the investigators of the second poster, “Real-World Adherence Patterns of Latanoprostene Bunod Ophthalmic Solution 0.024% in Medicare Patients with Comorbid Dry Eye Disease,” noted that concomitant DED could impact adherence to therapies like LBN.

To examine this, they conducted a retrospective claims analysis to identify LBN prescription adherence patterns among patients with and without DED. The investigators used 100% Medicare Fee-for-Service Parts A, B, and D data to identify patients aged 65 years and older with OAG who had an LBN prescription between January 2017 and June 2020. The index date was the earliest DED diagnosis or treatment during the 6 months following OAG identification.

Patients receiving LBN after the index date were followed over a 12-month period, with adherence assessed using the Proportion of Days Covered (PDC) until the end of the days’ supply, with 0.8 or greater indicating adherence. By contrast, discontinuation was defined as a minimum gap of 60 days after the end of their LBN prescription.

A total of 912 patients prescribed LBN were eligible for the study, most of whom were female (55%) and White (79%), with a mean age of 77.3 (8.1) years. Among the patients, the mean PDC for LBN was 0.73 (0.24), with 45.1% having an adherence of 0.8 or greater.

Meanwhile, approximately 44.5% (n = 406) of patients discontinued treatment, of whom 62.1% (n = 252) restarted LBN following discontinuation. Lastly, patients with LBN and without DED (n = 718) had a mean PDC of 0.73 (0.24), which was not statistically different than patients with LBN and comorbid DED (n = 194), who had a mean PDC of 0.75 (0.24; P > .05), suggesting that LBN is well tolerated regardless of DED status.

“Together, these findings highlight LBN’s durability, tolerability, and real-world utility,” the authors concluded.

References

1. Fronizer LM, Kim K, Bloomfield A, Rastegar J, Wind HM, Saundankar V. Treatment patterns for dry eye disease among Medicare Advantage beneficiaries. Presented at: AMCP 2026; April 13-16, 2026; Nashville, TN. Poster 373.
2. Sawhney G, Talwar A, Donckles EA, et al. Real-world adherence patterns of latanoprostene bunod ophthalmic solution 0.024% in Medicare patients with comorbid dry eye disease. Presented at: AMCP 2026; April 13-16, 2026; Nashville, TN. Poster 160.