“…In line with DED heterogeneity, many risk factors have been linked to disease, including demographics (eg, female gender, older age), comorbidities (eg, autoimmune diseases, sleep apnoea, pain conditions), medications (eg, antidepressants, antihistamines) and Open access exposures (eg, low humidity, air pollution). 1 Treatment of DED is likewise complex and involves over-the-counter products (eg, artificial tears, eyelid hygiene products), prescription medication (eg, antiinflammatories, tear stimulators, oral and topical antibiotics) and in-office procedures (eg, devices that target periocular skin health, clean the eyelids, heat the Meibomian glands), all of which have been studied over the years with thousands of resulting publications. These medications and procedures impart a significant cost to the patient, estimated at $6.08 billion for national expenditures and $1.18 billion for out-of-pocket expenditures in 2015-2016 (per capita expenditures $499.42 and $96.67, respectively) based on a study that examined the US Medical Expenditure Panel Survey database.…”