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Faculty & Disclosures

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    Faculty & Disclosures
    Laura M Periman, MD

    Periman Eye Institute, Seattle, WA, USA

    Laura M Periman, MD, is a fellowship-trained cornea and refractive surgery specialist with a background in molecular biology. As the founder and director of Dry Eye Services and Clinical Research at the Periman Eye Institute in Seattle, WA, she brings together her scientific expertise, clinical experience and creative drive to lead innovative care, research and educational initiatives. read more

    A passionate educator and internationally recognized speaker, Dr Periman has authored dozens of articles, including 23 peer-reviewed publications. Known as ‘The Dry Eye Master’, she excels at translating complex science into practical clinical insights, engaging audiences with relatable analogies and a sense of curiosity – qualities rooted in her Montana ranching heritage.

    Her early work as a molecular biology R&D associate at Immunex (now Amgen) sparked a lifelong interest in immunopathophysiology and continues to inform her approach to patient care and teaching.

    Laura M Periman, MD, discloses: Consultant/speaker’s bureau and/or advisory panel fees from Alcon, Aldeyra Therapeutics, Allergan/AbbVie, Amgen, Azura Ophthalmics, Bausch & Lomb, Bruder Healthcare, Dompé farmaceutici, Eyedetec Medical, Kala Bio, Lumenis, Mallinckrodt Pharmaceuticals, Myze, Nordic Pharma, Novartis, NuSight Medical, Olympic Ophthalmics, ScienceBased Health, Scope Eyecare, Sun Ophthalmics, Tarsus, Théa Pharmaceuticals, Verséa Ophthalmics, Viatris and Visant Medical. Grant/research support from Alcon, Bausch and Lomb, Kala Bio, Lumenis, Novartis, Olympic Ophthalmics, Tarsus and Viatris. Stock/Shareholder (self-managed) interests include Eyedetec Medical, Myze, NuSight Medical, Quench Method, Verséa Ophthalmics and Visant.
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    touchOPHTHALMOLOGY touchOPHTHALMOLOGY
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    Is there enough evidence to support neuromodulation in DED treatment?

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    Yes – I’m aware of supporting clinical data
       
    Possibly – but I’d like to see more robust evidence
       
    No – I’m not convinced by the current data
       
    I’m unfamiliar with neuromodulation as a treatment option for DED
       

    Tutorial

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    What is your primary approach to diagnosing dry eye disease?

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    Symptom questionnaires (e.g. OSDI, DEQ-5)
       
    Tear breakup time and ocular staining
       
    Meibomian gland evaluation
       
    Advanced diagnostics (e.g. tear osmolarity, MMP-9, meibography)
       

    Tutorial

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    Poll

    What do you believe the ‘vicious cycle’ in dry eye disease primarily refers to?

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    Ongoing tear evaporation contributing to reduced blinking
       
    A self-sustaining cycle of tear film instability, hyperosmolarity, inflammation and OSD
       
    Progressive lens changes due to dehydration
       
    Frequent switching between treatment options
       
     
    Expert Interviews
    Ocular Surface Disease, Neuro-ophthalmology, Refractive Surgery CE/CME accredited

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    Advances in dry eye disease: From diagnosis to new treatment targets

    Take CE/CME Test

    Laura M Periman, MD, is a fellowship-trained cornea and refractive surgery specialist with a background in molecular biology. As the founder and director of Dry Eye Services and Clinical Research at the Periman Eye Institute in Seattle, WA, she brings together her scientific expertise, clinical experience and creative drive to lead innovative care, research and educational initiatives. read more

    A passionate educator and internationally recognized speaker, Dr Periman has authored dozens of articles, including 23 peer-reviewed publications. Known as ‘The Dry Eye Master’, she excels at translating complex science into practical clinical insights, engaging audiences with relatable analogies and a sense of curiosity – qualities rooted in her Montana ranching heritage.

    Her early work as a molecular biology R&D associate at Immunex (now Amgen) sparked a lifelong interest in immunopathophysiology and continues to inform her approach to patient care and teaching.

    Laura M Periman, MD, discloses: Consultant/speaker’s bureau and/or advisory panel fees from Alcon, Aldeyra Therapeutics, Allergan/AbbVie, Amgen, Azura Ophthalmics, Bausch & Lomb, Bruder Healthcare, Dompé farmaceutici, Eyedetec Medical, Kala Bio, Lumenis, Mallinckrodt Pharmaceuticals, Myze, Nordic Pharma, Novartis, NuSight Medical, Olympic Ophthalmics, ScienceBased Health, Scope Eyecare, Sun Ophthalmics, Tarsus, Théa Pharmaceuticals, Verséa Ophthalmics, Viatris and Visant Medical. Grant/research support from Alcon, Bausch and Lomb, Kala Bio, Lumenis, Novartis, Olympic Ophthalmics, Tarsus and Viatris. Stock/Shareholder (self-managed) interests include Eyedetec Medical, Myze, NuSight Medical, Quench Method, Verséa Ophthalmics and Visant.

    Take CE/CME Test

    Laura M Periman, MD, is a fellowship-trained cornea and refractive surgery specialist with a background in molecular biology. As the founder and director of Dry Eye Services and Clinical Research at the Periman Eye Institute in Seattle, WA, she brings together her scientific expertise, clinical experience and creative drive to lead innovative care, research and educational initiatives. read more

    A passionate educator and internationally recognized speaker, Dr Periman has authored dozens of articles, including 23 peer-reviewed publications. Known as ‘The Dry Eye Master’, she excels at translating complex science into practical clinical insights, engaging audiences with relatable analogies and a sense of curiosity – qualities rooted in her Montana ranching heritage.

    Her early work as a molecular biology R&D associate at Immunex (now Amgen) sparked a lifelong interest in immunopathophysiology and continues to inform her approach to patient care and teaching.

    Laura M Periman, MD, discloses: Consultant/speaker’s bureau and/or advisory panel fees from Alcon, Aldeyra Therapeutics, Allergan/AbbVie, Amgen, Azura Ophthalmics, Bausch & Lomb, Bruder Healthcare, Dompé farmaceutici, Eyedetec Medical, Kala Bio, Lumenis, Mallinckrodt Pharmaceuticals, Myze, Nordic Pharma, Novartis, NuSight Medical, Olympic Ophthalmics, ScienceBased Health, Scope Eyecare, Sun Ophthalmics, Tarsus, Théa Pharmaceuticals, Verséa Ophthalmics, Viatris and Visant Medical. Grant/research support from Alcon, Bausch and Lomb, Kala Bio, Lumenis, Novartis, Olympic Ophthalmics, Tarsus and Viatris. Stock/Shareholder (self-managed) interests include Eyedetec Medical, Myze, NuSight Medical, Quench Method, Verséa Ophthalmics and Visant.

    Take CE/CME Test

    Laura M Periman, MD, is a fellowship-trained cornea and refractive surgery specialist with a background in molecular biology. As the founder and director of Dry Eye Services and Clinical Research at the Periman Eye Institute in Seattle, WA, she brings together her scientific expertise, clinical experience and creative drive to lead innovative care, research and educational initiatives. read more

    A passionate educator and internationally recognized speaker, Dr Periman has authored dozens of articles, including 23 peer-reviewed publications. Known as ‘The Dry Eye Master’, she excels at translating complex science into practical clinical insights, engaging audiences with relatable analogies and a sense of curiosity – qualities rooted in her Montana ranching heritage.

    Her early work as a molecular biology R&D associate at Immunex (now Amgen) sparked a lifelong interest in immunopathophysiology and continues to inform her approach to patient care and teaching.

    Laura M Periman, MD, discloses: Consultant/speaker’s bureau and/or advisory panel fees from Alcon, Aldeyra Therapeutics, Allergan/AbbVie, Amgen, Azura Ophthalmics, Bausch & Lomb, Bruder Healthcare, Dompé farmaceutici, Eyedetec Medical, Kala Bio, Lumenis, Mallinckrodt Pharmaceuticals, Myze, Nordic Pharma, Novartis, NuSight Medical, Olympic Ophthalmics, ScienceBased Health, Scope Eyecare, Sun Ophthalmics, Tarsus, Théa Pharmaceuticals, Verséa Ophthalmics, Viatris and Visant Medical. Grant/research support from Alcon, Bausch and Lomb, Kala Bio, Lumenis, Novartis, Olympic Ophthalmics, Tarsus and Viatris. Stock/Shareholder (self-managed) interests include Eyedetec Medical, Myze, NuSight Medical, Quench Method, Verséa Ophthalmics and Visant.

    Take CE/CME Test
    Faculty Podcast Featured
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    Learning Objectives
    • Explain the pathophysiology of dry eye disease, including the roles of tear film instability, inflammation, and neurosensory dysfunction
    • Describe the diagnostic process for dry eye disease, highlighting the use of clinical tools like tear breakup time, osmolarity testing and advanced imaging techniques
    • Apply best practices for the management of dry eye disease, including the use of neuromodulation therapies, to develop individualized treatment plans
    Overview

    In this activity, Dr Laura M Periman, a leading dry eye disease expert, explores the pathophysiology of dry eye disease, reviews key diagnostic tools, and discusses available treatments – including neuromodulation therapies – as well as the role of emerging targeted approaches to support effective clinical management.read more

    Target Audience

    This activity has been designed to meet the educational needs of ophthalmologists and optometrists involved in the management of dry eye disease.

    USF Accreditation

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Laura M Periman, MD, discloses: Consultant/speaker’s bureau and/or advisory panel fees from Alcon, Aldeyra Therapeutics, Allergan/AbbVie, Amgen, Azura Ophthalmics, Bausch & Lomb, Bruder Healthcare, Dompé farmaceutici, Eyedetec Medical, Kala Bio, Lumenis, Mallinckrodt Pharmaceuticals, Myze, Nordic Pharma, Novartis, NuSight Medical, Olympic Ophthalmics, ScienceBased Health, Scope Eyecare, Sun Ophthalmics, Tarsus, Théa Pharmaceuticals, Verséa Ophthalmics, Viatris and Visant Medical. Grant/research support from Alcon, Bausch and Lomb, Kala Bio, Lumenis, Novartis, Olympic Ophthalmics, Tarsus and Viatris. Stock/Shareholder (self-managed) interests include Eyedetec Medical, Myze, NuSight Medical, Quench Method, Verséa Ophthalmics and Visant.

    Content reviewer

    John Jarstad, MD has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributors

    Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu 

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 8 May 2025. Date credits expire: 8 May 2026.

    If you have any questions regarding credit, please contact cpdsupport@usf.edu

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Ocular Surface Disease / Neuro-ophthalmology / Refractive Surgery
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    This Activity Is Funded By:

    An independent medical education grant from Alcon Vision, LLC.

    The activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    This content is intended for healthcare professionals.

    Date of original release: 8 May 2025. Date credits expire: 8 May 2026.

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    Advances in dry eye disease: From diagnosis to new treatment targets
    0.75 CE/CME credit
    Question 1/5
    Which key TRP channels are expressed on corneal nerves and have been implicated in the pathophysiology of DED, particularly in response to tear film hyperosmolarity and inflammation?

    DED, dry eye disease; TRPA1, transient receptor potential ankyrin 1; TRPM, transient receptor potential melastatin; TRPML, transient receptor potential mucolipin; TRPV, transient receptor potential vanilloid.

    TRPA1, TRPM8 and TRPV1 are all expressed on corneal nerves and respond to a range of stimuli, including tear film osmolarity, pH, temperature, drying and endogenous inflammatory factors. They have roles in tear homeostasis, blinking and pain responses to inflammatory mediators, processes closely related to DED pathophysiology.

    Abbreviations

    DED, dry eye disease; TRPA1, transient receptor potential ankyrin 1; TRPM8, transient receptor potential melastatin 8; TRPV1, transient receptor potential vanilloid 1.

    Reference

    Vereertbrugghen A, Galletti JG. Exp Eye Res. 2022:222:109191.

    Question 2/5
    You are discussing the pathophysiology of DED with a junior colleague who would like to understand the value of tear osmolarity testing. How would you explain the role of hyperosmolarity in DED?

    DED, dry eye disease.

    Hyperosmolority contributes to ocular surface damage in DED, both directly and indirectly, through a cascade of inflammatory events.1 Inflammation induced by tear film instability and hyperosmolarity also contributes to neurogenic chronic inflammation,1 leading to neurosensory abnormalities characterized by changes in nerve physiology and function.2

    Abbreviations

    DED, dry eye disease.

    References

    1. Bron AJ, et al. Ocul Surf. 2017;15:438–510.
    2. Vereertbrugghen A, Galletti JG. Exp Eye Res. 2022:222:109191.
    Question 3/5
    A patient presents to your practice with persistent ocular discomfort, foreign body sensation, and intermittent blurred vision that improves with blinking. You suspect she may have DED. Following guidance included in the AAO PPP and the ASCRS algorithm for initial screening for OSD, how would you proceed?

    AAO, American Academy of Ophthalmology; ASCRS, American Society of Cataract and Refractive Surgery; DED, dry eye disease; MGD, meibomian gland disease; MMP-9, matrix metalloprotease 9; OSD, ocular surface disease; PPP, Preferred Practice Pattern.

    The AAO PPP suggests collecting information on signs and symptoms, exacerbating conditions and symptom duration, and recommends using validated symptom questionnaires.1 The ASCRS algorithm for preoperative diagnosis and treatment of OSD defines osmolarity and MMP-9 testing as essential screening tests.2 The AAO PPP for DED includes tear osmolarity and point-of-care MMP-9 testing as part of the potential diagnostic workup for OSD.1

    Abbreviations

    AAO, American Academy of Ophthalmology; ASCRS, American Society of Cataract and Refractive Surgery; DED, dry eye disease; MMP-9, matrix metalloprotease 9; OSD, ocular surface disease; PPP, Preferred Practice Pattern.

    References

    1. AAO. 2023. Available at: www.aao.org/education/preferred-practice-pattern/dry-eye-syndrome-ppp-2023 (accessed 14 April 2025).
    2. Starr CE, et al. J Cataract Refract Surg. 2019;45:669–84.
    Question 4/5
    How can neuromodulatory therapies improve DED?

    DED, dry eye disease.

    Maintenance of an adequate tear film is dependent on neurostimulatory pathways.1 Corneal sensory nerves respond to changes at the ocular surface to drive tear production.1,2 This process is often dysregulated in DED.1 FDA-approved neuromodulatory therapies target these pathways to restore tear production: varenicline nasal spray activates nAChRs in the nose, stimulating the nasolacrimal reflex.3,4 An FDA-approved device provides extranasal stimulation to activate the same reflexes.2 Acoltremon, an investigational eyedrop, targets TRPM8 receptors in the eye.5

    Abbreviations

    DED, dry eye disease; nAChR, nicotinic acetylcholine receptor; TRPM8, transient receptor potential melastatin 8.

    References

    1. Vereertbrugghen A, Galletti JG. Exp Eye Res. 2022:222:109191.
    2. Ji MH, et al. Transl Vis Sci Technol. 2020;9:23.
    3. Wirta D, et al. Ophthalmology. 2022;129:379–87.
    4. FDA. Varenicline tartrate PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2024/213978s005lbl.pdf (accessed 14 April 2025).
    5. Wirta DL, et al. Ocul Surf. 2022;26:166–73.
    Question 5/5
    A 60-year-old patient presents to your practice complaining of ocular discomfort. You determine that they have mild DED, with mild symptoms and conjunctival signs (ITF level 1) plus evidence of MG blockage. Alongside advice about lifestyle and dietary modifications that may help, and assuming treatment availability/approval, what would be your initial treatment recommendations for this patient?

    DED, dry eye disease; ITF, International Task Force; MG, meibomian gland.

    For patients with ITF level 1 DED1 and evidence of MG blockage, step 1 interventions described in the AAO PPP would likely be appropriate and include use of ocular lubricants (potentially lipid-containing supplements with MGD), eyelid hygiene of various types and warm compresses.2

    Abbreviations

    AAO, American Academy of Ophthalmology; DED, dry eye disease; ITF, International Task Force; MG, meibomian gland; MGD, meibomian gland disease; PPP, Preferred Practice Pattern.

    References

    1. Barber L, et al. BMC Ophthalmology. 2018;18:260.
    2. AAO. 2023. Available at: www.aao.org/education/preferred-practice-pattern/dry-eye-syndrome-ppp-2023 (accessed 14 April 2025).
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    This Activity Is Funded By:

    An independent medical education grant from Alcon Vision, LLC.

    The activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    This content is intended for healthcare professionals.

    Date of original release: 8 May 2025. Date credits expire: 8 May 2026.

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