What is the biggest treatment gap in dry eye and ocular surface disease care?

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One of the biggest challenges in dry eye care has always been getting the primary eye care population interested in treating ocular surface disease.
I have been on advisory and speaker boards for almost all of the major dry eye medications, and one question has remained the same over the years: Why do so many patients who carry a dry eye diagnosis not receive prescription therapy? When I am talking to the audience on the topic of ocular surface disease, I am usually not trying to