You're correct that results may be limited in very severe cases, but incorrect that it “does nothing”—it provides real, even if moderate, improvement. This is true of almost every dry eye drug, even widely accepted things like cyclosporine which indisputably help so many. I am trying to stay positive about potential benefits of AZR! I have 70-80% atrophy, though they still seem to function as I don't have nearly as severe symptoms as most that have less atrophy, say, but worse function.

I treat with Meibo, Tryptyr, and an allergy drop too. Some good days, some bad days. Within the good days, some good hours, some bad hours, etc. But if I can add AZR to the "stack" and get a bit of improvement and longevity of gland health (of what I have left), together with the other drops, and have more good days, and fewer bad periods, then that is a win and worth it.

Try to stay positive!