Prevention Starts Today
A primary prevention approach to dry eye disease can pay off.
KELLY K. NICHOLS, O.D., M.P.H., PH.D.
Imagine if you could stop something from happening. This sentence sounds like it’s from a movie trailer (cue the foreshadowing soundtrack). Although we strive to do this every day through secondary and tertiary prevention (see “Levels of Prevention,” below), patients are becoming increasingly wary about treatments and are often interested in prevention.
A sure fire way to integrate prevention into your practice starts with the ocular surface.
Rarely does the U.S. healthcare system focus on true primary prevention. Instead it is primarily reactionary — and by that I mean that physicians are trained to detect disease and then do something about the disease. There are many reasons for this, including the difficulty in measuring the long-term impact on costs, and competition for the same insurance dollars that treat those who have existing disease. Also, prevention requires an understanding of the cause of a disease, so that prevention efforts can be aimed appropriately.
Don’t wait to start DED therapy until you can detect it or it becomes so bad you have to. Think prevention today.
In eye care, we do not utilize many prevention efforts. In many instances this is because we do not fully understand why many eye diseases, such as glaucoma and AMD, occur.
How would preventative dry eye disease (DED) measures impact patients and the practice? Consider:
▶ DED most often occurs in women, and the incidence increases with age.
▶ At least 20% of your patients have DED, often undiagnosed previously.
▶ We, as eye care practitioners, know that we save chair time when managing mild vs. moderate or severe DED.
These facts suggest a practitioner could save chair time and treat more patients if he/she detected undiagnosed mild DED before it progressed.
|Levels of Prevention|
From a public health standpoint, three levels of prevention exist:
▶ Primary prevention. Preventing the disease from occurring, thereby reducing both the incidence (new cases) and prevalence (total cases) of a disease. Example: flossing to prevent tooth decay.
▶ Secondary prevention. Prevention efforts after the disease has occurred but before the person notices anything is wrong, also called “early detection.” Example: visual field examination to detect glaucoma.
▶ Tertiary prevention. Prevention targeting the person who already has disease symptoms with the goal of precluding further disease damage and pain, slowing the disease process and preventing disease complications. This is also called “rehabilitative care.” Example: pharmaceutical management.
Create a clinic?
Given the generally high number of undiagnosed DED patients, you may wonder whether it’s worth starting a “DED clinic” either imbedded into your practice or as a stand-alone entity (yes, some clinics focus exclusively on DED).
To determine the cost/benefit of creating a DED clinic, ask yourself:
▶ How much does it cost to manage DED (include staff, chair time and diagnostic equipment)?
▶ How much benefit is it to my practice to medically manage DED, in terms of gaining new patients, additional sales of sunglasses, etc.?
▶ How much could medical DED be streamlined in my practice if I could stop DED from happening, or, at minimum, slow the progression? (Note: You will still see patients who present with DED and require intervention.)
▶ What would primary prevention for DED in my practice look like?
As the population ages, more and more medications with drying effects are used and environmental strains continue (computer use, pollution, etc.), we will need these answers. In the mean time, don’t wait to start DED therapy until you can detect it or it becomes so bad you have to. Think prevention today. OM
DR. NICHOLS IS A FOUNDATION FOR EDUCATION AND RESEARCH IN VISION (FERV) PROFESSOR AT THE UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY. SHE LECTURES AND WRITES EXTENSIVELY ON OCULAR SURFACE DISEASE AND HAS INDUSTRY AND NIH FUNDING TO STUDY DRY EYE. SHE IS ON THE GOVERNING BOARDS OF THE TEAR FILM AND OCULAR SURFACE SOCIETY OF OPTOMETRY AND IS A PAID CONSULTANT TO ALCON, ALLERGAN, INSPIRE AND PFIZER. E-MAIL HER AT KNICHOLS@OPTOMETRY.UH.EDU, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.