Article

CLINICAL: Contact Lenses

Choose an Active Approach

Satisfy contact lens patients by taking extra steps to identify dry eye disease

One approach to treating dry eye disease (DED) is to wait until patients complain about their eye discomfort, or the optometrist notes obvious clinical signs of the disease. This passive approach can lead to self-diagnosing and self-treatment. If this describes your strategy, consider changing it to a more active approach with the following suggested steps.

1 ASK THE RIGHT QUESTIONS

A few different DED questionnaires exist: the National Eye Institute Visual Functioning Questionnaire-25 (VFQ-25), the Ocular Surface Disease Index (OSDI), the Standard Patient Evaluation of Eye Dryness Questionnaire (SPEED) and the Impact of Dry Eye in Everyday Life (IDEEL) questionnaire. Make the questionnaire you pick standard of care for all your exams and DED follow-up appointments. The goal for the latter is to determine whether your treatment is improving the patient’s perception of his symptoms.

2 LOOK FOR CLINICAL SIGNS

Steps to take in your clinical evaluation can be found in the Practicing Medical Optometry (PMO) diagnostic section of this issue and last year’s DED PMO at bit.ly/2KwuOZa .

Two easy steps I advise you take: 1. Evaluate the eyelids and meibomian glands, and 2. utilize staining with sodium fluorescein (NaFl) and lissamine green dyes during your anterior segment evaluation. Reason being: They do not take a lot of time and expense and can be seamlessly added to your exam sequence.

3 ENGAGE THE PATIENT

DED is a complicated condition with many contributing factors, such as medication use, and it’s not always easy to understand when or where to start. These are important points to bring up to your patient, so she understands that there is a process to arriving at effective treatment. As such, your script should discuss the symptoms, let the patient know you are going to begin treatment and follow her to look for improvement. For example: “Mrs. Smith, I understand your eyes are scratchy and water frequently. This is brought on by many factors, including clogged glands in the eyelid. I am going to start you on this heat mask and some lubricating eye drops to alleviate your symptoms. I need to see you back in a month, and I may need to prescribe a product to help treat this chronic condition.”

Utilize the two-dye system (lissamine green, top, and NaFl) to look for ocular surface irritation.
Images courtesy of Dr. Jason Miller

ACTIVELY TREAT YOUR PATIENTS

If you are not looking for patients who have DED, you won’t find as many as an eye care provider who is actively asking the right questions and trying to treat this chronic condition. In the absence of your diagnosis, patients will self-diagnose and treat with OTC products. Take those extra steps to get to the heart of dry eyes. OM