Article

DISPELLING DRY EYE MYTHS

A belief in DED falsehoods can short-change patients and practices

An estimated 16 million U.S. adults have diagnosed dry eye disease, with its prevalence higher among women and notable among those ages 18 to 34, reveals an American Journal of Ophthalmology study.

I have found there are many myths about DED that can discourage optometrists from expanding their services to benefit both these patients and their practices. Here, I name these myths and dispel them.

MYTH NO. 1: IT’S BENIGN

While it’s true that DED rarely can be sight threatening, the condition can compromise quality of vision, often necessitating glasses, contact lenses and even refractive surgery. As O.D.s, it is our job to diagnose and manage vision-threatening diseases, such as glaucoma, as well as optimize vision in all our patients.

Additionally, research shows that moderate-to-severe DED can incite a reduction in quality of life that is comparable with patients in dialysis, those who have severe angina and those who have disabling hip fractures, reports a Cornea study, further showing the condition is not, in fact, benign.

Management of most cases of DED requires only a systematic approach and an understanding of the vicious disease cycle.
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MYTH NO. 2: STARTING A CLINIC IS HARD/COSTLY

In actuality, support staff, DED questionnaire, slit lamp and vital dyes — people and items optometrists typically already have in office — are all that is needed to start a clinic. (Jerry Robben, O.D., discusses support staff in “Getting Staff DED Ready,” p.30.) The Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II places patient symptoms as the overarching trigger to pursue further diagnostics and initiation of therapy. Utilizing a standardized DED survey, as compared to clinical signs, has demonstrated a greater consistency in prevalence rates.

As this patient population grows, O.D.s can look into expanding their DED services with various diagnostic technologies and treatments. Glenn S. Corbin, O.D., and Selena McGee, O.D., discuss diagnostic devices and treatments, respectively, in “DED Diagnosis Simplified” and “DED Therapy Options” on p.18 and p.24.

MYTH NO. 3: MANAGING DED IS FRUSTRATING

Frustration in managing DED is usually due to unachievable expectations, poor patient compliance and late diagnosis. It is important to remember that DED, like glaucoma, is a chronic condition that cannot be cured. The O.D.’s goal should be to identify the risk factors influencing the tear film homeostasis and offer solutions to address these risk factors. As with any chronic condition, early intervention is likely to yield better patient outcomes.

The bottom line is that with a qualified DED survey, some good detective work, systematically identifying and eliminating the risk factors propagating the vicious disease cycle and the management of patient expectations, an O.D. can significantly improve patient outcomes with less frustration.

MYTH NO. 4: NO PRACTICE BENEFIT

Diversification of a practice can ensure it will be viable for future years to come. The economic impact of DED can range from $687 per person for mild disease to $1,267 annually for severe DED, reports a Home Healthcare Now study. Thus, in addition to improving these patients’ symptoms and vision, the ability to treat and manage DED patients can drive medical income and help doctors prevent loss of revenue by minimizing spectacle remakes, contact lens drop-out and poor refractive surgery outcomes.

WHY NOT GET STARTED?

O.D.s don’t need to be specialists to manage DED. They need only to start. Most DED cases will require only a systematic approach and an understanding of the vicious disease cycle. With millions of DED patients, many of whom remain undiagnosed, there is an opportunity for O.D.s to have a significant impact on a patient’s quality of life and healthcare, while improving their practice’s financial health. OM