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BUSINESS: New O.D.

Break Down Dry Eye Disease

Helpful analogies for patients right out of the gate

Helping patients understand dry eye disease (DED) is a problem that has plagued even the most experienced clinicians, and it can affect patient compliance to our prescribed treatments. As a new or recent grad, you can tackle this problem immediately by using analogies.

THE TEAR FILM AS A HOUSE

Dr. Ariel Cerenzie, of Studio 20/20 in Charlotte, NC, helps patients understand the complexity of the tear film layers by comparing them to a house:

  • Mucin layer: house foundation
  • Aqueous layer: bulk of the house (walls, etc.)
  • Oil layer: roof

This is what I say: “Without a stable foundation, a house will sink or lean. Without walls, there’s nothing to support a roof. Without a roof, the house is unprotected. The same goes for the tear film. When one, or more of the layers isn’t functioning properly, dry eye occurs.”

Wrinkled Saran wrap is analogous to dry eye vision.

BLURRY VISION AS SARAN WRAP/GLASS OF WATER

  1. Saran wrap. “Seeing through a clear cornea is like looking through a fresh sheet of taut Saran wrap: You can see through it without obstruction. But the more the eye dries out, the harder it is to see through. This is the case if you were to wrinkle the Saran wrap. If untreated, you can develop severe dry eye, which is like Saran wrap crumpled up in a ball: You can’t see through it.”
  2. Glass of water: “A nice, moist cornea is like a clear glass of water. You can see through it. Think of mild dry eye as adding three or four drops of milk into the glass of water. It starts to get cloudy. For moderate or severe dry eye, add more milk. Loss of transparency is noticed the more milk is added. The same goes for vision with the dryer the eyes get.”

WATERY EYES AS A FIRE ALARM

“I know it seems backwards that you have dry eye, but watering and seeming to have too much moisture is actually one of the most common initial symptoms of the condition. What happens is that when your eyes begin to dry out, your pain receptors are activated. Think of this like a fire alarm going off. Your pain receptors trigger your eye’s lacrimal gland to produce lots of tears to stop the pain sensation, just like firefighters would be triggered by the fire alarm and douse the fire with water. Because your lacrimal gland doesn’t know what quantity of tears to send, inevitably, you get too much, and this causes pooling and excessive tearing. To stop the tearing, we need to treat the underlying cause of your dryness.”

ASYMPTOMATIC DED AS AN OIL CHANGE

“We have oil changes to keep the car running smoothly and prevent the engine from seizing. Treating clinically significant dry eye before symptoms are bothersome is like getting an oil change to prevent significant engine damage.”

UNDERSTANDING IS KEY

Getting creative to help patients understand the complexity of DED has been one of my main keys to successfully treating DED because it has increased the likelihood of patient compliance to my prescribed treatments. OM

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