Over the years in my practice, I’ve slowly started to add dry eye evaluations and expand on my treatment options for patients. I find I commonly get asked a barrage of questions, which seems to relate to the barrage of information out there. The mentality that you have to “do it all to do it well” can be suffocating and overwhelming for someone trying to get her feet wet. Because of the complexity of what you can do, here are my top tips to getting started with evaluating and treating dry eye:
1. Just start looking for it. I promise you, it’s there. And you very well may be surprised of just how much of it there is. Now, you have to be comfortable starting a discussion with patients about dry eye before they are having significant issues. I’ve found that it can take many years for patients to recognize they have dry eye, even if they have presenting symptoms. Here are the easiest, low cost methods to start evaluating:
Start surveying patients to find those who are symptomatic. For example, this can be done with an established survey such as OSDI (Ocular Surface Disease Index) or SPEED (Standard Patient Evaluation of Eye Dryness), or a series of questions of your own choosing.
Evaluate meibomian gland function, or lack thereof. You can use standardized testing tools with consistent pressure application, or simply your own digital pressure. The key is to start evaluating.
Note tear meniscus height, the quality of the tears, and if there is any foaming on lid margins.
Look at lash health, and build up of scurf. For make-up, note application and debris. Is it on the lid margin? Caked in the lashes? Are there collarettes?
2. Begin addressing noted findings with simple treatment plans. This would likely involve carrying a small supply of care products at your office for patients to purchase. You can send patients out for it but be prepared for them to possibly purchase incorrectly and not follow the prescribed regimen as closely.
Recommend lid hygiene care. There are a variety of products from lid washes and sprays. I advise choosing a company and staying with their line of products. It can be confusing for both staff and patients when too many options are presented.
Prescribe warm compresses with massage. We know compliance at my office is better with a reusable mask rather than with home cloths/methods.
There are many, many artificial tears you can sell and/or prescribe for patients. Do some research, try some out, and again: pick a line or a strategy. The key is to find one to two drops that work for most and be able to advise those patients who don’t find relief (because remember, that’s all they are getting from this—relief) to other products. I tend to use mostly preservative-free options.
Create a print-out with instructions you can easily hand to each patient to advise them how to use these products. This cuts down on your time, staff time and the patients from calling to inquire.
Consider prescription options, but first educate yourself thoroughly on mechanism of action and correct patient candidacy.
Schedule follow-ups with these patients. You have to monitor to ensure the condition is improving.
3. Start to build your comfort level. As you become familiar with what you are seeing, and what you prescribe, your ability to expand upon testing and treatment options grows. More intermediate to advanced testing and treatment options include the following:
Supplements to address dry eye, such as omega-3’s.
Advanced meibography and tear film analysis.
In-office treatment systems for lid margin health, meibomian gland obstruction and inflammation, tear stimulation.
Dry eye affects an estimated 30 million Americans, much more so than glaucoma and macular degeneration combined. Not only is there opportunity, but there’s necessity in testing, educating and treating dry eye disease. You don’t have to do everything, but start somewhere. Become familiar with optometric colleagues you can refer to who do have advanced treatment options. Start small, and I promise, you can grow larger within the dry eye sector.
Gina M. Wesley OD, MS, FAAO owns and practices at Complete Eye Care in Medina, MN. Accolades include Minnesota's Young Optometrist of the Year in 2011 and the Early Professional Achievement Award from The Ohio State University College of Optometry in 2013. She is a member of the American Optometric Association, a fellow in the American Academy of Optometry and enjoys practicing, writing and lecturing in the industry. For questions or comments about this article, please contact firstname.lastname@example.org.