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Caring for Patients with Dry Eye Disease
March 2019 - Bridgitte Shen Lee, OD on Optometric Office
So much education is needed about dry eye disease (DED). DED is multifactorial, chronic, progressive and inflammatory in nature. Patients do not know that DED is a disease, and if left untreated, it will get worse. Since it is also caused by lifestyle and poor hygiene, patients need to develop regular lid/lash hygiene and healthy digital habits to prevent DED from getting worse.
There is no “one cure” for DED! Patients expect a drop, a procedure, a pill or that one something that they can do for a month or two to make it go away. Patients need to follow their doctor’s prescribed treatment—even after they notice their symptoms improve.
The prevalence of diagnosed dry eye disease in the U.S. is around 30 million people. In a busy primary eyecare clinic, the actual percentage of patients with reported dry eye symptoms or observed clinical signs are much higher. At our practice, more than 50% of patients complain of symptoms that align with DED.
IMPORTANCE OF PATIENT EDUCATION
Education on the “disease” nature of DED is vital. Many patients blame dry or red eye symptoms on allergies and attempt to treat the symptoms with over-the-counter drops, which may only provide temporary relief and mask the underlying chronic ocular surface issues. Annual eye exams are an ideal time to discuss the chronic eye issues that patients are experiencing but may not bring up because they don’t know there are effective treatment options. Optometrists don’t know if patients suffer from DED symptoms until we ask. Every optometrist has dry eye patients in their exam chairs every day. Questions can be built into case history, and conversations can be included in the treatment recommendations.
All optometrists should follow the official TFOS DEWSII (Tear Film Ocular Surface Society, Dry Eye Work Shop Report II, [published summer 2017]) recommended four-step protocol in treating and managing DED. (See link below.)
The first step in the protocol includes the following:
education regarding the condition, its management,
treatment and prognosis
modification of local environment
education regarding potential dietary modifications
identification and potential modification/elimination of offending systemic and topical medications
ocular lubricants of various types
lid hygiene and warm compresses of various types
To learn more about the four steps of DED management, visit: TearFilm.org and click on the “reports” tab.
VALUE OF ANNUAL EYE EXAMS
Dry eye is a chronic disease that too many patients attempt to treat on their own and do not know to discuss with their optometrists. As advocates for our patients’ vision and eye health, it’s our duty to diagnose and treat DED. An important first step is an annual eye exam, about which Think About Your Eyes serves to increase awareness. I’m proud to support these efforts.
Bridgitte Shen Lee, OD, is the founder and CEO of Vision Optique and iTravelCE. She writes and lectures on the topics of digital eye health, dry eye disease, anti-aging eyecare, healthcare social media, and ocular aesthetics. Lee is one of the TFOS Global Ambassadors, and she is the official spokesperson and medical adviser to The Vision Council. She is one of 22,000 doctors listed on the Think About Your Eyes doctor locator. First Vision Media Group is a media partner of Think About Your Eyes.
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