As an ophthalmologist with dry eyes, I know I am not alone among my colleagues. If you have this disease, you know it has a profound effect, not only on you, but also on your relationship with your dry eye patients.

When I share my personal story with my patients, they are relieved to know that I understand what they’re experiencing and that it is possible to find relief. I am sharing my story with you, so that those of you who are not personally affected by dry eye can appreciate the impact it has on quality of life as well as ocular health. In addition, I offer some insight into the psyche of the dry eye patient and provide a few tips on how to improve adherence with recommended therapy.

Denial: A Common Patient Reaction

For many years, I didn’t take my dry eye seriously. Occasionally, I would use artificial tears when my symptoms were severe, and I would think, “It’s really not that bad” and “I don’t have time for this.”

About 2 years ago, however, my eyes were so dry that my contact lenses became extremely uncomfortable — so much so that I had to remove them before the end of the day. This caused me to have a panic attack. How could I perform surgery if I couldn’t wear my contact lenses? I knew I had to take action.

I began a regimen of treatments that improved my symptoms significantly. Shortly thereafter, I had the privilege of hearing Patti Barkey, CEO/administrator of Bowden Eye & Associates, and her group discuss how to start a Dry Eye Center of Excellence, which motivated me to implement a dry eye clinic in my office, because, clearly, there is a need for it.

Erase the Stigma, Improve Adherence

I think it is fair to say that there is a stigma associated with dry eye disease. Often, physicians send patients home with a collection of different artificial tear products to “see what works.” When patients return and report that they’re still uncomfortable, they may feel like complainers or become convinced that they are blowing their symptoms out of proportion. As a result, patients often lapse into denial and avoid treatment.

As an example, I recently attended a family event, and when I told an older cousin, a business executive, that I would be speaking about dry eye disease at a professional meeting, he smirked and asked, “Is that really a disease?” This seems to be the prevailing attitude, even among educated people — including some physicians — and, as one who has suffered, I can tell you wholeheartedly that, yes, it is a disease and those who have it really need your help.

The first step toward helping dry eye patients is reassuring them that they have a real disease that needs to be treated. If you also have dry eye disease, speaking to patients about your own situation may help them understand and adhere to treatment. I don’t have this discussion with every patient I treat or I would never go home at night, but when a patient is frustrated and having difficulty adhering to treatment, I may share my personal experiences and how I have managed my disease. This brings the topic down to a personal level, making it more like two friends discussing a mutual problem rather than a doctor lecturing a patient.

Anything that legitimizes what patients are feeling will improve compliance. Many patients may have seen doctors who did not take them seriously, so when they find a doctor who does, they are truly grateful — and more likely to follow that doctor’s recommendations.

Address Patients’ Treatment Concerns

Patients may have concerns about the potential side effects of drugs, and some insist on not taking any drugs because they follow a holistic lifestyle. Again, I share my own attitude and experience, explaining that I, too, try to avoid taking drugs whenever possible. But, I found that artificial tears alone did not improve my symptoms. Ultimately, using Restasis (cyclosporine, Allergan) twice a day really helped me. I emphasize the safety of the therapies I prescribe, explaining, for example, that there is no increased risk of glaucoma or cataracts with Restasis, and studies have shown the drug is not absorbed systemically.¹

In addition, patients may have concerns about the time commitment involved with dry eye treatment. As they watch me do loops around the office, I say, “Yes, I know what it’s like to be really busy,” and I share some suggestions to help them incorporate treatment into their daily routines.

For example, I store my Restasis in a little paper cup and place it next to my toothbrush (Figure 1). I know that I will brush my teeth every morning and evening, and even if my kids come into the bathroom to talk to me while I am brushing my teeth and I am totally distracted, I have a visual cue to remind me to use the medication.

One of my colleagues also uses this method as a reminder to use Xiidra (lifitegrast, Shire) twice a day. She noted that Xiidra leaves a slight taste in her mouth, and brushing her teeth right away helps eliminate that taste, which also helps her to be compliant.

Patients may also worry that dry eye treatments will be painful. Again, when discussing LipiFlow (TearScience) treatments, I can share my own experience. The treatment takes less than 15 minutes and is painless. I was treated at the end of a busy workday, and was able to drive home in the dark with perfect vision. Hearing this personal experience makes patients more comfortable when considering treatment.

I also emphasize that dry eye is a chronic, multifactorial disease for which there is no single “magic bullet” treatment. Therefore, patients with dry eye disease must follow a multi-pronged treatment regimen. Having one LipiFlow treatment, for example, will not eliminate the need for artificial tears, Omega-3 supplements or prescription medications, and, as a physician, I continue to use these on a daily basis despite being treated with LipiFlow. When patients understand the reason for each intervention, they are more likely to adhere to their recommended dry eye regimen.

Team Approach

Successfully treating dry eye involves a team approach in the office. This starts with the technicians, who must ask the right questions, take detailed histories, and list any treatments that patients have already tried. Every patient leaves our office with written material, including a flow sheet, describing exactly what treatments may be recommended or prescribed, and what to expect from them. This reassures patients that we are taking their disease seriously.

Showing diagnostic test results that confirm the presence of dry eye also can be extremely helpful, particularly for patients who have become frustrated. For example, our technician shows the patient an image of normal meibomian glands and compares it with an image of the patient’s meibomian glands as shown by LipiView (TearScience) imaging (Figure 2), pointing out the differences. Patients now have visual proof that they have significant disease and that there is a medical basis for their symptoms.

Value of the Dry Eye Specialist

Sharing my experiences as a dry eye patient has helped me connect with the dry eye patients in my practice on a personal level. I encourage ophthalmologists who do not have dry eye disease to take this process seriously, and to show patients that you sympathize with them and will listen to their concerns.

By establishing a Dry Eye Center of Excellence with a standardized protocol that utilizes all of the diagnostic and treatment options available to us, you will show patients that there is a disciplined approach to treating their disease. This will be a win-win for you and your patients: You will have the satisfaction of knowing you have helped them, and they will refer others to you — their dry eye specialist. ■

Reference

1. Allergan. Restasis package insert.