According to a 2014 study by Paulsen et al, around 30 million people in the United States have dry eye disease (DED). With this degree of prevalence, this condition has an enormous impact on our population — both as a stand-alone disease and in conjunction with other conditions and disease states.

This issue of Ophthalmology Management explores DED, a complex condition that requires a systematic approach.

TIME WELL SPENT

While a high percentage of our patients have some form of ocular surface dysfunction or DED, we can’t diagnosis and treat the condition if we’re not looking for it. Many ophthalmologists go straight to the lens or look at the retina before carefully evaluating the ocular surface, including lid margins, tear film quality and cornea surface changes. However, for surgical patients, especially in the era of refractive cataract surgery, we have to prioritize our efforts to optimize the ocular surface in order to maximize outcomes (for more, see page 17).

Eyecare professionals (ECPs), including ophthalmologists and optometrists, overlook DED due to a variety of factors. One of the primary reasons is that it takes a great deal of time. ECPs see a lot of patients every day, and spending the time to explain this complex and chronic disease to each patient over the course of the day adds up. However, there are ways to save precious chair time with this process.

In my practice, we have a handout that we provide to patients. This handout includes a list of all of the therapies that could be offered for DED, from the use of prescription dry eye medications, artificial tears and lid cleaners to warm compresses to thermal pulsation treatment for meibomian gland dysfunction. In addition, this handout provides instructions for use of each particular therapy and reviews potential side effects of medications, for example, which ultimately saves chair time and callbacks to the office.

Along with the time spent talking to patients, DED takes a while to treat, which can be frustrating for ECPs as well as the patient. It’s one thing if the patient comes to us due to dry eye-related symptoms. These patients are suffering and want us to provide relief, which can be life-changing depending on how debilitating their symptoms may be. But if we are seeing a cataract patient for the first time who has asymptomatic dry eye, that person may be eager to proceed with surgery and would rather not delay for months while we treat their dry eye and put them on medication. But ultimately, it is worth the wait! The optimization of the ocular surface is critical to optimizing surgical results.

IN THIS ISSUE

All ECPs need to screen patients and help guide their therapy. Our dry eye experts featured in this month’s issue of Ophthalmology Management address a number of the options at our disposal — from the latest diagnostic approaches (page 30) to the key in-office tools for treatment (page 24). In addition, we look at several therapeutic options on the horizon (page 48).

DED treatment is imperative. It provides relief to many who are suffering with the condition as a stand-alone disease as well as critical optimization of the ocular surface, allowing for accurate measurements and outcomes in the surgical patient. With new and innovative treatments and technologies, we have many options to offer our patients. OM

Kathryn M. Hatch, MD, is an assistant professor of ophthalmology at Harvard Medical School and the director of refractive surgery service at Massachusetts Eye. She is the director of the anterior segment fellowship of Massachusetts Eye and Ear and is site director of Massachsetts Eye and Ear in Waltham. She has expertise in laser refractive surgery, including SMILE, LASIK and PRK, advanced techniques in cataract and corneal surgery, keratoconus and collagen crosslinking.

Disclosures: Dr. Hatch revealed relationships with Glaukos, Johnson & Johnson Vision, Kala Pharmaceuticals and Zeiss.