In this episode of Inside Intrepid, Melissa Barnett, OD, FAAO, FSLS, FBCLA, and Jessilin Quint, OD, MBA, FAAO, discuss simple yet effective strategies to improve outcomes for patients with dry eye disease (DED). The tips they share may help clinicians diagnose the condition earlier, improve long-term treatment outcomes, and support practice growth.
Dr. Barnett is a world-renowned optometrist and public speaker. She’s one of the foremost experts in the treatment of dry eye disease and has special interests in keratoconus, presbyopia, and specialty contact lenses. Dr. Quint is a board-certified optometrist and public speaker. She’s the co-owner of Smart Eye Care, which has offices in Bangor, Augusta, and Farmingdale, Maine. Like Dr. Barnett, Dr. Quint has special interests in specialty contact lenses and dry eye disease.
“I like to rule out dry eye [for] every single patient. We see dry eye in eight-year-olds; we see dry eye in 80-year-olds. Dry eye is so common, and years ago, we didn’t have any treatment options.”
DED fast facts
- Dry eye disease is very common, and every patient should be screened for it.
- Early diagnosis allows for quicker treatment, lowering the risk of permanent ocular surface changes.
- Patient education is one of the best and most effective ways to improve treatment outcomes.
- Every patient experiences dry eye differently. As a result, successful treatment requires personalized care tailored to the individual.
- Dry eye screenings can be integrated into clinical workflows to improve patient care and support practice growth.
Deeper dive: Insights for improved outcomes in DED
Dr. Barnett and Dr. Quint discussed how much screening and treatment protocols for DED have changed since they first started practicing.
Not so long ago, the condition was associated with middle-aged women and older individuals, but advances in research have shown that DED affects people of all ages,1 and early diagnosis and treatment can help slow its progression and improve outcomes.
Perhaps most important, though, is building long-term partnerships and meeting dry eye patients where they’re at. DED isn’t a one-time diagnosis, and cultivating lasting relationships can benefit those in your care and your practice.
Identify dry eye earlier
Dry eye disease affects approximately 16 million Americans, with some experts estimating the number to be 30 million or even higher. However, studies have found that a significant proportion of patients with DED may be asymptomatic. In one study, approximately 24.1% of participants with signs of the condition reported no obvious symptoms.2
Consequently, DED is often underdiagnosed and overlooked. Even when DED presents symptoms, patients may attribute them to outside sources such as fatigue or allergies. To ensure patients with dry eyes receive the best possible treatment, Dr. Barnett and Dr. Quint argue for DED screening as early as possible, even if it isn’t the primary reason for a visit.
Specifically, they recommend using resources such as diagnostic recommendations from the Tear Film & Ocular Surface Society (TFOS), the Ocular Surface Disease Index (OSDI) questionnaire, and the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire to identify DED early and initiate appropriate treatment.
For a deeper dive into evidence-based approaches to diagnosing and managing DED, check out What Optometrists Need to Know About TFOS DEWS III with Cheat Sheet!
Setting expectations improves outcomes
Diagnosing DED is only half the battle. Helping patients adhere to their treatment plans is equally important for achieving long-term symptom relief. Research suggests that improving patient knowledge and attitudes through education may help strengthen adherence, particularly among patients in later stages of their treatment course.3
“I start [by explaining] that dry eye is a chronic condition, and that this is a process. I like to talk about short-term relief and long-term relief: these are the things that we’re going to do right now to make you feel better faster, and these are the things that we’re going to do over time.”
Since some patients find a DED diagnosis overwhelming, it’s important to meet each individual where they’re at. One of the best ways to do that is by presenting information in easily digestible formats.
Some effective approaches include:
- Walking patients through the results of their imaging tests, such as corneal topography and infrared meibography
- Sharing informational brochures and/or one-page resources about DED
- Explaining the underlying factors contributing to each patient’s DED diagnosis
Dr. Barnett and Dr. Quint also recommend breaking treatment down into stages, with a focus on managing each underlying cause as part of a comprehensive treatment plan.
As Dr. Quint explains: "To really [help a patient] get better, we have to address all those underlying root causes. I usually break treatment down into phases—phase one, phase two, phase three—and map that out for patients. I send them home with an overview of what I saw, our treatment plan, what we’re starting with, and what we’ll likely address in the future."
How to incorporate dry eye care into your practice
Evaluating all patients for DED is an effective way to diagnose and treat the condition earlier. However, many ophthalmologists and optometrists worry they need specialized diagnostics or other equipment to add this service to their practice offerings.
The good news is that clinicians don’t need every available tool to improve DED detection and management. Dr. Quint and Dr. Barnett both noted that incorporating dry eye care into practice only requires a few simple resources.
These may include:
- Patient questionnaires
- Slit lamp analysis
- Ocular surface photos and imaging
- Vital dyes for corneal staining
- Tear film assessment
- The one-finger test (diagnostic expression) to assess for meibomian gland function (MGD)
“Some docs are a little intimidated to get into this space because they think that you have to purchase all this fancy equipment. It's fun to have, it’s helpful, and it serves a big role, but you can still treat dry eye and serve your patients with … the basics.”
Even using just a handful of these diagnostic tools can help you detect DED earlier and provide additional benefit to your patients.
Lifestyle still matters
Comprehensive management of DED also requires clinicians to understand the environmental and lifestyle factors that can contribute to its symptoms. Although prescription medications and artificial tears can often reduce dry eye-related discomfort, addressing underlying factors that contribute to symptoms can help support more comprehensive management.
Dr. Barnett and Dr. Quint recommend asking your patients questions about several lifestyle factors, in particular, including:
- Hydration
- Blinking
- Time spent looking at electronic screens
- Stress
- Diet
- Sleep
It’s also important to consider a patient’s overall health history, including any autoimmune diseases, as these conditions may affect tear production and contribute to DED.4
As the industry’s understanding of DED continues to evolve, successful management requires clinicians to address more than symptoms alone. DED is a chronic condition influenced by a variety of factors, including underlying medical issues as well as lifestyle factors.
Take home
This complexity means there’s no one-size-fits-all treatment solution. However, the providers who partner with their patients early to screen for and diagnose DED can help improve outcomes.
It’s important to remember that symptom relief is only part of the goal. The right treatment approach will also focus on restoring ocular surface health and improving quality of life.
