As a dry eye practice, we see a lot of eye dryness—but we’re also primary care providers. On an average day in the practice, we can expect that about 70% of patients who walk through our doors are presenting with some form of eye dryness. Whether that presents in pre-surgical exams for cataract or LASIK patients, or in regular exams for our contact lens or glasses patients, we have to address the tear film to make sure to get the best outcomes for our patients.
How to discuss eye dryness with patients
The discussion about dry eye starts at the door—we’re the Dry Eye Center of Northeastern Pennsylvania, after all. Every patient receives a SPEED questionnaire ahead of time as part of sensitizing patients to this condition. We build awareness of the prevalence of dry eye by educating that symptoms of eye dryness are manageable with first-line treatment. It is also important to ensure that your patients understand that eye dryness can be caused by a variety of factors and conditions and includes an array of symptoms.
Even our external marketing and website discuss eye dryness since we want to make sure our patients know that it is something they should bring up when speaking with our techs and doctors.
Once patients enter our doors, our staff performs a thorough evaluation of their history, lifestyles, and medications to make sure that we know about any aspects of their lives and health that might be affecting and contributing to their eye dryness.
Several tests we rely on for eye dryness
Staining—both fluorescein and lissamine—has a huge impact on diagnosis and communication for every single patient, no matter the reason they present at our practice. We use anterior segment photography to talk to patients about what we see, so that we can make the connection between signs and symptoms, particularly if symptoms are lacking. We use those signs to help gauge success as we treat our patients, and to explain the success of our treatments.
Making those signs as real to the patient as possible is key, whether that means engaging them in conversation about changes they’ve noticed in their eyes, or showing them the images from the staining and pointing out the dead cells.
Where artificial tears fit into treatment for symptoms of eye dryness
Artificial tears are an effective first step in treating eye dryness. Whether what you’re treating is identifiable as meibomian gland dysfunction, aqueous deficiency, or a combination of deficiencies, there are certainly artificial tears available that will work as a first-line treatment for symptoms of eye dryness.
When leveraging artificial tears as a treatment for eye dryness, it can be tempting to simply hand off samples to your patients and wave them out the door, but it’s important to follow-up with your patients. I have found that follow-up improves patient compliance. When you have eye dryness in your practice—regardless of whether you’re seeing patients for ocular disease or their primary care appointment—if you want your patients to treat your recommendations seriously, you must treat them just as seriously. Develop a methodical approach to prescribing artificial tears, including follow-up and patient education.
How to effectively recommend artificial tears
Always recommend a specific brand and type, and give your patients a frequency at which to use the drop. This is why it’s important to make sure your patients get coupons, incentives, or samples, because it’s natural to want to seek out the least-expensive option. If you send your patient to the drugstore with the simple instruction to use artificial tears, they’re just as likely to find the most economical drop in the store rather than the complex brand name and active ingredient that you identified for them.
Provide a coupon or utilize online portals to help your patients get the specific type you are telling them to use. Be clear in the type, the frequency, and the follow-up, and explain why you’re taking or recommending each step. When it comes to utilizing samples, it’s extremely beneficial to have them in the office. This gives you the option to try out the drops in the office and make sure they’re comfortable for your patients.
Finally, our staff is also trained to supplement these instructions at the end of the patient visit; I’ll recommend the drop to the patient and give them instructions on use, and then our office coordinator gives them those instructions and coupons before they leave the office.
When delivering your "script" consider these points:
- Indicate there are many options out there, but you are prescribing or recommending a specific OTC drop
- The drop you are prescribing may be more expensive than others, but this is the drop you believe will help them most
- Let them know you'll be monitoring for improvement and adjusting the treatment plan accordingly
Understanding the difference between tear products
There are many varieties of artificial tears, and identifying which product is best for which patient is part of the process of identifying the root cause of your patient’s eye dryness. There are two types of primary active ingredients in artificial tears: demulcents, which soothe irritation, and emollients, which are fats or oils and support the lipid layer of the tear film.
If you’re seeing mild to moderate signs of eye dryness, you might want to go with REFRESH® RELIEVA®—personally, this is my go-to drop across the board. This drop’s active ingredient is Carboxymethylcellulose sodium (CMC), one of the most commonly used demulcents. I prefer demulcents to emollients because demulcents are typically less viscous and have lower blur than some oil-based tears. However, if your patient is experiencing symptoms of eye dryness that may be a result of meibomian gland dysfunction, you’ll want to reach for an oil-based tear like REFRESH OPTIVE MEGA-3® or REFRESH OPTIVE® ADVANCED. Personally, I recommend REFRESH OPTIVE MEGA-3® because of the combination of CMC, Glycerin, and Flaxseed Oil (inactive ingredient). This artificial tear works on all three layers of the tear film and helps prevent natural tears from evaporating.
Gels are thicker and more viscous drops, and they’re best for patients that may experience exposure issues. The tears I recommend for those patients are often REFRESH OPTIVE® GEL DROPS or REFRESH P.M.® in cases where they have an incomplete blink.
I've also been using REFRESH® DIGITAL in my practice for a few months now. Screen time was already increasing before 2020, and now my patients are spending even more time with their screens than ever. REFRESH® DIGITAL offers a good solution for patients experiencing eye dryness that may be related to screen use—there's research out there demonstrating the decreased blink rates from extended use of digital devices, which can result in reduced oil output from the glands. This oil-based drop offers fast-acting relief and comfort, which is especially crucial for our patients who spend much of their work and leisure time with digital screens.
Overall, I find myself most often leveraging REFRESH® RELIEVA®, because it’s a great daytime tear due to its low blur and soothing hydration. There is also an option that is safe for contacts: REFRESH® RELIEVA® FOR CONTACTS.
Finally, for those patients who are hypersensitive or need a gentle type of artificial tear, it is worth considering preservative-free options like REFRESH® RELIEVA® PF which is gentle enough for sensitive eyes or also good for those patients who have had eye surgery.
Overview of REFRESH® Artificial Tears
How to request REFRESH® samples and resources for your practice
REFRESH® Concierge is the best way to help you bring relief to your patients. This program gives you access to all things REFRESH® including samples, patient coupons, product education, and REFRESH® Direct Ecommerce.
The easiest way to connect is to simply call 833-REF-SMPL.