Jaclyn Garlich, OD, FAAO, joins host Mark Schaeffer, OD, FAAO, of MyEyeDr in Birmingham, Alabama, on Inside Intrepid to make the case that dry eye is already in your exam chair—you are just not finding it yet.
Dr. Garlich, secretary of the Intrepid Eye Society, owns a private practice and dry eye specialty clinic in Boston's financial district, where she transformed a general optometry practice into a dual-track primary care and dry eye specialty model after purchasing it in 2020.
Dry eye fast facts
- Dry eye disease affects an estimated 16 million Americans; most patients normalize symptoms and do not report them spontaneously.1
- The DEQ-5 (Dry Eye Questionnaire 5) and SPEED (Standardized Patient Evaluation of Eye Dryness) are the two most widely used validated patient-reported outcome measures for dry eye in clinical practice.2,3
- A DEQ-5 score of 6 indicates clinically significant dry eye; a SPEED score of 8 indicates moderate-to-severe disease.2,3
- Sign-symptom discordance is well documented: objective clinical signs frequently do not correlate with patient-reported severity.4
The case for a validated questionnaire: why verbal intake is not enough
Most dry eye patients will not tell you they have it. They have normalized the grittiness, the end-of-day blur, the contact lens they pull out at noon. They have been doing it for years.
“Patients lie to us, but will tell the truth to a blank sheet of paper.”
To combat this, Dr. Schaeffer and Dr. Garlich built their five-minute workup around one non-negotiable: a validated symptom questionnaire surfaces what verbal intake never will. The conversation covers the DEQ-5 and SPEED, how serial scores create objective treatment response data, and the slit lamp sequence both doctors run on every patient—with or without advanced instrumentation.
How to get the most out of DEQ-5 and SPEED questionnaires
The DEQ-5 and SPEED are not screening tools—they are diagnostic anchors. A patient who scores a DEQ-5 of 8 while telling you their eyes feel fine is not inconsistent. They have normalized their baseline.
Dr. Schaeffer's recommendation: run the survey for 1 week without changing anything else, then audit how many patients scored above the clinical threshold while reporting no symptoms in the exam room. In his practice, that number is substantial. That gap is the volume of dry eye currently going undetected.
Serial scores at every visit create a numerical record of treatment response that does not depend on patient recall. A SPEED score dropping from 18 to 7 over 2 months is objective evidence—even when the patient says they feel no different.3
Symptom timing in the questionnaire guides the slit lamp exam before the patient reaches the chair. For example, morning dryness points toward incomplete lid seal, while end-of-day worsening points toward evaporative disease and incomplete blink.
Symptom-sign discordance in dry eye is well documented—objective clinical signs frequently do not correlate with patient-reported severity.4 A serial questionnaire score does not depend on how the patient feels about their eyes that morning. It is the same instrument, the same threshold, every visit.
“I have a protocol for slit lamp exams that I follow every single time. That consistency helps ensure I don't overlook anything.”
Conclusion
Watch the full conversation with Drs. Schaeffer and Garlich for their complete one-minute slit lamp sequence, meibomian gland expression technique, and the patient encounter structure that stops dry eye from being discovered on the way out the door.
Key takeaways
- Implement the DEQ-5 or SPEED questionnaire first, before changing anything else, then audit how many patients score above the clinical threshold without reporting symptoms.
- Verbal intake is an unreliable filter. Paper captures what conversation misses.
- Serial questionnaire scores at every visit provide objective treatment response data independent of patient self-report in the exam room.
- Symptom timing guides the slit lamp exam: morning dryness suggests lid seal issues, end-of-day worsening suggests evaporative disease.
- No advanced instrumentation is required to start. A validated survey, targeted history, fluorescein staining with a Wratten filter, and meibomian gland expression are sufficient to diagnose and initiate therapy the same day.
