In this video from Interventional Mindset, Preeya K. Gupta, MD, discusses how to present and communicate treatment options for
meibomian gland dysfunction (MGD) to dry eye patients.
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Communicating with patients about MGD therapies
When getting started with MGD therapies, it’s important not to get overwhelmed by the wide variety of treatments available and instead select one therapy to focus on. By choosing one therapy, you can perfect
treatment proficiency along with effectively communicating the features and benefits to patients.
The first obstacle that clinicians tend to face is feeling that they have to market or advertise MGD procedures in their practice. However, the reality is that, likely, you are already treating patients with meibomian gland dysfunction and dry eye, so it’s easier to focus on primarily discussing these treatments with current patients before investing advertising monies.
Dr. Gupta shared that when she initially used these therapies, she remembered feeling uncomfortable
talking to patients about procedures that required out-of-pocket costs. With time she found that discussing the financial costs of these treatments was facilitated by outlining the connection between dry eye, MGD, and the patient’s symptoms to help them better understand the disease.
Additionally, it’s key to clearly outline treatment expectations and potential side effects for patients when dealing with out-of-pocket costs. Ultimately, the patient needs to believe that the treatment is worth their monetary investment, and they must accept that they have a chronic disease that requires ongoing maintenance.
Patient stratification for meibomian gland dysfunction
When patients come in for a dry eye evaluation at Dr. Gupta’s practice, they start with clinical testing, specifically
meibography, as it helps to establish the disease severity. A patient with mild meibomian gland atrophy may only need one therapy or treatment for symptom relief. Conversely, someone with moderate or severe meibomian gland atrophy will likely need “polytherapy” to get full symptom relief. Polytherapy means simultaneously prescribing multiple treatments that target the underlying causes, such as pharmaceuticals, MGD-based in-office procedures, nutraceuticals, or a combination thereof.
Often, patients with MGD have not been made aware of their condition, so Dr. Gupta clearly outlines what treatments are necessary and how many treatments the patient will need to undergo or how long the patient will need them to experience symptom relief.
Set the expectation that it takes approximately 6 to 8 weeks to see results from
office-based MGD procedures, and it can take up to 3 to 4 months to see the peak effect. While the obstruction in the meibomian glands might be gone, it takes time for the patient’s ocular physiology to calibrate and start producing less viscous secretions.
A script for patient communication about MGD treatments
Once the expectations of the disease severity and necessary treatments have been outlined, Dr. Gupta tends to follow a basic script to connect everything together for the patient.
The script goes as follows:
“After performing an exam and running some diagnostic tests, we see that you have dry eye disease and meibomian gland dysfunction. There are two causes for dryness; dryness because you don’t make enough tears and dryness that stems from the tears you make evaporating too quickly. We have different prescription therapies to help with inflammation and tear production, which is one treatment option.
We also have different therapies to help with relieving the obstruction of the meibomian glands. In your eyelids, you have about 20 to 25 glands in each eyelid that are responsible for producing oil to lubricate the ocular surface. When those glands get plugged up and are unable to secrete the oils as they should, that’s when the surface of your eye gets dry. There are different therapies available that focus on heating the lid and then expressing those glands to remove the obstruction.”
It’s also important to mention to the patient that many of these treatments are not covered by insurance. Dr Gupta lays out to the patient the prices of the different treatments, allowing the patient to make an informed decision about which therapy to proceed with.
Performing objective testing on MGD patients
Lastly, it’s important to perform objective measurements, such as patient questionnaires, measuring tear breakup time, and corneal staining that you can repeatedly administer to patients over time to track improvements in symptoms and present these to the patient.
Patients must understand the difference between anatomical improvements and symptomatic improvements, as not every patient will achieve maximal relief in both categories. However, in Dr. Gupta’s experience, many in-office MGD therapies, such as
TearCare and intense pulsed light (IPL), provide significant anatomical improvements, though changes in symptomatology can be more variable.
Conclusion
With technological innovations in treating dry eye disease and MGD, it’s becoming easier to diagnose and treat patients earlier in the disease state. Specifically for
MGD-based therapies, proactive treatment intervention can allow for a more meaningful impact on the disease.
Keeping this in mind, clinicians should stay up-to-date on advancements in
dry eye and MGD therapies with the added caveat of a willingness to change treatment approaches, as ocular surface disease often requires multi-pronged therapies.
