Published in Ocular Surface

Practice Makes Perfect: The Dry Eye Dialogue

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7 min read

Join Damon Dierker, OD, FAAO, and Tracy Doll Lee, OD, FAAO, to discuss tips for dry eye patient education and how the dry eye dialogue is critical for success.

In this episode of Dry Eye Fireside Chat, Damon Dierker, OD, FAAO, and Tracy Doll, OD, FAAO, discuss patient education and how the dry eye dialogue is critical for success.
After a 15-year teaching career during which she piloted one of the first ocular surface disease centers inside a university, Dr. Doll transitioned into private practice and is now the Director of Ocular Surface Care Services at Sunset Eye Clinic in Beaverton, OR.

How clinicians can approach patient education on dry eye

Helping patients understand their disease state, process, and symptoms can help shape their expectations and goals for treatment, making patient education a key part of the dry eye disease treatment process.
In Dr. Doll’s experience, teaching patients about their anatomy and explaining how it relates to their symptoms and how they feel is a highly effective method of patient education. She utilizes slit lamp photography and meibography to explain what she is seeing and how it corresponds with their symptoms.
She then follows up her explanation by recommending the best treatment option for their specific diagnosis.

Dry eye patient education in action

Dr. Doll described a case of a rosacea patient who was sent to her by a colleague in Hawaii.
She showed the patient their telangiectatic blood vessels, backed-up meibomian glands, and concurrent blepharitis with Demodex mites. She also showed them pictures of their anatomy and clarified how that correlated with their symptoms.
She followed up with why different treatment modalities, such as topicals or intense pulse light, would work for them. The patient left with a treatment plan in hand and booked therapies.

The importance of offering the best dry eye treatment option

Dr. Doll notes that she never makes assumptions about patients based on their insurance or if they are paying out-of-pocket. Instead, she has found that it is better to always offer the best treatment option for a given patient.
If a patient expresses concern that they can not afford to receive these advanced therapies, she will then propose the next best solution.

Avoid offering too many treatment options to dry eye patients

Dr. Doll states that she avoids offering patients a “multiple choice” of treatment options and instead focuses on the one option she thinks will work best for that individual patient.
She remarks, “Wishy-washiness is probably one of the worst things that you can do because patients will then think that they get to choose and that everything is all alike.”
Instead: Emphasize that your treatments are tailored to each patient’s individual case. Patients need to know that you are confident in their treatment plan and your course of action.
For patients who have seen multiple doctors for their dry eye already, Dr. Doll recommends staying away from first-line therapies, as these patients have likely already tried various options. ”I’m not going to recommend an artificial tear for a patient if they’ve already taken multiple brands of artificial tears,” she notes.

Give credit to the referring doctor

Dr. Doll recommends that clinicians should avoid doing a disservice to the referring doctor by stating or implying that they “didn’t know what they were talking about.”
Instead: Emphasize how advanced dry eye therapies are a newer science, and encourage patients to be grateful to their referring doctor for sending them over. There is no bad time to start managing dry eye disease.
Dr. Dierker adds that he always keeps careful and thorough chart notes to send back to the referring doctor when co-managing patients. When he is able to share information on dry eye diagnosis and treatment, his patients’ primary optometrists are often able to begin managing similar dry eye patients themselves, saving a time-consuming commute to another clinic and enhancing patient satisfaction and outcomes.
“We’ve got to be educating everybody on how to take better care of our patients,” he notes. “I make sure that it’s very transparent what we’re doing and why we’re doing it.”

Leveraging resources to foster dry eye patient education and comfort

At her clinic, Dr. Doll ensures that every patient gets a detailed report and a list of treatments they will receive.
She also gives her patients a simple three-step process which includes:
  • Clean
  • Calm
  • Protect
She advises giving patients no more than five things to do because this can overload them. She also shares that at her clinic, there is a dedicated staff member to whom she can “hand off” patients with questions and who is instrumental in helping patients feel comfortable.
After Dr. Doll assigns a patient their “homework,” she has her staff member come in and reiterate the information she has already provided. She expresses that this strategy has been beneficial in helping patients better understand and remember what she has already stated.
The staff member, which Dr. Doll refers to as her “dry eye concierge,” also provides patients with a welcome packet that:
  • Explains the therapies and everything that was recommended during their visit
  • A business card of the staff member
This helps make patients feel more comfortable, as they know that if they have a question or need assistance, they can get it.

The importance of a great case history in dry eye patients

Dr. Doll emphasizes the importance of case history. Taking time to compile a more extensive case history by delving deep into a patient’s medical history and factors such as cosmetics will drive patients toward quicker diagnoses.
A patient’s case history can reveal factors that can help you communicate to the patient other interventions that they may need—such as improved nutrition, allergy testing, or evaluation by other healthcare providers.


Thoughtful and well-executed patient education and discussion can help shape patients' goals and expectations and get them the treatments they need.
There is no bad time to start managing dry eye, and the best time to start is now.

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Damon Dierker, OD, FAAO
About Damon Dierker, OD, FAAO

Dr. Dierker is Director of Optometric Services at Eye Surgeons of Indiana, an adjunct faculty member at the Indiana University School of Optometry, and Immediate Past President of the Indiana Optometric Association. Dr. Dierker is the Co-Founder and Program Chair of Eyes On Dry Eye, the largest event for eyecare professionals in the industry. He has made significant contributions to raising awareness of dry eye and ocular surface disease in the eyecare community, including the development of Dry Eye Boot Camp and other content resources across dozens of publications.

Damon Dierker, OD, FAAO
Tracy Doll, OD, FAAO
About Tracy Doll, OD, FAAO

After 15 years in the world of academia, Dr. Tracy Doll has transitioned to Sunset Eye Clinic in Beaverton, OR where she is the Director of Ocular Surface Care Services.

Dr. Doll graduated from Pacific University College of Optometry in 2006 and completed a residency with the Portland VA Medical Center in primary care in 2007. She then started a teaching career with Pacific University College of Optometry, instructing in didactive courses and clinical services for 1st through 4th-year students in the realms of ocular disease, procedures, and even optometric Spanish. She pioneered one of the first ocular surface dryness centers inside a university, supervising 4th-year optometry students and residents, as well as performing direct care for those with ocular surface dryness.

Dr. Doll has a passion for lecturing, writing, and research on the topic of improving ocular surface dryness and safe beauty for the eye. She is thrilled to be taking part as a contributor to the upcoming Tear Film and Ocular Surface Society (TFOS) Workshop, “A Lifestyle Epidemic: Ocular Surface Dryness,” where she will be part of the subcommittee on cosmetics.

Dr. Doll is delighted to serve on the American Academy of Optometry Anterior Segment Section leadership team and is a proud member of the Intrepid Eye Society and TFOS. She is also the Co-Medical Editor for Dry Eye Coach, offering online resources for doctors and the public alike.

In her free time, Dr. Doll enjoys exploring the Portland food and wine scene with her husband. She is also the dance mom of two hardworking daughters who love math.

Tracy Doll, OD, FAAO
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