In this episode of Interventional Mindset, Preeya K. Gupta, MD, and Priya Mathews, MD, discuss the importance of treatment compliance for dry eye disease prior to undergoing refractive surgery.
Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.
Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.
Patient education: Addressing noncompliance
The first step in managing dry eye treatment compliance is educating the patient and convincing them that there's a problem. As Dr. Gupta emphasizes, it's important to stress that dry eye is a chronic condition with no cure.1
Noncompliance leads to less effective treatment. Dr. Mathews emphasizes that being open-minded and non-judgmental is best, as cost can be a factor in noncompliance that patients may be hesitant to discuss.2
Patients can be classified as symptomatic or asymptomatic when evaluating compliance. Dr. Gupta notes that in one study she conducted, more than 80% of patients presenting for cataract surgery had dryness, and half of those were asymptomatic.3
Asymptomatic patients, such as those coming in for cataract surgery who do not have dry eye symptoms but have a severely affected cornea, are harder to persuade to begin therapy. For these patients, Dr. Mathews explains that treatment effectiveness will directly affect their outcome, as in the case of cataract surgery.
Additionally, Dr. Mathews has trained her technicians to play a major role in educating patients about dry eye and the importance of treatment. For patients, using images to communicate the severity of the condition can be helpful.
Dry eye treatment options
Doctors should be committed to understanding different types of therapies and identifying which will be most effective, while also considering affordability and access. Explain that the treatment process is a relationship and is tailored according to patient feedback. This is crucial because patients who have tried medication that didn't work sometimes believe there are no other options.
Dr. Gupta notes that the most commonly prescribed dry eye treatment is cyclosporine.1 Patients often generalize their experience and may dismiss cyclosporine as ineffective if they have tried one version, often without knowing which one, its concentration, or how long they used it.
Comparing newer dry eye medications
Growing competition among dry eye companies is driving efforts to make treatments more accessible. The modern approach to dry eye disease emphasizes therapies that work quickly.
Newer formulations of cyclosporine, such as VEVYE (cyclosporine ophthalmic solution 0.1%, Harrow) and CEQUA (cyclosporine ophthalmic solution 0.09%, Sun Pharmaceutical Industries), offer a rapid onset of action, are often better tolerated with less burning or irritation, and are easy to obtain.
Other quick-acting drugs include the newer TRP (transient receptor potential) channel agonist (acting within minutes) and MIEBO (perfluorohexyloctane ophthalmic solution, Bausch+Lomb), which provides a rapid anti-evaporative effect.4
Patients are more likely to stick with a treatment if they notice improvement within 2 to 4 weeks rather than within 2 to 4 months. These faster results allow for surgery to be performed sooner. With newer medications that have a quicker onset and are more tolerable, a topical steroid may not be necessary to help patients get past the initial "hump."5
Procedures such as punctal plugs, including the dissolvable LACRIFILL (hydroxypropyl cellulose ophthalmic insert, Nordic Pharma), are also patient-friendly and do not require daily compliance.4 For some patients, monthly in-office procedures such as those for MGD are favored over a daily regimen.
Addressing patient goals
Dr. Gupta states that clinicians should align the chosen therapy with the patient's goals and enhance quality of life.4 It is important to set expectations that a patient may need multiple treatments to manage their chronic disease and that their needs may evolve over time.
Dr. Mathews notes that dry eye disease is increasingly observed in younger patients, including 25-year-olds who cannot undergo LASIK due to dryness.
Ocular surface disease management
Clinicians should recognize that addressing ocular surface disease is crucial, as many patient symptoms, such as fluctuating vision,6 can often be traced to dry eye.
Dr. Mathews states that a key part of diagnosis is staining the patient's eye, and she recommends that every patient be stained to ensure the ocular surface is healthy. Advocate for the patient and simplify treatment by categorizing treatments (e.g., evaporative vs. inflammatory) and by having a clear algorithm in mind.
Dr. Gupta states that it is acceptable to select a treatment that targets the patient's most bothersome symptom, as this approach can lead to happier patients who are more likely to return to the clinic.
