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Dry eyes impacts millions of Americans, and finding a lasting solution can be a challenge, especially without guidance from an experienced eye doctor. To shed light on this common condition, OCLI Vision’s Dr. Marguerite McDonald sat down with leading experts Mitch Ibach, OD, FAAO, Ranjan P. Malhotra, MD, FACS, and Jessilin Quint, OD, MBA, MS, FAAO. Together, they discuss the etiology of dry eye and outline the most effective strategies for managing the condition so patients can start to feel relief fast.
Identifying the Underlying Cause of Dry Eye
Dr. McDonald, a renowned expert in dry eye treatments and a corneal and refractive surgeon, started the conversation by asking her colleagues to explain why identifying the underlying cause of dry eyes is so important. For context, there are different types of dry eye, including aqueous deficient, evaporative, or combined. And, the doctors all agreed that knowing the main type makes a difference when deciding on the most effective treatment.
However, as Dr. Quint pointed out, it is important to understand that not all cases fit neatly into one bucket or the other. Additionally, if there are multiple root causes of the dry eye, Dr. Malhotra recommended starting treatment with the most prevalent. This phased approach prevents the patient from becoming overwhelmed with excessive information. It also allows the patient to focus on the efficacy of just one treatment, which may even improve compliance. If other therapies are needed, they can be added in subsequent phases.
To help determine the most effective treatment, Dr. Ibach recommended listening closely to the patient’s symptoms to determine which dry eye type they have. Paying attention to the symptoms allows the doctors to treat those specifically, giving the patient the desired outcomes. Another takeaway was the importance of correlating the patients symptoms, such as vision fluctuations, stinging, itching, with the signs of the condition provided by diagnostic tools, (eg, fluorescein staining, meibography) to effectively diagnose the type of dry eye.
The Main Goal in Treating Dry Eye Is to Disrupt the Inflammatory Cycle
When treating dry eye, all the ophthalmologists agreed that restoring ocular surface homeostasis is the ultimate goal. When left untreated, inflammation can lead to tissue damage and chronic dry eye. Getting in as early as possible makes it easer to treat. Dr. Malhotra drove home the point that everyone experiences dry-eye insults on a daily basis, such as staring at a computer screen or environmental irritants, but they recover. Dry eye patients, on the other hand, enter the dry eye cycle and are unable to break the cycle, causing painful, irritating symptoms that can damage the eye if the inflammation is left untreated.
Treating Patients Without Delay
Most of the panelists agreed that treating patients for dry eye when they come in for a comprehensive eye exam or another type of consultation is vital, even if they are asymptomatic. While most patients will receive some form of treatment therapy at the appointment, the doctors will also schedule a follow-up appointment that may feature more in-depth conversations or treatments, depending on the progression of the condition.
Dr. McDonald also stressed the importance of dry eye care for pre-op patients. Dr. McDonald noted that any patients with a tear osmolarity score of 317 or higher when they arrive for their pre-op surgery appointment must be treated for dry eye before they can successfully undergo surgery. Both Dr. McDonald and Dr. Malhotra noted that patients are usually very receptive to fixing dry eye first before surgery to ensure the best outcomes. The conversation then highlighted the importance of eye doctors and surgeons working together to make sure the patient’s eye is healthy before sending them out for referral to the surgeon.
Thankfully, there are a number of simple and quick methods available to eye doctors to determine the presence and cause of dry eye. These tools help to ensure a high capture rate, meaning patient conditions do not go undetected. Dr. Quint detailed that, at the bare minimum, patients should undergo fluorescein staining to get a clear view of the cornea and a meibomian gland oil quality check to ensure proper lubrication of the eye. Dr. McDonald added that it’s important to include a SPEED (Standard Patient Evaluation of Eye Dryness) questionnaire and tear osmolarity test. Finally, Dr. Malhotra concluded that all of these diagnostic tools should be correlated to the symptoms described by the patient to get the most complete picture.
Getting Treatment for Dry Eye
The key takeaway from this expert discussion is clear: listening to patients, using the right diagnostic tools, and implementing a phased treatment approach can help millions of Americans break the dry eye cycle. If you’re experiencing dry eye symptoms or are preparing for eye surgery, schedule a consultation at the OCLI Vision office nearest you to explore your treatment options and start your journey toward lasting relief.
