AAOpt 2024: So you've diagnosed dry eye, now what?

Alongside Jaclyn Garlich, OD, FAAO, Jessilin Quint, OD, MBA, MS, FAAO, gave a presentation at the 2024 American Academy of Optometry (AAO) meeting in Indianapolis, Indiana on next steps after diagnosing dry eye, including developing treatment plans and managing follow up appointments.

Video transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Jordana Joy:

Hi everyone. I'm here today with Dr Jessilin Quinn of Smart Eye Care in Augusta, Maine. She's here to chat about a presentation on dry eye that she gave at this year's AAO meeting. So welcome, it's a pleasure to have you here today.

Jessilin Quint, OD, MBA, MS, FAAO:

Thank you. It's always so fun to be here. I'm so honored.Thank you for having me.

Joy:

Awesome. We always love having you. So first, would you be able to give us a quick overview of your presentation, what you talked about?

Quint:

Yes, so I co-lectured this really exciting course with Dr Jackie Garlich, and it was about, so you diagnose dry eye, what do you do now? Because dry eye is an exciting time. We've had so much innovation. There are so many dry eye tools in the toolbox to be able to treat patients. But sometimes, with so much innovation, it's like, which one do you pick? How do you navigate that? What do you do? What order? And so we talked about just kind of an overview of what those innovations were and really just how you can start incorporating them into your practice. So whether it's an in-office treatment, you're prescribing a different pharmacological agent, you're bringing in a nutraceutical. And so we just really walked you through, like, this is an exciting time. These are all the tools. This is how you can use them to help your dry eye patients.

Joy:

Absolutely, yeah, that sounds great. So what are your best tips for getting comfortable diagnosing dry eye with so much on the market, so much excitement surrounding the topic?

Quint:

So true. Dry eye sometimes can feel very challenging, because there's often different root causes, and there is so many different options right now. You know, my thing is just you have to start somewhere, and then with anything, when you gain more experience and you start to navigate things a little bit differently But definitely be proactive, like that would be my recommendation is be proactive in addressing this. Dry eye symptoms can be very non specific. A lot of times, patients will just think they have allergies or just think they need a change in their glasses or contact lenses, but being proactive and identifying it, if it's in those earlier forms, is ideal. Any disease process, if left untreated, is only going to get more complicated and just become harder to treat. So being proactive about identifying it as early as possible, and then just being with the patient on their journey, because sometimes with so many tools, they might need multiple tools, but sometimes you just have to start with one, and then as you go, then you add in another, and then you add in another. Or sometimes things work, and then you you can stick the course. Or sometimes they don't work how you thought, and you got to pick something else. So I think my other advice would just be, don't be afraid to pivot and try new things, and just realize that with dry eye, it is a journey. This is a chronic approach, which means that it's just going to take a little bit of trial and error sometimes, but take home, just be proactive and jump in as soon as you can with these patients.

Joy:

Going off of that guideline for patient care, do you have a standard or a guideline that you usually follow for being able to properly do follow up care with your patients, and what cases will deviate from the norm? And how do you adjust to that?

Quint:

True. I guess, if I break it down and simplify it, I first want to identify if a patient is actually having symptoms, so whether that's something mild, or it is really impacting their daily activities. And then, regardless of where we are on that scale, my first step is like to at least make the patient aware this could be a thing. So either we're just monitoring it, and they're self monitoring their symptoms, and we talk about it when they come in for their annual exams, or we're teasing that a little bit further. Step 2 clinically, obviously looking at this objective component, but my step 2 is really looking at the objective, like the clinical science. So I'm looking for any corneal staining. I'm looking for a decreased tear breakup time. I'm looking to see if we have any of the masqueraders, like neurotrophic keratitis, blepharitis, Demodex, MGD – like all of those different components – rosacea. And then, if so, I want to address that as quickly as possible. And then once I identify that, generally, I'll bring them back for more in depth dry eye work up where we do the stain, and we map out things, tear osmolarity, and whatnot a little bit further. And then we start a treatment plan, which is usually a combination of a little bit of over the counter at home therapy with either an in office treatment or maybe a prescription medication of some sort. And then we try that. Generally, after I start something, I'll see the patient back in 4 to 6 weeks, and then we'll assess where we're at. We might add something else we might stick the course. And generally, I'll watch these every 3 to 4 months until we get to a good spot that we're maintaining.

Joy:

Absolutely. So what does that good spot look like? Is that different for every patient? Or what things do you look for?

Quint:

I think it depends on the patient. for sure. Ideally, in a perfect world, we're improving clinical signs and we're improving a patient's symptoms. So until I see improvement in one of those, I'm going to keep trying to do that. But sometimes the goal for the patients dry I might be different. So sometimes, for a more formal dry workup, where we're really kind of deep diving into this, I always ask patients like, "What are your goals for dry eye?" And I document that, and then as we go through the course, because sometimes improvement can be very gradual, and sometimes a patient can meet all of their goals but still not feel satisfied. And so that's why having it documented is helpful, but sometimes that end point of maintaining is just being able to meet the patient's goals. Dry eye's a chronic condition, there's no cure, so you're not necessarily chasing a cure for dry eye, but it's really just getting the clinical signs comfortable, so vision is stable and comfort is there, and then hopefully addressing and improving the patient's goals as whatever subjective component that might be.

Joy:

Absolutely, yeah. A lot of compounding factors there. So do you find that there are any treatment options that tend to be overlooked and what patients are best suited for some of those treatments?

Quint:

Probably so many. I definitely think the evaporative component of dry eye, sometimes we immediately think of like a thermal hot compress at home, or maybe a thermal pulsation treatment. But there's a new eye drop Miebo that really tackles that evaporative piece. And I've had so many of my patients that have had really great success. So sometimes I think that that's often overlooked, 1, because it's new, but 2, because sometimes when we think about evaporate dry eye, we're just focusing on the meibomian glands, right, and thinking about that. But we now have this drop that can really help improve that evaporative component for those patients.

Joy:

Absolutely. Was there anything else that you wanted to add that we haven't gotten to?

Quint:

I would say just dry eye is here, and it's here to stay. Be proactive in addressing it. It's awesome if you have all the fancy tools to address it, but at the end of the day, you really just need the slit lamp and possibly a little bit of stain and just being able to ask the right questions in a different way in order to uncover this. And then from there, if you are really passionate about dry eye, this is a big segment of your practice that you can grow. But even if you're not passionate about dry eye, this is an opportunity for us to refer to our colleagues, right? Sometimes in optometry, we don't refer to each other enough. And this is a real opportunity that if dry eye is not your thing, send it to somebody who is really passionate about this so that ultimately, the patients are getting the best care.

Joy:

Absolutely. Well thank you very much for taking the time today. Dr Quint, we always appreciate it.

Quint:

Thank you.