Optometrists, organizations provide insight for State of Dry Eye survey

With dry eye disease (DED) becoming increasingly more prevalent, eye care providers are finding it more important than ever to discuss its side effects and associated risk factors with patients.

A revealing survey released by Bausch + Lomb, the State of Dry Eye, in early July elicited many reactions from practice owners and dry eye experts alike. The survey included participants that have both experienced dry eye symptoms and been diagnosed with DED and those that have not. Data collected from the survey found that not only does dry eye impact quality of life for a majority of those diagnosed, but participants were also largely unaware of the severity and symptoms of dry eye.¹

Informing the public

Adam Ramsey, OD, of Socialite Vision, said patients may not know the latest information about DED because they try to mitigate their symptoms alone without the recommendations of their eye care provider, or may not be forthcoming about their DED concerns. “Access to care is one of most pivotal parts of eye care that needs to be addressed the most,” he said. “Patients a lot of times feel like they can try and solve their dry eye issues with over-the-counter products alone, but they are quite confused on which ones to use. They’re not sure about the validity, they’re not sure about the success rate of the products that are available to them over-the-counter.”

With 1 of the findings from the survey that dry eye patients feel that they have to give up certain hobbies or daily activities to relieve their dry eye symptoms, Jessilin Quint, OD, MBA, FAAO, of Smart Eye Care, said that education plays an important role to let patients know that changing daily activity may be a last resort. ”That might be true for some occasions, but really that conversation should be with an eye care provider,” she said. “More often than not, with as much innovation and treatment options as we have, you shouldn’t have to give up the things that you love because we do have the tools to manage dry eye”

Gabby Marshall, OD, past president of the Great Western Council of Optometry, said that better public knowledge regarding DED starts with stressing the importance of underlying systemic etiologies to optometric students. “Dry eye disease is often a result of systemic inflammation and while we know that, it's a challenging concept for the public, especially when they want a quick fix,” she said.

Assessing and treating

Kelly Nichols, OD, MPH, PhD, dean and professor at The University of Alabama at Birmingham School of Optometry, said that the most striking finding was that many patients in the survey experienced dry eye so severe that they could “hear themselves blink.” “This isn’t a symptom we as clinicians query, but I think it is very identifiable to patients,” she said. “In the normal state, there is no awareness of the eyes—you can’t feel them, similar to the lack of awareness when wearing pants or a shirt. But if there is a wound on the arm for example, a shirt would cause a negative sensation. Asking patients if they have awareness of their eyes, and when, may help determine how severe the dry eye might be and what kind of treatment could help.”

Quint said that this finding is also compelling in that some participants treat these symptoms as the norm. “When you think about how that impacts your daily activities and really you shouldn’t have to think about your eyes,” she said. “If anybody has to think about their eyes that’s kind of a red flag that maybe there’s something that we can do there to improve upon things a little bit more.”

Nichols continued on to state that the patients’ inclination to change routines in their daily lives is also telling of the impacts of DED. “While data showing an impact of dry eye on quality of life isn’t new, the high percentage of dry eye patients in this survey (67%) that have changed something, like discontinuing contacts, stopping wearing make-up, or reducing screen time is also something clinicians should ask patients,” she said. “What a patient has given up because of dry eye is just as important as what a patient has tried to treat the condition.”

Additionally, Ben Casella, OD, FAAO, chief optometric editor for Optometry Times, said that accurate diagnoses of DED and educating patients starts with listening to them. “Before we begin thinking about educating our patients, we first have to listen not only to them, but to their eyes as well,” he said. “Most patients don't come in complaining of their eyes actually being dry. Transient blur, watery eyes, gritty eyes, redness, contact lens intolerance, and fatigue with digital devices merit special attention, but the eyes can tell us things during the course of the exam. During a refraction, the phrase, ‘Hang on and let me blink a couple of times,’ speaks volumes to the integrity of the tear film and its coverage of the ocular surface. By listening, we can make more accurate diagnoses of dry eye disease, which is actually a family of diseases based on underlying cause and treatment modalities”

Selina McGee, OD, FAAO, owner and founder of BeSpoke Vision, also added that questionnaires have proven to be useful assets to be sure that patients are screened properly and thoroughly. “Take the opportunity to really screen each patient in your chair for dry eye by utilizing a questionnaire – I use SPEED, checking meibomian gland functionality, and using vital dye to asses corneal health.,” she said. “Our patients are looking for answers and we need to empower ourselves to help.”

Tips and resources

In terms of tips for diagnosing DED, Casella said that respecting and understanding the complexity of DED goes a long way. “One of my go-to education pearls is my conveying the fact that dry eye is more complex than simply, ‘if it's wet, dry it, and, if it's dry, wet it.’ As well, setting goals and appropriate timelines for treatment is of the utmost importance. For many dry eye patients, it took a long time for their eyes to get that way, and it may take a minute to see improvement,” he said. “If this is understood upfront, then there will be less impatience along the road to better teat film function. Lastly, there is no silver bullet for dry eye disease. It is a multifactorial disease, and our patients are multifactorial individuals. Time is on our side, however. We need to collect our data, have meaningful discussion with our patients, sit back, and tailor therapy accordingly. Don't rush it, and don't fall into the ‘Here's a bottle of tears; I'll see you whenever your vision benefit pays for another exam’ practice modality.

Resources for education also play a role in patient knowledge and optometry’s role in mitigating DED. American Optometric Association (AOA) President Steven Reed, OD, said that given the believed correlation between dry eyes and increased screen time, the AOA has taken on a number of initiatives to help educate patients. “We know that just two hours of screen time each day can cause many symptoms, including dry eyes and blurred vision. The AOA and doctors of optometry across the country are actively providing guidance and counsel to patients, helping them understand the impact their daily environment has on their eyes – and how to care for them,” he said. “Earlier this year, we partnered with Deloitte Economics to assess the impact of screen time and determined that more than 104 million Americans are exposed to excessive screen time, yet 32 million hadn’t seen a doctor in the past year. From making sure our doctors have the right resources to counsel their patients on dry eye and its cause to encouraging patients to go to their AOA doctor of optometry through our Eye Deserve More initiative, we will continue to identify ways to address the pressures today’s digital and environmental world place on our eye and vision health.”

Reference:

1. Millions of Americans experience dry eye symptoms, yet new national survey shows sufferers struggle to find relief. News release. Bausch + Lomb. July 8, 2024. Accessed August 7, 2024. https://ir.bausch.com/press-releases/millions-americans-experience-dry-eye-symptoms-yet-new-national-survey-shows