A beginner’s guide to dry eye treatment integration (2024)

August 9, 2024

Dry eye can have debilitating effects on a patient’s vision and their life, depending on how bad the anterior segment problem gets. As optometrists, we can and should be on the front lines of providing not only vision exams and correction but also vision care. It is emotionally rewarding as well as beneficial for the practice and patients.

In 2017, 2 huge reports made me excited about ocular surface treatment: One was the TFOS DEWS II (Tear Film & Ocular Surface Society Dry Eye Workshop II) report, and the other was CEDARS.2, published by the Cornea External Disease and Refractive Society. These reports were the catalyst for me to incorporate dry eye treatment into my practice. Although it took about 2 years to implement it effectively, it was so successful that we opened a whole new facility focusing solely on dry eye treatment.

Three steps to integrating dry eye therapy

We implemented dry eye treatment in phases. Here are my top 3 tips for successfully implementing dry eye treatment into a practice.

1. Ask the right questions and do a screening survey.

These can include the Ocular Surface Disease Index or Standard Patient Evaluation of Eye Dryness questionnaire, which are easy to use and implement in your practice. Patients may not know what dry eyes feel like, so it is best not to ask, “Do your eyes ever feel dry?” because it requires a simple yes or no answer and is ineffective as a conversation starter. Instead, start by discussing the patient’s lifestyle to identify any visual habits that may put them at risk for dry eye. For example, patients who are computer engineers and spend 12 to
15 hours a day on digital devices are at risk for not only dry eye but also eye strain and other visual effects. They may be asymptomatic or believe any irritation or varied vision is due to eye strain when it may be treatable dry eye.

1. Take images—they are worth a thousand words.

We have many imaging options that enable patients to see what is happening with their eyes. For example, fluorescein dye creates a cool neon effect that shows where surface damage is occurring from dry eyes––a powerful image to show the patient. You can demonstrate how quickly it takes for the tears to disappear. This can help the patient connect what they are physically feeling to the diagnosis of dry eye.

1. Understand the different treatment levels for different severities.

Using certain over-the-counter products is a great place to start, as this can help patients develop a routine of putting in drops, keeping their eyes clean, or taking a vitamin supplement. There are many superb pharmaceutical options and also more procedure options available now. Knowing what each option does for each patient based on their dry eye diagnosis is vital to developing effective treatment.

When treating meibomian gland dysfunction (MGD) specifically, there are 3 main areas to target: inflammation, obstruction, and production. Different devices can help fight problems with all 3. For example, intense pulsed light is becoming popular for dry eye and MGD treatment. It has an anti-inflammatory effect that uses light waves to target tissues and calm inflammation so that the glands and surrounding structures can work better. To remove blockages and obstruction, we have blepharo exfoliative treatments for surface eyelid issues to remove biofilm and bacteria from around the eyelid edges. Low-level light therapy, also known as photobiomodulation, helps stimulate cellular activity to effectively have tissues make more of the critical components of our tears. Radio frequency is starting to come into play, which tightens the skin and builds collagen. If the collagen and skin are tighter around the eyes, it allows for a better mechanical blink with more compression, which results in better expression and more tears.

Make it easy for patients to accept your treatment plan

All these procedures and technology are beneficial to patients when they are accessible. Some of the procedures for dry eye are covered by different medical insurances, and some are not. In our practice, we package treatments and offer a percentage discount for bundled items. We also accept, in addition to typical credit cards, the CareCredit health and wellness credit card, which enables patients to pay over time, often with promotional financing.

Finally, my best advice is not to hesitate. You are the front line for patients in all things regarding eye care and correction. Once they know you have treatment options available, you will find that dry eye will become a thriving portion of your practice.