Therapies

5 questions with Marguerite McDonald, MD, about Dry Eye Therapies and the Staff’s Role

As more practices focus on dry eye, what role will you play?

Marguerite McDonald, MD is a leader in dry eye management and an advocate of a dry eye-focused approach to practice known as ‘dry eye centers of excellence.’ She spoke with Ophthalmic Professional about staff’s role in a dry eye center, including providing patient education and understanding related therapies.

Q. What would a technician be able to see before or during an initial work-up that may indicate a dry eye diagnosis?

A. Symptoms are very helpful, though, approximately 50% of patients with true dry as defined by hyperosmolarity have no symptoms whatsoever. But nevertheless, half do. So, look for presents whom present with any ocular surface complaint, such as, ‘my eyes are red. They’re heavy. They burn. Fluctuating vision or light-sensitivity.’ Another is mild itching. Severe itching is not dry eye, but mild itching is very typical of dry eye patients. As a matter of fact, we have all of our patients take a questionnaire, the Standard Patient Evaluation of Eye Dryness, or SPEED (TearScience). In about 90 seconds, it can tell us whether the patient has symptoms or not and, if so, their frequency and severity. If you see even one of the symptoms checked off , that means it’s OK to proceed with an Osmolarity Test (TearLab) before the patient sees the doctor.

The groups most likely to have dry eye are:

■ Anyone 40 and over (that’s when dry eye spikes).■ Anyone with ocular surface complaints.
■ Anyone with a history of dry eye.
■ Anybody who’s undergone just about any kind of eye surgery in their past including LASIK, PRK, cataract, and transplants.

Q. What technologies for testing and treatment are available for dry eye treatment?

A. Dry eye centers of excellence have all sorts of devices. These include the LipiView and LipiFlow technologies (TearScience). Also, the Oculus Keratograph has all sorts of fantastic new ways to analyze the tear film such as automated tear breakup time, automated height and image analysis of the anterior tear meniscus. All the technology available is amazing. In a dry eye center of excellence, the doctor provides the technician with a template outlining what to do before the doctor even walks in. These tests support the efforts of the doctor, who must also see the patient each visit.

Q. What can staff tell patients to keep them from having to return to the doctor with questions? How can they assist with dry eye education and compliance?

A. For instance, I have a standing order when my technicians see patients check off any symptoms, I want them to run a Tear Osmoloarity test. They review the patient’s responses and, when appropriate, say, ‘Dr. McDonald has requested I do Tear Osmolarity testing on you.’ You don’t have to tell the patient there’s a standing order for anybody with these complaints to get Tear Osmolarity, but if they inquire you can say that. Tear Osmolarity testing really is a great way to introduce compliance. Patients find out what their initial score is and, when they come back, if their score has improved, in other words, gotten lower, they’re overjoyed to hear it. That can help patients stick to their program. But, one of the most important things staff can do is take away the burden of education. If patients have blepharitis, somebody’s got to sit there and tell them how to do lid scrubs. You have to physically demonstrate it.

Q. What educational materials are available to give out to patients?

A. We have American Academy of Ophthalmology handouts on dry eye and blepharitis. When we suggest a specific treatment, we offer the manufacturer’s educational brochures. Samples, I think are critical as are coupons. Anything that helps the client get started and be compliant. This is where the well-educated technician comes in.

Q. What are some of treatments nurses and technicians may need to be familiar with for dry eye?

A. We recommend therapy based on the findings. For mild dry eye, we recommend artificial tears four times a day. Moderate dry eye would include the artificial tears four times a day and Omega-3s, because Omega-3s have been shown to be so helpful in dry eye. Those patients also get a script for cyclosporine ophthalmic emulsion (Restasis, Allergan). For severe dry eye patients, I switch them to preservative-free tears every two hours while awake. OP