Dry eye disease (DED) patients definitely have questions. These patients come in many forms — for example, those who have been to multiple eye-care practices seeking help and those who are asymptomatic, to name two. Both groups could be hearing about their disease for the first time, and they will often have questions regarding the steps the physician will take to manage DED. Patients also want to know what role they will play in the care process.

Answering questions and providing clear instructions is essential in the patient experience — and outcomes. DED requires a partnership between the practice and the patient because proper treatment is ongoing — it cannot be identified by one test and usually requires the patient to comply with chronic therapy. For this partnership to work — and for treatment to be successful — the patient must leave the office with a thorough education and understanding of DED.

At Bowden Eye & Associates, we utilize counselors, who perform a majority of the dry eye education and become a primary point of contact for many of the dry eye patients. Here, two of our counselors provide common questions they receive from patients and how they respond in these scenarios.

Q: “How do I get rid of my dry eyes?”

A: “There is no cure for DED. The goal of recommended therapy from your physician is to keep the eyes comfortable and to stop the disease progression.”¹

Q: “Why do I need to do all of these treatments if my eyes feel fine?”

A: “Your eye-care provider sees evidence of DED, for which you may not experience symptoms.² But, just like other parts of our body, our eyes require steps to maintain their health with proper hygiene and maintenance. Not following your physician’s recommended treatment and therapies could lead to your DED progressing to the point in which you would require further intervention.”

Q: “My eyes water all of the time, so they aren’t really dry, right?”

A: “Actually, over production of the lacrimal gland, which is the water layer of your tear film, creates those tears to compensate for the lack of healthy tears. Your natural tears consist of three layers: water, oil, and mucous. Watering of the eye is a sign that you may have an insufficient amount of oil or mucous on your eye.”

Q: “Why can’t I just use any OTC drop to make my dry eyes better?”

A: “Not all lubricating drops are the same.³ Your physician has chosen this one specifically to treat your dry eyes. It may depend on an array of factors relating to your specific ocular condition, such as the layer of the tears in which you are found to be deficient through diagnostic testing.”

Q: “If my physician thinks I need these procedures, why does my insurance not cover them?”

A: “There have been some wonderful advances in diagnosing and treating DED over the last 5-6 years. This has changed our understanding of the disease and how we diagnose and treat. The coverage offered by insurance companies simply has not yet caught up to the technology.”

Q: “How long will I have to use the drops/regimen?”

A: “Since there is no cure for DED, what the physician has outlined is an ongoing treatment plan to help maintain the ocular surface.¹ Ultimately, compliance with follow-ups and therapies are going to be the most helpful resolution to your symptoms.”

Q: “I do not have time to use the recommended at-home therapies. What else can I do?”

A: “Everything recommended by your physician is to prevent the progression of DED. We have dry eye procedures available to help with a more long-term effect, but continued care is needed with at-home therapies. Following up with your physician regularly also can help keep track of any changes in meibomian glands.”

Additional tips

Be careful not to overwhelm the patient. It is a good practice to use images, videos, brochures, etc., as visuals also tend to stick with the patients. The vendors in the dry eye space offer brochures that are helpful — creating your own is an option as well. If you can show the patient’s meibography images, for instance, in comparison to normal images, the patient can get a better idea on the severity of their MGD.

When a physician advises patients they have a disease but treatment is not covered, the patient many times doubts the need for treatment. The patient’s thought process may go to using OTC eye drops instead of paying for treatments. Again, offer brochures to substantiate the treatment plan and advise these patients of insurance’s lag behind technological advances. It can also be helpful to have published studies printed and ready to highlight and hand to patients.

Many of the current therapies are an out-of-pocket cost for the patients. These patients do require some handholding, much like a premium cataract and refractive patient. An example of this is following up if a patient leaves to “think about scheduling.” OP

REFERENCES:

1. Dry Eye Syndrome PPP – 2018. American Academy of Ophthalmology. https://www.aao.org/preferred-practice-pattern/dry-eye-syndrome-ppp-2018 . Published Nov. 2018. Accessed October 15, 2019.
2. Sullivan B, Crews L, Messmer E, et al. Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications. Acta Ophthalmologica. 2014 Mar;92(2):161-166.
3. Tear Film and Ocular Surface Society members. TFOS DEWS II Management and Therapy Report. The Ocular Surface. 2017; 15:3; 575-628. https://www.sciencedirect.com/science/article/pii/S1542012417301143 . Accessed October 15, 2019.
4. Patti Barkey, COE, Courtney Measday, CPSS, and Whitney Rice, CPSS, are employees of Bowden Eye & Associates, a multi-location practice in Florida specializing in primary eye care as well as ocular disease treatment.
   Dry Eye University (dryeyeuniversity.com ) got its start at Bowden Eye.