Dry eye. Keratoconjunctivitis sicca. Symptoms include itching, watering, foreign body sensation, and just a general feeling of not being right. It’s annoying at times. At other times, the light sensitivity, tender eyelids, headaches, and ever-present gritty feeling can be debilitating. I know, because I am a victim (and survivor!) of dry eye. As difficult as the condition can be for the patient, it can also be difficult for both the technician and the physician if the patient does not understand their diagnosis. It is our job to make sure they both understand the condition and how to manage it.

In managing the dry eye patient, the doctor may select a therapeutic regimen that includes prescription medications, artificial tears, masks and compresses, goggles, lid cleansing wipes and sprays, nutritional products, and lid hygiene devices, as well as treatments offered in the office.

To support the doctor’s plan, ophthalmic professionals face a challenge, especially during the pandemic: How do we effectively educate patients, who are constantly bombarded with information, with the guidance and direction they need to understand dry eye and comply with their therapeutic plan once they leave the office?

Guidance

First and foremost: the patient education we provide must be medically appropriate. Sit down with your doctors and review the language to be used with patients. Review what, specifically, they would like discussed between a staff member and patient versus those topics that are more appropriate to be discussed between the doctor and patient.

Some doctors are completely open to having their technicians explain what contributes to dry eye and how to manage it before they see the patient, while other physicians would rather examine the patient first and then offer tailored recommendations for treatment. Make sure you and the doctor agree to one direction, understanding that there are practical challenges and advantages to either approach.

One example of an advantage: When technicians discuss treatment options, such as a device used once a day to reduce signs and symptoms associated with blepharitis and dry eye, they are planting a seed and watering it with information. When the doctor finishes the exam and then mentions the device, the seed is nurtured and grown with factual information; that is, the patient now firmly associates the device with the treatment of blepharitis and dry eye. Now the patient has to continue to water the corneas ... er ... plant ... in order for it to be healthy. (See what I did? If you smiled, then this quip was informative and relatable, and you will likely remember it.)

Second, the tone in which we educate patients is what our patients will remember the most. People relate better to a goal-driven discussion than they do when they feel they are being lectured. If you sound condescending, the patient may become defensive, and instead of retaining the information, they think about how they didn’t like your tone versus the information given. If you are engaging and maintain eye contact while smiling through that constant mint-flavored fog that obscures your vision (if you are like those of us who wear glasses and masks 10 hours a day), your patient is more likely to hang on your every word and be more compliant with their treatment.

Remember to use tact. Rather than explaining Demodex to the patient as, “Well ma’am, you have bugs on your lashes,” consider, “All adults have Demodex, a small mite, on their eyelashes, but too many can cause blepharitis. Fortunately, the condition is manageable ...” Presentation definitely counts.

Direction

How do you get patients to be compliant? We have a variety of tools at our disposal including one-on-one discussions, patient handouts, waiting room videos, after-visit summaries, websites, portal messages, slideshows patients can watch while dilating, and flyers or posters displayed in the exam lane. There are even point-of-care presentations that can be accessed through touch screen displays.

While these tools work in one way or another for a variety of patients, my answer to the compliance question is this: Engage with your patients. For example, by appealing to their sense of humor, when appropriate, you may also satisfy their curiosity regarding their condition. You don’t have to hit yourself in the face with a pie. Conduct a guided discussion. Speak in terms appropriate for the patient and be mindful of cultural respect.

Remember, too, that each patient is different. Some people learn extremely well from clinical information presented the first time. The technical terms just click. Providing education for them is easy (like instruction manuals for Ikea furniture). Some learn better by seeing and others by hearing. But, like many others, I learn most effectively when I am emotionally engaged.

Here are two examples where your teaching skills and engagement come into glorious play:

• The 30-something coding whiz, whose eyes are watering while staring at the computer, will understand that the tear film dries out when he focuses on reading and doesn’t blink as much. He gets that this causes his eyes to flood with those pesky poor-quality tears—as a means to help the cornea—instead of the nice fatty lubricating tears our eyes maintain when we blink routinely. The "20-20-20" rule, taking a break for at least 20 seconds, every 20 minutes, and looking 20 feet away, is something he can easily remember and easily comply with. Now, add a drop of artificial tears every time he takes one of those breaks? That is icing on the cake.
• How about patients in their 80s who are on multiple glaucoma drops and not consistently cleaning their eyelids before bed? They might be suffering from medication buildup on their lashes or lid margins causing further irritation. Simply suggesting they clean off the residue of the medication (personally I have found that cotton balls or cotton rounds have been the most helpful with removing debris) or after every dose will help them clean their eyelids in the process. They can do it at home with minimal effort.

Direct the discussion making sure the patient knows the why, what, how, and what’s next for every issue you have addressed. Let’s take one and try it out:

• Why does the patient have symptoms? Blepharitis.
• What is blepharitis? Inflammation on the eyelids usually caused by bacteria, skin build up, old makeup, skin oils, and, sometimes, lash mites.
• How do we manage it? By keeping our eyes properly lubricated and our eyelid hygiene consistent.
• What next? Continue the lubrication/hygiene regimen twice per day for 6 weeks and come back to assess the improvement.

In a welcoming manner, ask the patient to repeat back the plan. Always end the conversation with what the patient can expect to achieve between now and the next visit. This reassures patients that you are going to celebrate along with them when they return and have shown improvement.

The time to share

As professionals, we have the information. We know which topics are easily understood (sleeping in contact lenses is bad!) but we also know which topics our patients struggle with easily understanding (watering = dry). We know the types and brands of artificial tears that demonstrate consistent results. We understand which methods of warm compress work and which should not have been recommended. This is information we can share freely, but with purpose. Break bread with words when we cannot break bread otherwise. Find your educating voice. OP