Managing dry eye disease is a great entry point for practicing medical optometry, for new graduates and established optometrists alike.
There is a tremendous need for dry eye care, as an estimated 7-34% of Americans suffer from dry eye disease.(1) As the population ages, we are seeing an increase in the number of patients with dry eye disease. However, it is not only the aging population that is affected.
The industry is also seeing younger populations, especially adolescents and young adults, displaying signs and symptoms of dry eye.(2) This trend is thought to be linked to increased screen time with phones, computer monitors, TVs, and other digital devices.(2) Given our ever-increasing reliance on technology, this is a trend that we do not expect to go away, rather experts expect the issue to grow over time.
Combined with the estimate that one out of every four visits to an eyecare provider is currently for dry eye related issues,(1) it is easy to recognize the need for dry eye care. From that, it follows that integrating dry eye care can be a great practice builder.
As the need for dry eye care has increased, so has the prevalence of diagnostic tools.
Previously, diagnosis of dry eye was heavily reliant upon clinician judgment. This could make it difficult to objectively gauge the status of a patient’s disease, especially over time. In recent years, we have experienced a rapid growth in the number of technologies available to us in the dry eye arena with some of the most impactful being meibography and tear film imaging. It is estimated that 86% of all patients with dry eye have some degree of meibomian gland dysfunction, therefore assessment of the meibomian glands is critical.(3)
Using meibography and tear film imaging, we can objectively measure the structure and function of individual meibomian glands as well as observe the thickness of the lipid layer of the tear film.
Dry eye is a chronic and progressive disease, and with meibography and tear film imaging, we can objectively track structural changes to the meibomian glands and tear film over time, much like we use OCT to track changes to the optic nerve in glaucoma. We can then use this information to assess how our patients are responding to specific treatments and adjust their management plans accordingly. Additionally, this imaging is invaluable in terms of patient education.
It is one thing to tell a patient they have meibomian gland atrophy, but it’s another experience entirely when you can show them pictures of their own glands.
Dry eye is a tough condition to treat and patient compliance is often an issue, so anything that can help get patients on board with treatment can be a key factor in successfully managing their disease.
There are many other diagnostic tools available that provide useful data for our dry eye patients as well. Devices that measure tear film osmolarity and detect inflammatory markers on the ocular surface can also be helpful in objectively assessing tear film health. All these diagnostic tests provide valuable information that can be used to create individualized treatment plans and then objectively monitor the effectiveness of treatment over time.
The need for dry eye care is obvious and with all the new diagnostic devices available it is an exciting opportunity to implement medical care into a practice.
However, it can also be overwhelming at first. So, before you invest in some of these devices, the easiest way to start building a dry eye practice is to simply start looking for it. Three easy ways to evaluate patients for dry eye include assessing the health of the meibomian glands and lid margins, examining the tear film, and asking patients about symptoms. Whether you have the latest and greatest dry eye devices or are just starting out, these three diagnostic assessments will help you identify patients with dry eye disease and help you begin building your dry eye practice.
- Murphy, JJ. Dry eye and inflammation: A discussion with Dr. Michael Lemp. MDLinx.com. https://www.mdlinx.com/ophthalmology/article/846. Published May 4, 2017. Accessed December 8, 2018.
- Shire. Modern technology and a multi-screen lifestyle viewed as important factors in rising prevalence of dry eye disease. multivu.com. www.multivu.com/players/English/7893551-shire-dry-eye-disease-awareness/. Published October 17, 2016. Accessed December 8, 2018.
- Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472-8.