Publication Exclusive: What should we call this problem?

It is summer, and my thoughts once again turn to the basics.

On my professional journey, I come in contact with all kinds of impressive, intelligent folks from all walks of our shared eye care world. We are truly blessed to practice in a specialty that attracts this kind of person on both the professional side as well as the industry side. One only needs to look at how hard our friends at pharma and medical device companies work to stay in our field after all of the various and sundry mergers and acquisitions to know that eye care is somehow different, in a good way, from much of the rest of medicine.

That is not to say that we always agree on things, even basic things such as what we should call a clinical entity described as “a multifactorial [problem] of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface.” Heck, my editors here are wondering if we should call it a disease (a specific disorder of structure or function that results in a recognized group of signs and/or symptoms) or a syndrome (a collection of symptoms and/or signs that is not necessarily tied to a single underlying cause). One young MD consultant I met at an advisory meeting was adamant that our present nomenclature was woefully outdated and painfully inaccurate; he felt we should have multiple names for every such entity for both professional discussions and patient interactions.

What do you think? What should we call it when a patient sits before us complaining of burning, tearing and scratchiness? What term should we use when we hear blurred or unstable vision despite a stable refraction and 20/20 vision? How about redness and discharge? “Eye fatigue” after hours on a computer or reading? Is there a new, all-inclusive term we should adopt, or rather is my young colleague more correct, and we should have multiple, ever-more precise names for a number of different entities tied to very specific pathology?

Let’s apply the KISS protocol and just call it “dry eye.”

Keep it simple for the patient

There are a number of reasons to seek simplicity in discussing dry eye, both in the exam room and among colleagues. Everything about my approach to dry eye is centered on the patient, so let’s begin with why using the most simple and inclusive term in the clinical setting makes the most sense. For starters, pretty much every patient in North America has heard the term “dry eye.” No matter what particular type of dry eye may be present, it is a straightforward proposition that you present to your patients when you tell them what they have and how you will help them feel better. Your eyes are dry, and they need more or better lubrication. Simple.

Patients typically do not need a detailed explanation of the pathogenesis of their dry eye. They are either suffering because they are not producing enough tear volume, or their symptoms are caused by tears that do not work well enough. Aqueous-deficient dry eye and its treatment are particularly easy to grasp: Make more tears, make your existing tears hang around longer, and/or supplement your own tears with artificial tears. The more arid the clime, the greater the need there is for water. Patients get this.

Evaporative dry eye is equally easy to explain if we continue with our KISS strategy. Patients with meibomian gland dysfunction (MGD) and ineffective tears will typically have plenty of tear volume, but their tears simply do not work well enough. In this setting, we invariably are confronted with the question, “How can I have dry eye if I have lots of tears?” Because burning is a common symptom, I find it useful to run with the metaphor of fire. Kerosene is certainly wet, but if we use it to put out a campfire, we are more likely to run afoul of Smokey the Bear than we are to quench the flames. The treatment of this type of dry eye is to make the tears more effectively wet — water rather than kerosene. Either way, we have provided our patient with a simple, familiar diagnosis that is understandable and actionable.

Click here the read the full publication exclusive, The Dry Eye, published in Ocular Surgery News U.S. Edition, July 25, 2015.