Ocular surface disease: One physician’s approach to testing, examining and making a diagnosis

One or another form of ocular surface disease, usually dry eye syndrome, blepharitis, meibomian gland dysfunction, ocular allergy or conjunctivitis, accounts for nearly 40% of patient visits to a comprehensive ophthalmologist. DES and blepharitis/MGD with associated evaporative DES are the leading diagnoses made, and in various studies, as much as 15% of the population suffers from at least mild DES.

The accompanying cover story is quite interesting and highlights opinions from prominent actively practicing clinicians from around the world. I have found that the definition of dry eye, the diagnostics employed, and the treatments available and utilized vary significantly as I travel the world interacting with my colleagues. In this commentary, I will give a few thoughts as to how my approach to the diagnosis and treatment of DES and blepharitis/MGD has evolved and is evolving in a high-tech/high-touch integrated MD/OD care delivery model in Minneapolis. Of note, I consult widely in this field with industry and, as a fellowship-trained corneal specialist, see a diverse group of patients. Over the last 10 years, the way I manage patients with DES has changed dramatically. I am sure some of my approaches will be controversial, but they will represent an accurate portrayal of what currently works for me.

At Minnesota Eye Consultants, we have 13 ophthalmologists, 11 optometrists, 26 ophthalmic technologists, technicians or assistants, and two physician assistants who work collaboratively and collegially in the care of a large volume of patients. Our patients, whether new to the office or returning for follow-up, are usually seen first by a non-MD for a preliminary history, vision, refraction and appropriate diagnostic testing as indicated and ordered. If possible, I like to have the non-MD who works up my patients perform appropriate diagnostic tests before I see the patient. This presents the first challenge: Who deserves to be tested for DES, and with what test or tests?

Our non-MD technical team is quite sophisticated, and I am comfortable delegating to them the responsibility to initially screen for symptoms of DES during their work-up. The easiest and most efficient way to do this is to simply ask the patient a question such as, “Are your eyes comfortable? Do you have any ocular irritation, burning or itching symptoms?” If the answer is yes, these are quantified as to severity and recorded in the electronic medical record.

Click here to read the full publication exclusive, Lindstrom's Perspective, published in Ocular Surgery News U.S. Edition, January 10, 2016.