BLOG: Three new truths about dry eye

ByJohn A. Hovanesian, MD, FACS

Just a few years ago, many clinicians considered dry eye an afterthought to the “real” care that we provided patients in our offices. Many of us looked upon the condition with indifference or even disdain. With limited tools, some felt that there was little we could do for patients with this condition, that it didn’t really affect their quality of life and that it was very time-consuming to treat. In fact, a study by TearScience showed that the average clinician spent 10% of his time treating dry eye but earned only 2% of his income from the condition.

Now, everything has changed. It’s difficult to keep pace with all of the new dry eye drugs and devices that are available or soon to be. For three reasons, the old paradigm of running away from dry eye is out, and we are now running toward this special disease entity. Here’s why:

1. In treating dry eye, everyone wins. I have long believed that technologies become popular when they bring success for patients, physicians, and the drug and device industry. Many of the new dry eye treatments allow reimbursement for the clinician caring for the patient. Many are not covered by Medicare or private insurance. Nevertheless, most are priced fairly, especially when you consider that the average patient with moderate dry eye currently spends more than $200 a month out of pocket between lubricant drops and medications. With these new treatments, clinicians can get paid at a level that more closely manages their time spent. And the drug and device industry also receives fair compensation, considering the high cost of bringing these new treatments to market.

2. Patients benefit most. The new emphasis on dry eye has brought attention to this previously ignored condition and brought true innovation to the space. A 2003 study by Rhett Schiffman taught us that patients who suffer from moderate to severe dry eye have a condition as crippling as heart failure because they are unable to participate in activities that make life meaningful. Offering them treatment is the right thing to do.

3. Every practice must get involved. Some clinicians will never be excited about treating dry eye, no matter how the landscape is changing. Candidly, I am one of these. A few years ago, I coached one of my optometrist colleagues to consider taking up dry eye as a specialty when she wanted to grow her practice. She not only embraced my suggestion, she dove into the subject and has become one of the country’s most skilled practitioners in treating dry eye. I would encourage every colleague who is hesitant to spend more time on dry eye to do the same. If you run a small office, consider bringing another doctor in periodically to spend a half day seeing these patients. It will benefit your practice, and you will win the loyalty of your patients forever.

Maybe the biggest reason to embrace dry eye in your practice is because the population is growing enormously. As the cover story in this issue of OSN discusses, we are just seeing the tip of the iceberg of this condition. Young patients with severe dry eye are turning out in alarming numbers, and there is no sign of this trend reversing. It’s time to roll up our sleeves and take care of these patients.

Reference:

Schiffman RM, et al. Ophthalmology. 2003;doi:10.1016/S0161-6420(03)00462-7.

Disclosure: Hovanesian reports he is a consultant or investor in a variety of eye care companies, including some addressing dry eye.