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BLOG: Ophthalmology’s failing dry eye report card
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In my practice, we spend a lot of effort following up with electronic patient questionnaires after office visits or surgery. We want to make sure our treatment or procedure has adequately addressed the problems we were entrusted to solve. To do this, we use a cloud-based follow-up care system called MDbackline. It has given us valuable (and often humbling) insights on conditions such as dry eye, in which we recommend remedies but don’t necessarily schedule a follow-up appointment.
How happy are most of our dry eye patients with their recommended treatment? We do fairly well, with about 70% “very satisfied” or “somewhat satisfied,” but that leaves another 30% who are either neutral or overall somewhat dissatisfied with their treatment. Worse yet, about 45% of dry eye patients questioned 2 weeks later tell us their condition is “about the same” or “worse” than before their office visit.
If there were a professor grading us, we’d be repeating this dry eye class next semester. If we scored like this in cataract surgery (we do much better actually), our practice would lose most referrals.
So how can we be so bad at treating dry eye, and what can we do about it? Our data suggest we are challenged with the same obstacles as every other practice. The issue lies somewhere between compliance and needing better treatments. Of patients who report compliance with the treatments we’ve prescribed, about two-thirds are satisfied, while that same portion is dissatisfied among non-compliers. The treatment perceived to be most effective is artificial tears (60% say they help), followed by warm compresses (35%). Patients taking omega-3 supplements are, not surprisingly, more likely to tell us they’re effective if they take more than 3 g per day. Among patients prescribed more advanced treatments, it’s not entirely fair to judge satisfaction because these patients have, by selection, more advanced, recalcitrant disease.
These sobering data tell me our specialty needs far more tools to combat this complex, multidimensional disease, which only gets worse with age. Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) continues to be a valuable tool, and we’re optimistic about Shire’s lifitegrast once it is approved. We’re trying to figure out who are ideal candidates for treatments such as BlephEx, LipiFlow (TearScience) and intense pulsed light. And diagnostics such as MMP-9, osmolarity and Sjögren markers are slowly helping us understand patients and their problems better.
Our effectiveness in treating dry eye is akin to the way we treated cataracts in the early 1980s (before my time, mind you), when IOLs were implanted under air because viscoelastics hadn’t yet been invented and foldable IOLs were not yet even an idea. The future is exciting for this disease because we know so little and have so much to gain for our patients by expanding our offerings.
Disclosure: Hovanesian reports he is a consultant to Shire, Allergan, BlephEx and TearScience and has an equity interest in MDbackline.