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BLOG: Stay the course
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As with many specialists who are willing to see the most severe, most difficult cases in a particular area, we often find ourselves in the position of being the third, fourth or 11th eye doctor asked to “fix” a dry eye patient. As you can imagine, these are some of the most frustrated and unhappy people to cross our threshold at SkyVision. One difference between the bad old “frontier” days of dry eye and today is that there has been an almost uniform good faith effort made by each of the preceding docs to solve the patient’s problem.
There is a definite trend that we see in this group, though. By and large, the most frustrated and sometimes even angry patients have “tried” and “failed” on pretty much everything you might be thinking about doing for them. For example, I recently saw a new patient for a consult, ostensibly to consider LipiFlow (TearScience). This patient had seen five doctors over the prior 6 or 7 months. She’d been “treated” with Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) (4 weeks), AzaSite (azithromycin ophthalmic solution 1%, Akorn) (2 weeks), doxycycline (2 weeks), topical steroids (2 weeks) and pretty much every single OTC tear you’ve ever heard of. Detect a pattern?
Dry eye patients can be among the most impatient people you will ever see. Our response as docs should be precisely the opposite: pick a path and then stay the course. It is always helpful to set some ground rules at the beginning of a treatment cycle, including the need to follow a particular treatment strategy to its logical conclusion. Dry eye can present real diagnostic dilemmas. Not only that, but dry eye is often multifactorial when it comes to cause. Your initial treatment may not solve all of your patient’s symptoms, but if he or she is improved at all, you are likely now able to attack another aspect of the disease.
We really have little recourse when a patient leaves our care in search for that next, better doctor. We do, however, have control over how we will address that patient’s disease in our own clinic. We should be ever mindful of how our various treatments actually work and resist the temptation to jump ship before your strategy has a chance to work.
Stay the course.
Disclosure: White reports he is a consultant for Bausch + Lomb, Allergan, Shire and Eyemaginations and on the speakers board for Bausch + Lomb, Allergan and Shire.