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Get back to the basics with dry eye
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Prior to its airing, I had heard a radio spot for the recent NFL draft. Boasting full coverage of the first round, the spot encouraged listeners to, “Join us for live coverage beginning at noon, with the first pick at 8 p.m.”
While a fan of the NFL, I could not help but think, what could they possibly talk about for 8 hours prior to the actual draft? After all, since the off season began we have been inundated with draft speak. Painstaking analysis. Every detail ranging from a potential draftee’s vertical leap to their off-field character assessment.
The reality is that the NFL draft is a mere snapshot of the world in which we live. A world of information overload. Largely driven by technology, we find ourselves inundated with increasing amounts of information disseminated over shorter periods of time. While no one disputes the fact that information is important in decision-making, in certain situations too much information is counterproductive.
Certainly, this was the sentiment of H. Igor Ansoff when he coined the term “paralysis by analysis.” While Ansoff’s comments were originally directed to decision-making in the business world, today, paralysis by analysis is everywhere.
As eye doctors, we encounter our share of paralysis by analysis moments daily. Perhaps this is no more evident than in managing dry eye. We know dry eye to be relatively common, impacting an increasingly diverse demographic and presenting in a variety of ways. It is a condition for which we lack a firm grasp of the underlying pathophysiology. It can be a diagnostic dilemma, often presenting with conflicting symptoms and objective findings. Most importantly, dry eye can be a therapeutic challenge. Sifting through a plethora of potentially conflicting diagnostic tests and identifying the most effective treatment protocol can be daunting.
No doubt, validated questionnaires, meibomian gland analysis, dry eye biomarker diagnostics and technologies quantifying tear film volume, thickness and stability all play crucial roles. Likewise, on the therapeutic side, lifestyle and environmental modifications, omega-3s, heated eye masks, topical lubricants, topical immunomodulators and hematologic-based eye drops are critical in successful management. Add the increasingly important in-office treatment modalities, including eyelid margin exfoliation, intense pulsed light and radio frequency stimulation, meibomian gland expression, and amniotic membrane placement, and a couple of things become apparent.
First, we are better equipped than ever to manage dry eye. Second, there is the potential for more confusion than ever. Does every patient need every diagnostic test? How should we interpret conflicting test results? Ultimately, how do we arrive at the best treatment ... one that is efficient, value-based and effective? We know the more complex the treatment protocol, the greater the likelihood for noncompliance.
Arguably, the most plausible approach is a return to the basics. I think most would agree that a good history, a little fluorescein and a careful biomicroscopic evaluation is all we really need – all we really need to then select appropriate higher level diagnostics and then devise an efficient, value-based, effective treatment plan. Getting back to the basics is an effective antidote for paralysis by analysis.