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Panel: Evaluate patients earlier for dry eye
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NEW YORK – “We know that vision quality, healthy-looking eyes and successful contact lens wear are all related to what’s going on with the ocular surface,” Jack Schaeffer, OD, said here at the Ocular Surface Disease Symposium, held prior to Vision Expo East. “The key is primary prevention.”
Primary Care Optometry News co-sponsored the panel discussion.
Schaeffer detailed his practice’s approach to wellness, which includes yearly eye exams for all patients and 6-month eye exams for all children.
“No child should ever go 6 months without an eye exam once they show any amount of hyperopia or myopia,” he said. “Every patient gets an ocular surface disease (OSD) work-up as part of the contact lens eye exam.”
PCON Editorial Board member Marc Bloomenstein, OD, said, “We don’t call it a contact lens fitting. We call it a contact lens or ocular health evaluation. We all need to be measuring osmolarity. That number is part of my contact lens regimens.”
Bloomenstein also urged optometrists to avoid linking dry eye to an older age.
“We know we’re making more dry eye in kids today,” he said. “We’re not blinking enough.”
Panelist Richard Adler, MD, said in the world of dental medicine, “We don’t wait for a problem. We’re using fluoride every night even though we don’t have a cavity. What are we doing every day to ensure we don’t have a problem [with our ocular surface]? Every 6 months we get our teeth cleaned. What’s the equivalent in eye care?”
Panelist Paul M. Karpecki, OD, touted the advantages of using meibography for diagnosis as well as patient education.
“I say, ‘I’m seeing something here that concerns me,’” Karpecki said. “Patients will pay attention to this. Show it to them and tell them what will happen if you don’t treat it. I tell them if we let this go, they won’t be able to wear their contacts, or their cataract surgery may not go as well.”
Bloomenstein said he tells patients their lashes may fall out.
Schaeffer said he conducts OSD work-ups on all patients diagnosed with cataracts. He said he tells patients: “I have to take care of your ocular surface first so you will have a better surgical and comfort outcome.”
He explains that the cataract surgery will be scheduled for anywhere from 4 to 10 weeks out, depending on the results of the OSD work-up.
“If they need to be treated with Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) or Xiidra (lifitegrast ophthalmic solution 5%, Shire), they don’t work in 2 weeks; that’s why we say 9 or 10 weeks,” he said. “We assess the corneal surface after 2 to 3 weeks, then we start talking about IOLs.”
Adler said that some eye doctors are reluctant to treat the ocular surface because they are apprehensive about telling their patients they have to use another drop.
“Patients who spend tens of thousands of dollars getting cosmetic surgery have no trouble investing in skin care products to protect their investment,” he said. “That’s the way I present it: ‘If I could give you another drop to potentially improve your results after cataract surgery, would you want it?’” – by Nancy Hemphill, ELS, FAAO
Reference:
Schaeffer J, et al. The dry eye institute: The “why” and the integrated health care model. Presented at: Vision Expo East, New York. March 30-April 2, 2017.
Disclosures: Adler reports he is a consultant for Allergan, Lumenis and Topcon. Bloomenstein is on the speakers’ panel for Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, Better Vision Institute, BlephEx, Bruder, Macular Health and TearLab. Karpecki receives consulting fees from AcuFocus, Aerie Pharmaceuticals, Anthem, AMO, Alcon Labs, Allergan, Akorn, Bausch + Lomb/Valeant, BioTissue, Bruder Healthcare, Cambium Pharmaceuticals, Eyemaginations, Essilor, Eyes4Lives, Eye Solutions, Focus Laboratories, iCare USA, Johnson & Johnson Vision Care, OcuSoft, Freedom Meditech, Konan Medical, MacuLogix, Beaver-Visitech, Ocular Therapeutix, Reichert, Shire Pharmaceuticals, Regeneron, RySurg, Science Based Health, SightRisk, TearLab, TearScience, TLC Vision, Topcon and Vmax. He is on the speakers’ bureau for Glaukos and Oculus; has conducted research for Akorn, Allergan, Bausch + Lomb, Eleven Biotherapeutics, Fera Pharmaceuticals, Rigel Pharma and Shire; and has an ownership interest in Bruder HealthCare and TearLab. Schaeffer is a consultant for Alcon, Allergan, Bausch + Lomb, CooperVision, Essilor and Vistakon.