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Proactively evaluate patients without obvious OSD
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NEW YORK – Panelists at the Ocular Surface Disease and Wellness Symposium here at Vision Expo East urged attendees to test asymptomatic patients for ocular surface disease.
“What do we owe these people who don’t have the disease yet?” panelist Richard Adler, MD, FACS, asked attendees at the symposium, which Primary Care Optometry News partially sponsored.
“We don’t wait for a cavity to visit the dentist,” he said. “If you’re going to be wearing contact lenses and you have no problems, what should we suggest if we’re going to be proactive?”
Panelist Paul M. Karpecki, OD, FAAO, said clinicians should be testing for meibomian gland dysfunction, expressing meibomian glands.
“It only takes a few minutes,” he said.
Also, he said to ask every patient four questions: Do your eyes ever feel irritated or burn or are they dry? Do they look red? Do you have blurry or fluctuating vision? Do you ever have to or feel the urge to use artificial tears?
“You’d be amazed at how many people answer ‘yes’ to these questions,” Karpecki said. “Then you start doing basic testing.”
Adler said that 60% of patients with dry eye are asymptomatic.
“That’s the problem with those four questions,” he said. “What do we owe patients who are asymptomatic? What’s the likelihood you’ll catch elevated osmolarity or meibomian gland dropout in someone who comes in for an IOP check?”
Moderator Jack Schaeffer, OD, said before he works up a patient for contact lenses, “which change the entire ocular surface,” he stains them with fluorescein, evaluates the size of the tear lake, asks how their vision is at the end of the day and uses new technology.
“If they’re not as comfortable at the end of the day, do something,” he said.
“We don’t wait until we see visual field defects to start treating glaucoma,” panelist and PCON Editorial Board member Marc Bloomenstein, OD, said. “We check pressure on every visit even though we know it’s not the sole indicator for glaucoma. We have to step back and say, ‘What other things can we do to ensure patients don’t have risk factors?’” – by Nancy Hemphill, ELS, FAAO
Reference:
Schaeffer J, et al. The specialty practice of ocular surface disease and the current state of the dry eye practice. Presented at: Vision Expo East; March 14-18, 2018; New York.
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 and TearLab and a consultant for Abbott Medical Optics, Akorn, Allergan, BioTissue, Lunovus, OcuSoft and TearLab. Karpecki receives consulting fees from Aerie Pharmaceuticals, Akorn, Alcon, Allergan, AMO, Anthem, Avellino Labs, Bausch + Lomb, Beaver Visitec, BioTissue, Cambium Pharmaceuticals, Calhoun Vision, Candor Pharmaceuticals, Essilor, EyeBrain, Eyemaginations/Rendia, Eyes4Lives, Focus Labs, iCare USA, Imprimis, Johnson & Johnson Vision Care, OcuSoft, Freedom Meditech, Konan Medical, MacuLogix, 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, Eye Therapies and TearLab. Schaeffer has received honoraria, compensation or served as an advisor to: Alcon, Allergan, AMO, ArcticDx, Aton, Bausch + Lomb, Brien Holden Vision Institute, Bruder, CooperVision, ClearPath, Essilor, Ista, Hoya, MiboFlow, Nicox, Optovue, Optos, TearScience, Valeant, Vistakon and Zeiss Vision.