BLOG: Educate patients about dry eye flares
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Many ocular conditions can be difficult to explain to patients, both in concept and terminology. In our clinic, we are constantly breaking down astigmatism and meibomian gland dysfunction into simple terms that patients can understand.
With dry eye flares, the rapid-onset, acute symptoms triggered periodically in about 80% to 90% of patients diagnosed with dry eye (Multi-Sponsors Surveys; Kala Pharmaceuticals; Brazzell RK et al.), we have the advantage of discussing a familiar concept. Most patients already know that arthritis, asthma, seasonal allergies and other conditions can cause a flare-up, and they have no problem understanding that the same thing can happen to their eyes. The keys are to get patients talking about dry eye flares, set expectations for these episodes and get patients immediate relief when dry eye flares occur.
Getting the details is easy
If you want to know if your dry eye patients get dry eye flares, just ask — they’ll tell you.
I ask, “Are there times of the year or certain situations when your eyes feel worse?” Eight in 10 say, “Yes.” If I start to tell them the symptoms of dry eye flares, they can finish my sentence. Symptoms vary, but they generally include burning, fluctuating vision, grittiness and the feeling of an eyelash in the eye.
It’s common to hear, “This time of year, I crank up the heat in the car, and by the time I get home, my eyes are burning, and I’m squinting. The feeling just builds up day after day and until it’s happening all day long.”
Setting expectations early is essential
I was so used to thinking of dry eye as a long-term war that I did not necessarily get concerned about the short-term battles. But I learned that patients see it differently.
Consider a patient who has paid for Optima IPL (Lumenis), TearCare (Sight Sciences) or LipiFlow (Johnson & Johnson Vision), along with monthly copays for prescription immunomodulator eye drops. Now the patient is working 12-hour days to meet a deadline and using a computer right under a blowing air conditioning vent. By the end of the week, the patient’s eyes are dry, red and burning, and it doesn’t go away when the work day is over.
This is a dry eye flare, but the patient may not know this. The patient may think, “I have paid all this money and done these treatments, but this is definitely not working. I still have symptoms, so maybe I should see another doctor.” If the doctor has not set the expectation that exacerbations are not always continuous in nature and may have a “rollercoaster-like” effect, then the patient doesn’t know that this is a flare.
If we don’t set expectations early on for dry eye flares, patients will think that we didn’t give them the treatment they need. They’ll lose faith in our abilities and look elsewhere for help. However, if we set expectations up front and educate patients about dry eye flares, we will retain more patients.
I tell my patients that dry eye can be chronic and progressive, but there will likely be occasional short inflammation-driven episodes called dry eye flares. They should expect that this will happen, and when it does, it doesn’t mean that chronic therapy isn’t working for them. They can contact me to get short-term rapid relief to “put out the fire” caused by dry eye flares.
Help is available
When my patients experience a dry eye flare, they know that they should contact me, and we will talk about whether they need to come in to see me or if a telemedicine visit is sufficient. In many cases, I can prescribe Eysuvis (loteprednol etabonate ophthalmic suspension 0.25%, Kala Pharmaceuticals) as my first-line prescription choice for fast relief of inflammation due to dry eye disease.
When we educate patients and set the expectation for dry eye flares, we set them up for success because they know what’s happening and they know to contact us for help right away. We ensure our own success as well because patients see that we fully understand their condition, so there are no surprises and no untreatable symptoms.
References:
- Brazzell RK, et al. Prevalence and characteristics of dry eye flares: a patient questionnaire survey. Presented at: American Academy of Optometry; October 12-15, 2019; San Francisco, Calif.
- Kala Pharmaceuticals. Kala Pharmaceuticals Announces Dosing of First Patient in Phase 3 STRIDE 3 Trial of KPI-121 0.25% in Patients with Dry Eye Disease. Available at: https://investors.kalarx.com/news-releases/news-release-details/kala-pharmaceuticals-announces-dosing-first-patient-phase-3. Accessed March 2, 2021.
- Multi-Sponsor Surveys Inc. Study of Dry Eye Sufferers. 2018. Available at: https://www.multisponsor.com/wp-content/uploads/2018/11/Dry-Eye-Sufferers-18011.pdf. Accessed March 2, 2021.
For more information:
Roberto “Bobby” Saenz, OD, MS, FAAO, is the chief medical officer at Parkhurst NuVision, a multispecialty surgical and eye care practice in San Antonio, Texas.
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