BLOG: Prepare for dry eye flares to satisfy, retain patients
Click Here to Manage Email Alerts
In a multispecialty practice, most patients who are referred to us for dry eye disease have gone through multiple attempts at therapy.
They’ve had punctum plugs, immunomodulators, warm compresses — any of which might improve their condition for a time, but when symptoms return, their doctor refers them to us, or patients search for “dry eye experts” on their own.
Some cases are complex, with underlying rheumatoid or inflammatory conditions such as Sjögren's syndrome or rosacea. Often, patients simply need a more comprehensive approach to this multifactorial disease, so we immediately go to the treatments that may not be available in most practices, such as intense pulsed light therapy (Optima IPL, Lumenis) and thermal treatments (LipiFlow, Johnson & Johnson; or TearCare, Sight Sciences).
Recently, we’ve realized that some of the patients who doctors refer to us or who find us on their own are more straightforward cases than initially thought. Imagine patients who have spent over $1,000 on dry eye disease (DED) treatments not covered by insurance. They are happy after the procedure but wake up one morning with burning eyes and fluctuating vision. They are frustrated. They spent money on these treatments to get rid of these symptoms, and now they’re back.
These patients are experiencing dry eye flares, which are a rapid-onset, inflammation-driven response to a variety of triggers. Patients who don’t have troublesome continual symptoms of DED , and more severe patients on chronic therapy can still have breakthrough flares. By recognizing and actively treating dry eye flares, the education of DED patients becomes key in preparing them on what to expect and when to ask for help.
If patients know about flares, they won’t feel as frustrated, because they expect that a flare will happen. I wouldn’t blame patients who don’t know about flares if they looked for a second opinion, thinking, “Those treatments I had didn’t even work.”
Think dry eye flare first
I recently got a referral from an optometrist who had tried everything — cyclosporine, Xiidra (lifitegrast, Novartis), compresses and so on. Normally, it might be time for IPL and/or thermal pulsation, and I’d look for other concurrent problems. In this case, which the optometrist described as quite severe, however, I anticipated using cryopreserved amniotic membranes. Our discussion with the patient showed she’d been doing well on chronic therapy for months and then they suddenly had inflamed, irritated, dry, red eyes. We also learned that she had just started in a new work environment with blowing air circulation.
Another patient was referred after going to his optometrist for sudden-onset red, inflamed eyes. His doctor noted no signs of infection, and the patient normally did not have signs or symptoms of DED.
Both of these patients were experiencing dry eye flares. I explained the problem, prescribed a short-term steroid that is FDA-approved for treating DED, Eysuvis (loteprednol etabonate ophthalmic suspension, Kala Pharmaceuticals), and scheduled them to come back in 2 weeks. Both patients returned feeling comfortable and happy, saying they’d started feeling relief within days of starting medication.
At this point, with patients under control and feeling better, I always guide them back to their primary eye care doctor. When flares are the problem, I make time to educate about signs, symptoms, triggers and treatment. Additionally, I let their doctor know there is now a short-term treatment and share some easy questions they can use with patients to help uncover these episodic exacerbations. Once we’ve restored balance to the ocular surface, patients will likely continue to succeed on their chronic therapy and need treatment for occasional dry eye flares.
Don’t underestimate dissatisfaction
The practice advantages to treating dry eye flares are clear — write a prescription and educate patients, and it will reduce the chance of patients leaving your practice. I also hope doctors understand that when they don’t treat dry eye flares early and proactively educate patients on what to expect with future flares, it can take a big toll on patient satisfaction. Unfortunately, some of these patients assume their doctor’s dry eye treatments didn’t work, so they search for a new doctor.
In the best possible situation, a patient with a dry eye flare says, “This is what my doctor told me might happen. I’m supposed to schedule a visit and get a prescription.” That way, patients know that their doctor really understands DED and how to confidently use all the treatment options available to do the best thing for their eyes. It’s a win for the doctor, the practice and, most importantly, the patient.
Collapse