BLOG: Comfort, compliance go hand in hand for patients with dry eye disease

Dry eye disease is chronic, multifactorial and complex. As a result, management plans have to account for many variables, from underlying conditions to work environments.

But every management plan has some commonalities, including eye drops — artificial tears for everyone and prescription drops if appropriate. The key to getting all the benefits of any eye drop is compliance.

For eye drops, the most essential element of compliance is comfort. If a drop stings or burns, patients will try it once and never use it again. Nowhere is this problem clearer than with my patients who present after they’ve been self-treating dry eye disease (DED).

Here’s how I overcome their negative experiences to ensure they’re compliant with the drops I recommend and get the healing relief they need.

‘I’ve been using eye drops’

On a daily basis, I see patients who have self-treated DED for months, or even years, before seeing the eye doctor. And self-treating means eye drops, gels, ointments and whatever else patients can get their hand on. As we know, the eye drop aisle is overwhelming — it’s even confusing to me.

Understandably, people who don’t know the relative benefits of these drops make their choice based on brand recognition and price. Generally, that means they’ve been using anti-redness brands and generics. Occasionally, when the cheap tears don’t work, patients spend more on a higher quality tear, but I find they’ve still been suffering with frequent (six-plus times a day) use of preserved tears when they need comprehensive care.

Self-treatment with the wrong eye drops may not improve DED’s signs and symptoms. These patients can still present with red, irritated and inflamed eyes and significant staining, as well as the characteristic indicators of meibomian gland dysfunction (MGD) and/or aqueous-deficient DED.

‘Why should I try eye drops again?’

Once I’ve developed a management plan based on the diagnostic exam, I find that patients’ past self-treatment works against me. I have to explain why the old drops didn’t work and get them to trust me about trying new drops.

After I explain to patients that their old burning, stinging eye drops had ingredients like preservatives and vasoconstrictors that actually made their condition worse, I explain why the eye drops I recommend will feel good and improve DED.

For example, I recommend iVizia (Thea) artificial tears, which are preservative-free, so they feel comfortable no matter how many times a day patients use them. They’re better for the ocular surface and have ingredients such as povidone, hyaluronic acid and trehalose that will hydrate, lubricate and protect their eyes.

Once patients understand the difference between their old and new artificial tears, they’re willing to try. But we need long-term compliance, and that means that from the first drop, the artificial tears need to be comfortable. They also must reduce symptoms quickly because patients are eager for improvement.

I advise them to use artificial tears every day in the morning, at bedtime and when needed for relief throughout the day. If a patient has aqueous-deficient or mixed DED, I might wait a few weeks for symptoms to improve with iVizia before starting an immunomodulator like Cequa (cyclosporine ophthalmic solution 0.09%, Sun Pharma), Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) or Xiidra (lifitegrast ophthalmic solution, Novartis).

Prescription drops require another encouraging conversation along the lines of, “These drops might sting a bit, but if you use them consistently twice per day, I think you’ll see significant improvement in your long-term goals of reducing signs and symptoms of dry eye disease.”

‘My eyes feel exponentially better!’

I’ve had excellent results encouraging patients to comply with my instructions for using comfortable, quality eye drops that do what they expect them to do: feel refreshing, work fast and provide long-lasting relief.

Patients who have been self-treating are amazed to finally feel more comfortable reading, driving, using screens and wearing contact lenses. Recently, a 38-year-old patient who works in IT told me that by using the recommended drops proactively, he’s able to comfortably wear his contact lenses for the full workday, which includes 8-plus hours of screen use.

The iVizia drops have other features that encourage compliance, like an easy-to-use multidose bottle and an affordable price. Cheerleading goes a long way, too — “I know you can do this! Try it for 2 weeks.”

But none of those things would succeed without comfort.

For more information:

Jade Coats, OD, is in practice at McDonald Eye Associates, an OD-MD practice in Rogers, Arkansas.