It is extremely important to have dry eye disease (DED) screening questions in place before patients come into your office. This way, you can be prepared for the answers to these questions before a patient is scheduled, or when you or your staff take histories.
In December of 2014, a group of about 35 leading optometrists met in Denver to advance the identification and management of one of the largest patient populations observed by optometry—those with DED. The group of DED leaders taking part in this Optometric Dry Eye Summit provided insight into many areas of diagnosis and treatment, but their resulting screening questions in particular have served me and my affiliated practices extremely well. These questions have helped identify about twice as many patients with the disease or in its early stages, such as those with MGD, than would have been uncovered otherwise.
Since DED is an immune-mediated disease, it requires a lifetime of therapy once the disease process takes hold. Early identification may help spare patients the eventual disease progression that can lead to severe effects on quality of life. In fact, patients with severe DED have shown quality of life scores equivalent to those who require regular dialysis or those with severe angina.1
Screening Questions to Ask
At a minimum, every patient should be asked the following four questions at each visit:
1. Do your eyes ever feel dry or uncomfortable?
2. Are you bothered by changes in your vision throughout the day?
3. Are you ever bothered by red eyes?
4. Do you ever use or feel the need to use drops?
Given the fact that we live in a digital world and patients over 18 are now spending more than 12 hours per day on digital devices,2 the addition of a fifth question regarding digital device time is essential*:
5. Do you spend more than 4 hours per day on digital devices?
Incorporating these screening questions into your examination process prior to the exam, or as part of the history when the patient arrives to your office, is invaluable. You will identify far more disease than without soliciting this information, intervene for patients at a stage where they can be more easily managed, and prevent the DED from progressing to gland damage that will likely require a lifetime of therapies.
KEY TAKEAWAY: Incorporating the right screening questions into your examination process can help you identify a greater number of patients with DED.
1.Uchino M, Schaumberg DA. Dry eye disease: Impact on quality of life and vision. Curr Oph-thalmol Rep. 2013 Jun; 1(2):51–7.
2. The Nielsen Total Audience Report: Special Work From Home Edition. August 2020.
*Adapted from the DED protocol utilized by Keplr Vision, where I serve as medical director.
Supported by an independent medical grant from Kala Pharmaceuticals
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