Be Relatable

Dry eye conversation touches on a common condition

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What Shire has done for optometry is nothing short of remarkable, says Gina Wesley, OD, of Medina, Minnesota. “Patients come in having seen the eyelove® campaign on TV or in magazines, and suddenly there’s an increased awareness in their understanding of dry eye.”

That makes it easier for her to have a conversation about how she can diagnose and treat their conditions. “I work from the preventive care model, and so often, we start with patients having no thoughts at all about the condition we’re going to discuss. I have to start with planting the very first seeds. Then eventually, patients will say, ‘Oh, she’s talked to me about this often, and now I see what she means.’ That’s the best thing that has come out of the increased attention to dry eye,” says Dr. Wesley.

Dr. Wesley actively screens every patient in her office for dry eye, looking at both the ocular surface and the meibomian gland function. “Everyone hears about it, just like everyone hears about the steps to take to prevent macular degeneration. Millions more people suffer from dry eye than from macular degeneration or glaucoma, so this is arguably the most relevant issue we can talk about with the majority of our patients.”

She also uses the SPEED survey, which has patients rate the frequency and severity of dry eye symptoms such as dryness, grittiness or scratchiness; soreness or irritation; burning or watering; and eye fatigue. Based on those subjective ratings and some questions about the use of lubricants, habits and fluctuating vision, she has a solid basis for what to do immediately and what further tests are needed. “When I started looking for dry eye, I found that so many people have it. It’s not dependent on age or activities or demographics; it’s widespread,” she says.

She often starts patients on Xiidra® (lifitegrast ophthalmic solution) 5% because it relieves both the signs and symptoms of dry eye. “Sometimes patients feel bad, but their eyes look pretty good; some patients present with white, clear eyes, but they have a lot of complaints. If inflammation is an underlying cause, I can see results fairly quickly,” she says. Most of the data shows that patients gain relief within 12 weeks, and for many, she says that it’s been faster than that. “Every patient’s tolerance for discomfort is different, so that’s why it’s worth having the conversation, no matter what my clinical observations are,” she says.

Improve Comfort Quickly

The key factor is to get patients started quickly. “The crux of success is providing the patient with relief. That will reinforce adherence to the prescribed regimen,” she says. She tells them to be a little patient: “You didn’t get to this point overnight, and we’re not going to be able to solve it that quickly either,” she says. Dr. Wesley has built up her dry eye practice recently, adding a LipiFlow system and InflammaDry testing, so that she can continue to work with patients to resolve more severe issues when the inflammation has subsided, too.

Dr. Wesley has returning patients redo the SPEED survey. Typically, that shows an improvement in the subjective measures, which helps to reinforce compliance even more.

Indeed, she doesn’t necessarily wait for dry eye symptoms to manifest themselves. “I proactively treat my contact lens patients for dry eye. I tell them that I want to make sure that they’re able to wear their contact lenses for as long and as comfortably as possible,” she says.

It’s a tremendous opportunity for optometrists as the primary eye care providers. “Right now, optometrists are prescribing more Xiidra than any one group of health care providers. It should be that way. We’re at the forefront, and we have the opportunity to help these patients before it becomes a dramatic problem for them.”