Understanding how to manage dry eye is crucial

The British Contact Lens Association’s 2017 Dry Eye Practitioner of the Year, Nick Dash, shares his thoughts with OT 

Why is dry eye an area that you are interested in?

Dry eye has an impact on the lives of so many people. It can have a huge impact on quality of life – some studies have evaluated dry eye and found the wellbeing impact to be equivalent to living with angina. I treated one woman with dry eye whose grandchildren would ask her, “Granny, why are you always crying?” Being able to help someone in that situation is very rewarding. When people say ‘Thank you for giving me my life back,’ you know you have done a great job.

Understanding and knowing how to manage dry eye is crucial as an optometrist. The tear layer is the primary refractive surface. Over 60% of the power of the refractive error is at the tear/air interface. It therefore impacts on quality of vision and the fundamental process of having clear stable vision. On a scientific level, I find the science of dry eye enormously rewarding as it brings my background of immunology, cell biology and optometry together in a practical way.

"Think of treatment as only the start of a management strategy, keeping in mind that dry eye is often a long-term, chronic condition"

What are your top tips for practitioners managing and diagnosing dry eye?

Think of the cause. With 80% of dry eye being evaporative, the meibomian glands are often a significant contributor to the aetiology of dry eye. Lids and lashes need investigation and demodex mites are often present in many patients with dry eye.

It is important to be analytical in your diagnosis of dry eye. To this end, I like the use of tear sampling methods, and osmolarity measurements. Detailed examination of the ocular surface is essential. Consider non-preserved solutions with a balance of hyaluronic acid and osmolarity/tonicity control. Think of treatment as only the start of a management strategy, keeping in mind that dry eye is often a long-term, chronic condition. 

Why did you establish your dry eye clinic at Midland Eye Hospital?

We started up the clinic to meet an unmet need. Dry eye is becoming more and more prevalent due to lifestyle and environmental factors. Dry, air-conditioned offices, and the increasing use of electronic devices that reduce the blink rate can put patients at a higher risk of developing dry eye.