Not a dry eye in house

Johnson & Johnson Vision’s director of professional education & development for the UK, Ireland, Nordics and Germany, Dr Kamlesh Chauhan, speaks to OT  about tackling dry eyes

Dr Kamlesh Chauhan

How has the prevalence of dry eye changed during your experience in optics?

Dry eye is something that I believe practitioners have been aware of for a long time because it is something that their patients have frequently reported.

However, what I think has changed is that the industry, as a whole, has achieved a lot in improving the products that are available to help manage the condition, as well as the analysis that has been done on eye dryness symptoms. As a result, practitioners feel better equipped to deal with the symptoms than they were before. Because of this, I think practitioners, who in the past would have just given the patient advice, are taking much more of an active role in helping to manage it.

There is such a plethora of products now available to both diagnose and to manage dry eyes and I think practitioners are embracing that.

Why do you think it is a condition that patients increasingly present with?

I think it’s twofold. We have a growing ageing population, and as the proportion of older people becomes greater, the number of people experiencing the symptoms of dry eyes is likely to rise as it is a condition that is associated with age.

When it comes to younger patients presenting with eye dryness, the prevalence has no doubt increased because of people’s lifestyles. People are working in environments that are air conditioned and are therefore drier, which can lead to eye dryness symptoms. The other key area is around digital screen use and the amount of blinking that people do – when taking part in any cognitive task, including using screens and digital devices, we blink 4 or 5 times less than we would normally.

Do you have any tips for practitioners when talking to patients about dry eye?

As practitioners, we are familiar with patients saying they have symptoms of eye dryness or dry eye, and we are probably aware of what that feels like ourselves.

However, patients will probably never think about the reasons for why they are experiencing the symptoms of eye dryness. Uncovering the reasons why is key to managing the condition and is something that practitioners should begin thinking more about.

I would encourage practitioners to consider using questionnaires with their patients to help them get to the root cause. While some questionnaires are lengthy and not easy to use, personally, I find the OSDI very useful – it is short, powerful and FDA-approved for clinical trials.

When implementing a questionnaire like this, the whole practice can also get involved. It can perhaps be introduced to the patient at the point of making an appointment, and if that is done online, the questionnaire could be mounted on the website, for example.

What can practitioners do to better manage dry eye?

The identification of dry eye can often be done quite easily if the right questions and tests are employed. But finding the cause of dry eye can be problematic.

Because there are so many management options out there, what really needs to happen is that practitioners need to start thinking much more about what the cause is and then which options to recommend.

We also need to understand what we mean by the term Dry Eye Disease as the proportion of people who suffer DED is about 5% – ranging up to 15% in some populations. It is the symptoms of eye dryness that are much more prevalent and reported to be as high as 70% plus.

I would suggest practitioners really try to figure out what is causing the eye dryness and once they have they should be very clear about what management option they use, including selecting the most appropriate eye drop formulation. Some of that might involve a little bit of trial and error, which is not unfamiliar in medicine at all, though there is now some clear guidance in the DEWS II report. Practitioners also need to have the confidence to talk to patients and say: “This is my first attempt, let’s see how we get on with this. However, I have a lot more in my armory in order to help you.”

"It is a fantastic time to be an optometrist and I think that as patients look for better levels of care, optometrists have an opportunity to serve many unmet needs – the whole concept of ocular surface disease and symptoms of eye dryness is an amazing opportunity for optometrists to embrace"

Why should practitioners embrace dry eye?

There is a real opportunity to satisfy patients who suffer from eye dryness due to the products that are available.

The diagnosis and management of eye dryness and most dry eye disease is well within the remit of optometry - and perfect for primary eye care management in the community - and does not need to be done by ophthalmology who struggle with time or GPs who don’t always have the equipment or expertise.

It is a fantastic time to be an optometrist and I think that as patients look for better levels of care, optometrists have an opportunity to serve many unmet needs – the whole concept of eye dryness is an amazing opportunity for optometrists to embrace.

Two studies estimated the quality of life impact of Dry Eye Disease, finding that for patients with severe Dry Eye Disease, the impact of their disease on their lives was similar to the impact of moderate to severe angina. If patients have these types of needs, practitioners should be aware that it is not an insignificant condition and they should look to see how they can serve their patients better by investigating it and managing it the best they can, particularly as prevalence increases.

Does JJV offer any support to practitioners on this topic?

We will certainly be growing the number of support materials that we offer in this area.

Something that we are looking to run again are some courses on dry eye, which we have previously offered at the Johnson & Johnson Institute. We used to run a two-day programme that was a very comprehensive guide for practitioners on the investigation and management of dry eye. Through the programme, we looked to demystify dry eye because it has in some ways been poorly understood. We also have eLearning modules on our website and we will increasingly be looking to do more of these types of modules, especially in light of having acquired two businesses that work in dry eye as a whole – the blink® range of drops and TearScience.

What are JJV’s goals through these acquisitions?

As a whole, JJV’s goal is to look to see how we can support patients from the early years through to the latter part of life. To date, we have largely been concentrating on the population that needs vision correction and supplied them with the ACUVUE® brand of contact lenses. As we observe that patients’ needs around vision are vast, we want to concentrate on how we can really start helping practitioners meet more of their patients’ needs. This means starting to look at a portfolio of products that will serve patients from their early years through to the end of their life – it’s these latter years where they are likely to need more support because the prevalence of eye conditions is greater in older age.

Therefore, the acquisitions are one element of this overall goal. Another part was acquiring Abbott Medical Optics, which marked JJV’s entry into the cataract surgery field.

What we are really doing is looking at how we can, in a significant and substantial way, help practitioners help their patients. By providing a range of quality products and services we can help practitioners become better at providing high quality care for their patients.