Unforgiving dry eye

With an ageing population and screen use dominating both work and leisure time, like most practitioners, I encounter a steady stream of patients presenting with dry eye symptoms during a routine clinic. Given the regular punctuations of these cases throughout the day, I am mindful of the potential to become blasé to the impact this often-chronic condition may have upon the individual. Nevertheless, I must confess that it is the patient with wet age-related macular degeneration that keeps me awake at night, more so than those with ‘just’ a gritty eye. But, there is nothing better to challenge the perspective of the ‘triviality’ of dry eye than one’s personal plight, especially when it arrives with a ‘fast forward’ button.

Searching for relief

It has been a year since I took the plunge and had LASIK. Taming my 7D of myopia coupled with 3D of astigmatism has certainly been liberating, and I am now the proud owner of the perfect refractive error (in my view) for an emerging presbyope of R -1.50, L -1.00.

Now, of course, being lumbered with dry eye after the procedure was not unexpected nor downplayed by the surgeon during my pre-operative consultation. And, there are certainly no regrets for this trade-off given the quality of vision I now experience. Yet, in the first few weeks after treatment, I was using ocular lubricants up to eight times a day, regular warm compresses (and even taking omega 3 supplements – well, it can’t do any harm, can it?).

"Imagine the day-to-day challenges that the dry eye management scenario brings for an elderly arthritic patient"

Despite my clinical know-how, easy access to a range of products, and the skill to easily instil eye drops, I won’t deny that prepping to make sure I was ‘tooled up’ on a daily basis was never far from my mind. Now imagine the day-to-day challenges that the dry eye management scenario brings for an elderly arthritic patient.

We have all come across those patients who may have been self-managing their symptoms, buying preserved eye drops, or indeed, in the absence of an optometrist-led approach, prescribed such interventions by their GP. The sense is that things are changing for the better.

We have the ‘luxury’ of having a properly funded enhanced services scheme in our local area, which allows optometrists the time and resource to examine and educate patients, providing suitable interventions for the long term, thereby aiding compliance.

Stark reminder

As the uptake of enhanced services gathers momentum and more practitioners upskill with additional qualifications, appropriately funded primary care management of dry eye and other minor conditions becomes an intriguing prospect.

It is a year on from my refractive surgery and, thankfully, in line with expectations, my symptoms have abated. Nevertheless, the experience has allowed me to re-evaluate my empathy levels when dealing with dry eye patients in clinic.

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