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The rewards of treating dry eye

Nick Howard explains that dry eye should no longer be viewed by the profession as a “minor nuisance” in order to improve patient care

02 Jul 2018 by Andrew McClean

As a contact lens optician with over 30 years’ experience, dry eye management and treatment has been an integral part of my day to day clinical routine

It has expanded over recent years with the development of a specific dry eye clinic. Treating dry eye successfully can be hugely rewarding when working with a patient suffering from long term, chronic and painful symptoms.

Modern lifestyles, in particular environmental factors combined with extensive use of digital devices, along with a heightened personal awareness of signs or symptoms, has resulted in a significant increase in the number of dry eye patients. This includes a disturbing percentage of juveniles and young adults requiring careful and empathetic management programmes.

The majority of my contact lens patients have complex ocular conditions, which demand contact lens correction – for life. It is vital that intervention plans are proactive, rather than reactive as any inflammatory event or a drop in comfort will make contact lens wear intolerable.

"Treating dry eye successfully can be hugely rewarding when working with a patient suffering from long term, chronic and painful symptoms"

Working predominantly in a hospital setting, I am now seeing many new dry eye patients with moderate to severe debilitating conditions, which may be difficult, time consuming and expensive to manage to a satisfactory level. Many of these patients possibly could, or should have been treated and given appropriate advice at an elementary stage to arrest progressive disease. Once referred into the hospital system, the High Street eye care practitioner has in reality lost their valued patient and, it could be argued, has failed to satisfactorily look after their best interests.

DEWS II has effectively given the profession a compass, with which it can confidently navigate the oceans and seas. The co-operation and collaboration of 150 clinicians and researchers from around the world has given practitioners clear classification, guidance and direction in the necessary diagnosis and subsequent management of the multifactorial ocular surface disease.

Loss of homeostasis, ocular symptoms, tear film instability, hyperosmolarity, inflammation and damage, and neurosensory abnormalities are key pointers from the definition of dry eye disease, permanently etched on the signpost to resolution.

Nick Howard

A straightforward flow chart now forms the foundation model: triaging questions, risk factor analysis, diagnostic tests and subtype classification tests, a spectrum of evaporative and aqueous deficient conditions. This is the pathway.

A small number of specific, specialty dry eye clinics are catering for the needs of a huge potential patient base, but this appears to be a rarity. Dry eye is seen by the profession as a minor nuisance and the majority of patients receive inadequate assessments, time, attention and advice from their trusted eye care professionals.

There needs to be a fundamental change to business approach with an encouragement and investment to develop and expand new, specific skill sets to improve dry eye treatment. Also, recognised accreditations or qualifications leading to increased public awareness and improved, effective investigative and treatment options may have a huge impact and benefit to individual quality of life.

Nick Howard is a contact lens optician who works in two Lancashire hospitals and in private independent practice, developing techniques for management of dry eye and myopia

Image credit: Getty

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