Let’s face it, dry eye will only become more prominent in our practices by the year 2030. It is estimated that over 61 million patients will reach geriatric ages and need extensive medical care.1
Thanks to a host of changing environmental factors, the dedicated use of liquid crystal display (LCD) screens, various facial products,2 and systemic medications, dry eye treatment will continue to be a necessary and important toolset within most practices.
Optometrists come prepared with abilities to diagnose and treat, but how do they implement different treatment options, diagnostic systems, and nutritional supplements fully within our practices to benefit patients? There are many options, but here is what I have found to be helpful.
Related: Blog: Why dry eye?
Diagnosis is half the battle
It is optometrists’ responsibility to elicit a complete history from patients.
This can be achieved in several different ways, including questionnaires (such as the Standardized Patient Evaluation of Eye Dryness [SPEED] Questionnaire), electronic surveys, simple paper forms, or my personal favorite—talking with the patient. Patients already fill out a lot of forms, so I take the time to personally take their history and include the questions that would be found in a validated questionnaire.
Our practice heavily incorporates vital dyes and views them as a gold standard for our approach to diagnosing and monitoring dry eye. In the initial visit with a patient, I take a three-fold approach to tackling dry eye:
• Objective measurement of tear-break-up-time (TBUT) using sodium fluorescein
• Visualization of meibomian glands using meibography
• Clinical evaluation at the slit lamp
• A lot of practices use MMP9 (InflammaDry, Quidel) and tear osmolarity (TearLab Osmolarity Test) tests to objectively evaluate and follow their patients. ODs should use the approach that works best for them and their patients.
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2. Wang MT, Craig JP. Investigating the effect of eye cosmetics on the tear film: current insights. Clin Optom (Auckl). 2018 Apr 3;10:33-40.
3. Dry Eye Assessment and Management Study Research Group, Asbell PA, Maguire MG, Pistilli M, Ying GS, Szczotka-Flynn LB, Hardten DR, Lin MC, Shtein RM. n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. N Engl J Med. 2018 May 3;378(18):1681-1690
4. Kokke KH, Morris JA, Lawrenson JG. Oral omega-6 essential fatty acid treatment in contact lens associated dry eye. Cont Lens Anterior Eye. 2008 Jun;31(3):141-6; quiz 170.
5. Pinna A, Piccinini P, Carta F. Effect of oral linoleic and gamma-linolenic acid on meibomian gland dysfunction. Cornea. 26:260-4, 2007.
6. Brignole-Baudouin F, Baudouin C, Aragona P, Rolando M, Labetoulle M, Pisella PJ, Barabino S, Siou-Mermet R, Creuzot-Garcher C. A multicentre, double-masked, randomized, controlled trial assessing the effect of oral supplementation of omega-3 and omega-6 fatty acids on a conjunctival inflammatory marker in dry eye patients. Acta Ophthalmol. 2011 Nov;89(7):e591-7.
7. Barham JB, Edens MB, Fonteh AN, Johnson MM, Easter L, Chilton FH. Addition of eicosapentaenoic acid to gamma-linolenic acid-supplemented diets prevents serum arachidonic acid accumulation in humans. J Nutr. 2000 Aug;130(8):1925-31.
8. Laidlaw M, Holub BJ. Effects of supplementation with fish oil-derived n-3 fatty acids and gamma-linolenic acid on circulating plasma lipid profiles in women. Am J Clin Nutr. 2003 Jan;77(1):37-42.
9. Schnebelen C, Viau S, Grégoire S, Joffre C, Creuzot-Garcher CP, Bron AM, Bretillon L, Acar N. Nutrition for the eye: Different susceptibility of the retina and lacrimal gland to dietary omega-6 and omega-3 polyunsaturated fatty acid incorporation. Ophthalmic Res. 2009;41(4):216-24.