Why the tear film matters

Ocular surface disease is a common condition that we are seeing every day in our practices. How many times have you heard or read that? Yet, as I speak to optometrists around the country, there are universal themes with regard to our attitude toward dry eye disease:

• We are not looking unless patients are complaining

• We are not familiar with the Dry Eye Workshop (DEWS) that established four levels of dry eye that direct diagnosis and management¹

• We are not quick to adopt the latest technologies that can more accurately and objectively diagnose and guide treatment

• We are worried about getting patients to buy in to management in the absence of overt symptoms

Related: Why dry eye means poor vision

Why aren’t we evaluating the tear film?

If patients are coming to us for a comprehensive examination, and vision begins at the tear film, why aren’t we routinely and objectively evaluating this critical layer? The biggest change in refractive index occurs when light passes from air to the tear film. If it is unstable, insufficient, or breaking up too quickly, vision suffers.

In 2007, the International Dry Eye Workshop (DEWS) report published guidelines to categorize and manage dry eye.¹ Most ODs are under-diagnosing and under-treating. For example, a level-2 patient has moderate symptoms, tear film signs, and corneal staining. According to DEWS, this patient should be treated with cyclosporine. Most of us put this type of patient on artificial tears, going against expert recommendations.

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