Around 70 to 75% of all patients who have dry eye can be managed using a “very simple system” without the need for “fancy equipment… or huge amounts of information”, according to Professor Lyndon Jones from Centre for Ocular Research and Education (CORE), at the University of Waterloo in Ontario, Canada.
Professor Jones was visiting Australia to speak at the 4th World Congress of Optometry in Melbourne on a number of topics, including an initiative set up between the World Council of Optometry (WCO) and Alcon, called ‘the Dry Eye Wheel’. The Wheel aims to simplify dry eye management for clinicians by drawing on learnings from the Tear Film and Ocular Surface Society’s Dry Eye Workshop II (TFOS DEWS II).
“I think practitioners sometimes get concerned that to be able to manage patients with dry eye… they need lots of specialist equipment, they need specialist education, and that’s simply not the case,” he told mivision in an exclusive interview.
He explained that the Dry Eye Wheel considers three aspects of dry eye: how to mitigate, measure, and manage the disease.
“Mitigation looks at how you can avoid the patient getting dry eye to begin with and gather data on them.
“Measurement means how you measure what the patient has – the symptoms and signs – to decide whether they have dry eye, what type of dry eye, and how severe it is. And then the management system basically looks at how you manage that.”
Within the Dry Eye Wheel, these three aspects are divided into gold, silver, and bronze, with bronze being achievable with “the most basic education, with the most basic of management systems”.
“Silver is where you will need some level of extra equipment, some better level of education, and the patient typically has more severe dry eye, but that’s a relatively small amount.
“And then the gold system is the ultimate.”
Comprising about 5% of all patients with dry eye, patients are managed within the gold tier by practitioners “who are at the peak of their profession. They really have taken a lot of interest”, he said.
Professor Jones said when most optometrists treat patients at the bronze level, in the early stage of the disease, “you break that vicious cycle of dry eye disease, restore homeostasis to the ocular surface, and you’ll get rid of both symptoms and signs”.
For contact lens wearers, he said research is now confirming that a healthy ocular surface is critical to ensure comfort, regardless of the contact lens material prescribed.
“Let’s make sure that whether it be a new patient or an existing symptomatic patient… the tear film’s good, there’s no meibomian gland dysfunction, no dry eye issues, no blepharitis, no Demodex, all of those. If you clear those up and keep them in the same (contact lens) material, you’re going to get a good result.
“We’ve got really good evidence these days around the fact that just doing those treatments to treat ocular surface disease automatically makes the contact lens more comfortable without doing anything else.”
SPECIALISATION IS THE FUTURE
Professor Jones believes that the future of optometry will involve specialisation.
“You can be a generalist, but that means you’re going to be okay at lots of things… (instead) become really good at something. What that ultimately means is, you might see a patient and decide they can do better by seeing somebody else.
“So, either refer within your practice to someone else who does have that interest… or be big enough to say, ‘You know what, I’ve got a colleague who’s down the road, we’re going to refer you to them’. And then have an arrangement with that colleague so once they’ve managed the issue, they send the patient back.
“I think we need to become bigger and better and understand that ultimately this isn’t about us, it’s about the patient. So, make sure we are doing the best that we can for the patient. And if that means they need help outside of your level of expertise or equipment, be big enough to accept that, send them off.”
