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Clinical Pearls for Management of Dry Eye Disease


Experts conclude their discussion sharing clinical peals on the management of dry eye disease (DED) and how providers may invest in their practice to better screen and treat their patients.


Bill B. Trattler, MD: We have time for maybe one or two last pearls from each of you that you want to share. Our program title is Modern approaches for the optimal management of dry eye disease, and I think we've covered it in a fantastic way. We'll start with Dr. Nichols and then Dr. Brimer and then Dr. Matossia. We go through one or two last pearls for the modern approach of our dry eye patients. Dr. Nichols?

Kelly K. Nichols, OD, MPH, PhD: My first tip would be to just look and then do something, and that's not artificial tears usually. So, slit lamp is your friend and is important and the meibomian glands need to be evaluated, and don't underestimate what patients are willing to pay for their treatment or do for their treatment in order to feel better. I learned that early on in dry eye and I have an example that just stuck with me and so as we get more and more tools, I think it's important to remember that we want to do what's best for our patients and offer these new therapies that are coming out. Since we have a therapy now, we're looking at Demodex too, have the patient look down. That's a critical thing that I think we're not doing, and we need to use dyes. As Cynthia mentioned earlier lissamine green and fluorescein are critical in the evaluation of ocular surface.

Crystal Brimer, OD: I love that. When I'm talking about slit lamp exam and just the uniformity of it, the way I approach it, it always starts with look down. It doesn't matter what they're there for, it is look down and look at those lashes. But that's not my pearl, that's Kelly’s. So, I would say a couple of things. Don't feel like just because you don't have everything you can't treat dry eye. Do something. Get your toes wet because the need is abundant, and these folks, the more you try to put your head in the sand and ignore it, the more you're going to see them recurring on your schedule. It’s going to be a thorn in your side because you don't want to see them because you don't have an answer for them. It's inevitable that you're going to need to dive in. So go ahead and do it. And the easiest way I could recommend to start is to screen everybody. Whatever your method is, just pick something and screen every single person that walks through the door, so that it's rising to the surface, it's coming to your attention, and then you're being accountable to that result and you’re answering the need of the patient. So that's number one: screen everybody. Number two: do not be afraid to invest. I find that this fear of putting capital out there to buy equipment is debilitating for a lot of doctors that they're paralyzed. And my advice to doctors in deciding what to buy is fourfold. Number one: does it work? If it works, you’re going to pay for it and you're going to be building your reputation and your practice meanwhile. If it doesn't work, I don't care how cheap it is, don't buy it because your reputation is going to suffer for it. Number two, what is the experience like for the patient? Is it pleasant? Did it seem like it was worth the money you charged them? Number three, what's the business model over three years? It's not about the check you write, it's about all the things. What's the disposable cost? What's the profit margin, the MSRP? How many times would you repeat it, once a year versus twice a year versus 32 years? And then number four is the people and the support behind the company. For me, if you are thinking about, man, I want to do dry, I want to do something, but I'm afraid, I'm afraid to take that step and write that check. Look at those four factors and stop being afraid because everybody else is going to pass you by. I look in my town and all of a sudden there [are] like six or seven IPLs popping up. Where did this happen? But the last thing I would say is just because you've gone out and you bought a device, and now you're doing something, you cannot assume that it's going to work all by itself. There's nothing out there that fixes all brands of dry eye and ocular surface disease. You still have to take the time to look at the underlying cause and then pair the treatment with what's right for it. But even that needs ancillary treatment. It's going to need the omega 3 or it's going to need something else for bacteria. You've got to take the time to look at it, so that all these IPLs that are popping up, or evacuations, [they don’t] end up giving a bad name to the treatment because it was promised to be something it wasn't.

Bill B. Trattler, MD: That was a great, thank you. So many outstanding pearls. I love them all and I know that Dr. Matossian is probably going to add her own but maybe integrate some of what you just shared because those are really helpful. Dr. Matossian?

Cynthia Matossian, MD, FACS: Very, very helpful pearls. Thank you, Kelly and Crystal. What I want to say is don't feel overwhelmed. I hear it from so many colleagues. Oh my god, Cynthia, where do I start? I can't keep up. There's so much happening. Help me. Well, there are people who are willing to help you. We are here as mentors. Reach out to us. We will be happy to pair you with other mentors. Start with baby steps. We never end up as marathon runners on day one. We have to crawl, walk, start walking, you know, power walking, and eventually be the dry eye center that we want to be. Start small, buy one or two pieces of equipment, master them, then move on to the next and so forth, and you can't do it by yourself. You need a community. You need your team. Identify people within your practice, staff, people who may be as passionate about dry eye or have the potential to be passionate about dry eye. Educate them, invest in their training, send them to seminars, and take them with you to meetings. Get key people at the front desk who can talk to the patients who are calling so that those patients can be scheduled with you. You create your own mini team within the practice and that's how you start building a dry eye center.

Bill B. Trattler, MD: Dr. Matossian, Dr. Brimer, Dr. Nichols, these are all fantastic pearls. I just love them all. They are really effective in helping our viewers understand various ways that we can help our patients. One pearl I was going to share was that sometimes we could get stuck in that even though we've tried what we think is almost everything, we just can't figure out how to help a particular patient.And the good news I think all three of you shared was that there are experts that love dry eye, and there are other places where patients can be sent. So don't give up. There are always other things that can be done. Maybe some of even the investigational things we didn't even cover today because we couldn't cover everything. So just don't give up on patients. They're looking to us for guidance, but if you can't particularly help them, just recommend someone else who can maybe have a different approach. With that, I just want to thank each of you, and Ophthalmology Times for having us here. It's really fun to share and learn from each of you and I know our viewers really appreciate all of you. Thank you so much.

Transcript is AI-generated and edited for clarity and readability.

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