o.d. to o.d.

It’s Right in Front of You — Do You See it?

Do fluctuating vision, red eyes, irritation, dryness or contact lens intolerance make you think of dry eye?

BY SCOT MORRIS, O.D., F.A.A.O. Chief Optometric Editor

If you see the same thing every day, do you notice it? Sometimes, some thing is right in front of us and for whatever reason we become oblivious to its presence.

Maybe this is because we choose not to acknowledge it, maybe we choose to avoid it, maybe we have become so accustomed to it that we don’t see it anymore, or maybe we don’t know what we are seeing.

The focus for this month

This month, Optometric Management focuses on dry eye. We focus on what it is, how to listen and look for it and what to do about it. There are lots of new definitions, new acronyms, new treatment protocols and new therapeutic agents that have entered the marketplace in the last two decades since I saw my first dry eye patient. Yet the one thing that is consistent is that a lot of people have dry eyes.

However, through the years of speaking on this subject I have come to believe that dry eye disease (DED) and its related conditions are that “something” that eyecare providers don’t always notice. Since DED and its related conditions affect more than 20% of our population, it is probably the most common ocular disease we see after ametropia. So it’s right in front of us. We just have to “see it.”

It’s part of the job

Think about it this way: If a patient came in reporting that he was having difficulty driving at night, and you found that he had a refraction of -0.75-1.00x020, would you give him night-driving glasses? Of course, you would. After all, isn’t our job to help people see well? You heard the symptoms and saw the condition and knew the perfect treatment. DED is no different. The common symptoms include fluctuating vision, red eyes, foreign body sensation, irritation, dryness and contact lens intolerance. If you hear those symptoms, think about looking for DED.

We each look through a slit lamp several times every day. Since we are already looking at the lids, lashes, cornea and conjunctiva during our standard exam, it might only take a second or two to instill some lissamine green, and look at the surface in those patients that we “hear” have DED symptoms. Do you see it now?

What do you do?

When we hear the symptoms and see the signs, do we do anything about them? Do we prescribe a solution to the problem? Do we address that the patient has an issue and that we would like to bring her back to see whether we can fix her issues and make her life better? DED is the proverbial “low-hanging fruit” that has a low-price entry point to treat (a slit lamp and lissamine green strips can get you started). Treating it can make a dramatic difference in our financial success and our patients’ happiness and visual comfort.

So please read on as our columnists and feature writers share a few ideas of how to deal with what is sitting right in front of us every day. OM