CLINICAL

  the front

Four OSD Myths

Is OSD just a benign nuisance? Does patient education take too long? Believe these and other myths at your own risk.

MARGIE RECALDE, O.D., FRESNO, CALIF.

Why do patients leave a practice? Do they leave as a result of bad customer service, poor product or cost? The answer is all the above. Yet, a prevalent reason is “perceived indifference,” or the belief their doctor doesn’t care about them.

So, how can we, as O.D.s, show our patients we genuinely care about them? The answers: By listening and properly addressing patient complaints and asking questions whose answers may reveal an undiagnosed condition. Unfortunately, some of us fall short in these areas when it comes to ocular surface disease (OSD). If you don’t listen to your patient’s complaints and discuss OSD, they will perceive you don’t care and may never return. Also, they will tell 20 others about their negative experience.

Here, I list and debunk the myths about the condition that prevent many of us from giving OSD the attention it deserves.

MYTH #1 Educating patients about OSD takes too long.

DEBUNKING THIS MYTH: It is possible to educate patients about OSD without sacrificing too much chair time. First and foremost, provide all patients presenting for an eye exam with an OSD questionnaire they can fill out in the reception area. Then, have a staff member give you the survey results before you see the patient.

Second, have a short script that explains OSD, should the questionnaire results reveal the patient would benefit from additional diagnostic testing. An example script: “Mrs. Smith, the OSD survey and exam today show that you have ocular surface disease. This is a group of conditions that affect the front surface of your eyes, tear film and eyelids. To be sure, I need you to schedule an appointment for additional diagnostic testing.” You don’t want to present too much information. Patients forget 40% to 80% of what we tell them, sometimes as soon as they leave the office. This may be due to a number of factors, including complex medical terminology, verbal vs. written instructions and the patient’s educational level and expectations, says the Journal of the Royal Society of Medicine.

Should additional diagnostic testing show the patient has OSD, have a staff member explain the treatment protocol in detail. In addition, have the staff member provide the patient with written, detailed instructions. Meaningful Use requires we print a clinical summary of the patient’s visit, which includes the treatment plan. This makes sense: If patients do remember verbal instructions, half of what they remember is incorrect. Thus, written instructions help to improve patient understanding and compliance to your prescribed treatment.

MYTH #2 OSD is just a common, benign nuisance.

DEBUNKING THIS MYTH: A total of 14.4% of those older than age 50 living in the U.S. have dry eye disease, says Investigative Ophthalmology & Visual Science.

Interestingly, it is estimated that 86% of patients who have dry eyes also have meibomian gland dysfunction, says Cornea. In contrast, roughly 40% of the general population suffers from ocular allergies, and 40% to 60% of patients have both allergies and dry eyes, say Current Opinion in Allergy and Clinical Immunology and Annals of Allergy, Asthma & Immunology, respectively. Based on these statistics, OSD has proven to be more than an annoying inconvenience; it is undeniably a real problem. Sadly, some doctors dismiss OSD because they underestimate the patient’s symptoms and, therefore, do not understand just how much it is disrupting their patient’s life.

In fact, in one particular study, in which a symptom questionnaire was used, patients rated their symptom severity worse than what their doctors estimated the symptom score should be 23% to 60% of the time.

MYTH #3 Artificial tears provide enough relief for OSD.

DEBUNKING THIS MYTH: Artificial tears can provide enough relief in some, not all, cases. This is why cyclosporine ophthalmic emulsion 0.05% (Restasis, Allergan), ocular allergy medications, omega-3 supplements, proprietary warm compresses and an array of devices to alleviate the symptoms and signs of the condition are widely prescribed.

MYTH #4 OSD does not have any serious long-term consequences.

DEBUNKING THIS MYTH: When untreated, OSD progresses and leads to significant visual problems. These problems range from intermittent blur to constant blurred vision and intense ocular pain. Severe corneal complications include epithelial defects, ulceration, scarring and perforation.

In addition, one out of 10 chronic DED patients have undiagnosed Sjögren’s syndrome. Sjögren’s syndrome patients are 46 times more likely to develop Non-Hodgkin’s B-Cell Lymphoma, studies show. Therefore, a diagnosis of chronic OSD may not only lead to the diagnosis of Sjögren’s syndrome but to cancer as well.

No more excuses

Now that you know the facts, start talking about OSD with your patients today. They will appreciate the extra steps you take to show that you truly do care, binding them to your practice. American author John C. Maxwell once said, “The people will never care how much you know until they know how much you care.” OM

Dr. Recalde is the chief of optometric services at Eye-Q Vision Care in Fresno, Calif. She is a consultant to Allergan and Bausch + Lomb. E-mail her at mrecalde@eyeqvc.com, or send comments to optometricmanagement@gmail.com.