Three ways to achieve treatment buy-in

“But, doc, if my eyes don’t feel dry, why do I have to use this?” I would bet we have all heard something along these lines from our asymptomatic dry eye disease (DED) patients.

So, what is the most useful approach to initiating therapy that helps them understand the importance of adhering to the treatment(s) we prescribe? I have found the following three steps effective:

1 PROVIDE EVIDENCE

I have discovered that the old adage “seeing is believing” rings true for these patients. By making a point of showing them their DED diagnostic test results, it helps them to understand the why and get on board with treatment compliance.

The available diagnostic tests, in alphabetic order: AS-OCT, blink rate measuring device, corneal topography, dry eye questionnaire (SPEED or OSDI, as examples), meibography, meibomian gland expression, metalloproteinase-9 (MMP-9) in-office test, phenol red thread test, Schirmer’s test, slit lamp biomicroscopy, TBUT and the tear osmolarity test. Additionally, in the case of demodex, some optometrists like to employ a microscope with video to show patients the mite.

Most patients don’t realize the vast array of symptoms that can actually be attributed to DED and ocular surface disease. By implementing an entrance dry eye questionnaire (such as SPEED or OSDI), you can begin to plant the seed in the patients’ minds that they may be experiencing problems, opening their minds to the diagnosis and, therefore, their ears to management solutions. Further, pointed questions by work-up technicians regarding problems, such as grittiness, eye pain, sensitivity with headlights or fluctuating vision, also work in such patients.

2 EDUCATE ON CONSEQUENCES

While reviewing diagnostic test results, I have discovered it is beneficial to educate the patient on the significance of the specific finding(s) and inform them of the result, should it be left untreated.

For example, “Mrs. Smith: I’m seeing some meibomian gland dysfunction. This means the glands in your lids that express oil needed for a healthy tear film are becoming clogged. If you look at the image of your lids acquired by the meibography device, you can see the problem. If this condition progresses, those glands could permanently stop producing oil and can’t be restarted, causing much worse symptoms.”

I have found that once patients have an idea of the problem, it becomes easier for them to understand why treatments are necessary, despite lack of symptoms.

3 DISCUSS TREATMENTS

The final step I’ve found successful in helping asymptomatic patients, and gain adherence to my prescribed treatments, is to state the purpose of each part of treatment and how they should be used. It is also important to be firm in your delivery, avoiding being wishy-washy or indecisive, so that the patient feels confident in your treatment plan.

For example, “Mrs. Smith: To help control eyelid bacteria overgrowth, I’m prescribing medical grade eyelid cleaning scrubs that I want you to use twice a day by lightly scrubbing the lid at the base of the lashes.”

In my experience, this step also works for in-office treatments.

BRINGING IT ALTOGETHER

By educating asymptomatic patients on how their condition appears, the consequences of failing to intervene and the reasons for and use of their treatments, they become more invested in the management of the problem. OM

DR. KOETTING practices at Virginia Eye Consultants, and she is adjunct faculty for Pacific University, MCPHS, Salus University, Southern College of Optometry and the University of the Incarnate Word. She has received consulting fees or honorariums from Oyster Point, Glaukos, Quidel, Horizon, Ocular Therapeutix and Eyevance.