When managing dry eye disease (DED), ensuring realistic patient expectations is critical to optimizing adherence to treatment and improving patient satisfaction. Clinicians are urged to educate patients about DED and discuss goals and length of treatment in clearly understandable terms.


 

Considering there is no cure for dry eye disease (DED), ongoing treatment and lifestyle adjustment will be required for most people with DED. “Patient education is a vital component to DED management,” explains Bridgitte Shen Lee, OD, FBCLA, FAAO. “When talking with patients, clinicians need to convey the complex and chronic nature of the disease, ensure that they understand the potential for DED to progress, and provide information on available treatments options.”

Since many factors can contribute to DED, a multi-targeted treatment approach is often required to address signs and symptoms. Conventional first treatment options include over-the-counter artificial tears and warm compresses. “Ocular lubricants may provide temporary symptomatic relief, but the successful treatment and management of DED cannot happen without a comprehensive baseline ocular surface disease exam,” says Dr. Shen Lee. “The underlying pathophysiology of DED needs to be identified first.”

When treating patients, Dr. Shen Lee recommends conducting a medication review to identify systemic and topical medications that may contribute to DED (Table). Cosmetic and skin care product use and ingredients should also be reviewed. “It is important to discuss how other treatments and products can impact DED and then collaborate with patients to see if switching to alternative therapies is feasible,” she says. “Helping patients understand this aspect of DED can empower them to take a proactive role in their treatment. Furthermore, there should be candid discussions about treatment costs, health insurance coverage, and potential adherence challenges to complex regimens that are under consideration.”

 

Setting the Bar

It is critical that patients understand DED treatment will be ongoing and should be told that therapy takes a few weeks before symptom relief will occur. “Some pharmacologic treatments that address underlying DED pathophysiology may take 2 to 4 weeks to reach onset of therapeutic effect,” Dr. Shen Lee says. “Patients should also recognize that these treatments may have tolerability issues. These educational efforts help set realistic expectations with patients and can increase the likelihood of treatment success.”

In many cases, patients will begin to benefit from DED treatment within the first few weeks of initiating prescribed treatments. “However, even after achieving symptomatic relief, clinicians should reemphasize that compliance with ongoing treatment will still be necessary,” says Dr. Shen Lee. “Adherence to therapy through the expected treatment time is critical. Patients must be educated to this fact and encouraged to persevere with treatment for maximal benefit. It is helpful for clinicians to give patients an estimated time frame of what therapy options need to be maintained.”

 

Treatment Considerations

Since more than one therapeutic modality is often needed, patients should understand the rationale for using prescribed treatments for DED. “When prescribing a therapy, patients should be educated on how the agent works and the goal of using the treatment in terms that are easily understood,” Dr. Shen Lee says. “They should also clearly understand the expected duration of treatment. In addition, patients should be instructed on the proper sequencing of DED treatments and how they will be performed during morning and evening routines. A detailed written treatment plan that includes information on sequencing DED treatment and skincare routines should be provided. These plans should also be shared electronically so patients can refer to them when they leave the office.”

Whenever prescription ophthalmic drops are prescribed, it is helpful to explain to patients that they may experience symptoms like stinging, blurred vision, or an altered sense of taste from drug instillation. “Clinicians should reassure patients that such side effects should not be grounds for concern,” says Dr. Shen Lee. “The immediate discomfort after instillation often decreases over time with continued use of treatment. This is important because patients need to be encouraged to persevere with treatment to achieve maximal benefit.”

 

A Critical Cornerstone

Patient education is a cornerstone of optimizing care for patients with DED, according to Dr. Shen Lee. “Despite our broader understanding of DED and the advent of therapies, there are still many challenges to overcome,” she says. “Fortunately, emerging treatments are aiming to address limitations with currently available DED therapy. By thoroughly educating patients on DED prevention strategies and treatment options, we can motivate them to be active participants in their treatment and enhance their quality of life.”

 

References

Shen Lee B, Kabat AG, Bacharach J, Karpecki P, Luchs J. Managing Dry eye disease and facilitating realistic patient expectations: a review and appraisal of current therapies. Clin Ophthalmol. 2020;14:119-126. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969676/.

Craig JP, Nelson D, Azar DT, et al. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017;15(4):802-812. Available at: https://www.tearfilm.org/public/TFOSDEWSII-Executive.pdf.

Ong ES, Felix ER, Levitt RC, Feuer WJ, Sarantopoulos CD, Galor A. Epidemiology of discordance between symptoms and signs of dry eye. Br J Ophthalmol. 2018;102:674-679.

Vehof J, Sillevis Smitt-Kamminga N, Nibourg SA, Hammond CJ. Predictors of discordance between symptoms and signs in dry eye disease. Ophthalmology. 2017;124:280-286.

Schaumberg DA, Uchino M, Christen WG, Semba RD, Buring JE, Li JZ. Patient reported differences in dry eye disease between men and women: impact, management, and patient satisfaction. PLoS One. 2013;8:e76121.