Issue link: https://optometricmanagementsupplements.epubxp.com/i/635658
A pproximately 3 years a g o , a f t e r h a v i n g p r a c t i c e d i n N e w York for many years, I relocated to Phoenix and opened a new practice with my wife and colleague. I decided that my portion of our dream practice would focus solely on ocular surface disease and dry eye. We built it and they came, and with a steady stream of complex dry eye patients, I quickly came to realize that much of what I thought I knew about treating dr y eye was fundamentally wrong. In particular, aqueous-deficient dry eye is only a small part of what I see in practice. Rather, evaporative dry eye is often the problem — or at least a major contributor — for the overwhelming majority of patients. According to the literature, 86% of dry eye patients have evaporative dry eye (Figure 1) 1 . In my practice in arid Arizona, that number is greater than 90%. I've learned that the best and most effective way to manage most dry eye patients is to focus on the evaporative components. With that in mind, a treatment algorithm qu i ck ly e volve d ( Fi g u re 2 ) , an d my success rate — in other words, my p a t i e n t s a t i s f a c t i o n r a t e — increased from about 65% to higher than 90%. Here, I outline my essential treatment strategies. Tear Supplement Choice Artificial tears are useful for keeping patients comfortable as they're moving through the treatment algorithm. However, their effectiveness hinges o n t h e p r e s c r i b i n g p h y s i c i a n's understanding that each drop has specific characteristics and its own me chan is m of a c t i on . To d ay, we benefit from a number of advanced Dry Eye Therapeutics The treatment approach that supercharged my outcomes ■ By Arthur B. Epstein, OD, FAAO Figure 2. A treatment algorithm that focuses on the evaporative components of dry eye has proven to be highly successful at The Dry Eye Center of Arizona. [MGD = meibomian gland dysfunction; EDE = evaporative dry eye; HOCL = hypochlorous acid; BCL = bandage contact lens; ADE = allergic dry eye] Figure 1. Meibomian gland dysfunction is a primary or major contributing factor in most cases of dry eye. FEBRUARY 2016 | 9