Dry Eye Management, Diagnostic Procedures Vary Among Clinicians

Optometrists report using a variety of diagnostic and treatment strategies for dry eye management, according to research published in Contact Lens and Anterior Eye. Despite these differences, it appears that clinicians are using a stepwise treatment approach, which is consistent with Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II management recommendations, according to the report.

Researchers included online survey responses from 131 UK-based optometrists obtained between October 2021 and July 2022. The team used multiple choice, Likert style, and free text questions to examine optometrists’ perceptions of dry eye disease, confidence in diagnostic and management ability, and satisfaction with available treatment options. 

Overall, the survey respondents reported seeing an average of 33 patients with dry eye disease per month and estimated the disease’s prevalence to be 47.1% among their patients. While most optometrists reported confidence in providing dry eye management, independent prescribing clinicians, who composed 18.8% of survey respondents, demonstrated significantly more confidence (P =.031) and knowledge regarding available treatment options (P =.049) compared with optometrists without independent prescribing status.

Non invasive breakup time (NIBUT), fluorescein tear breakup time (FBUT), and tear meniscus height (TMH) were infrequently performed during routine eye examinations, according to the report. However, approximately 90% of the clinicians performed fluorescein corneal staining and break up time and meibomian gland evaluation once patients reported dry eye symptoms.

A total of 60% of survey respondents reported satisfactory dry eye management with artificial tear treatment alone and recommended a preservative free option with increasing severity. The clinicians identified punctal plugs, systemic and topical medications, and scleral and therapeutic lenses as appropriate management strategies for severe dry eye disease, and while all reported confidence in treating mild dry eye symptoms, a small number of respondents reported a preference for referring severe cases to colleagues or ophthalmologists.  

According to the researchers, the study has “identified an increase in therapeutic management and shown that a stepwise approach to management is being employed. Although an increase in evidence-based practice can be seen, the limited adoption of tear film biomarkers for diagnosis and management highlights the potential to further improve the translation of dry eye research evidence into clinical practice.”

Study limitations include an unknown response rate and the inclusion of participants from only 1 nation.