The mind is a powerful wonder, complimented by imagination, supported by fact, and misguided by emotion. Things are not always black and white. Things are not always easy to treat. Things are not always diagnosed correctly.
This philosophy extends to medicine, specifically, ocular health care. Whilst having dinner with a friend this weekend, I noticed that her left eye was drip-drip-dripping as she spoke; it was distracting and in fact, somewhat Felliniesque considering that we were seated in a Parisian café discussing life. Initially, she dismissed the tearing as a new condition that was no more than vexing but when pressed, she revealed that it is affecting her efficiency at work.
She works with numbers. Numbers found on excel spreadsheets. Numbers found on pages and interminable pages, of data. She is a quantitative analyst for a bank, trading derivatives. Misinterpreting a 7 for a 2 in her industry is akin to a fashion designer ordering reams of canary colored fabric rather than chartreuse for the spring collection. Either miscalculation can reap significant financial ramifications. Now, because tears blur her vision, she struggles to focus on her screen. She is also overwhelmed with fear that, what was an initial inconvenience, will transform into a chronic condition. A disease.
According to Dr. Scott Schachter, “dry eye disease is a vision disease because if you don’t have a good tear film you cannot have good vision.” In this light, dry eye should be considered “A disease, not THE disease” and symptoms should be looked for on all patients and not just the symptomatic ones. Historically, however, many doctors have dismissed dry eye disease as a non-threatening condition and subsequently ignored the symptoms until they were advanced. Unfortunately, many continue to dismiss dry eye in their practice.
Dr. Schachter’s strength is “streamlining ocular surface assessments into comprehensive examinations.” He argues that his approach should not be unique that doctors not only can but also should ensure that it is treated and preemptively managed. According to his experience, too many doctors “get stuck on trying to create a protocol and the result is that they are forced into no action.”
Dry eye clinics are being inaugurated globally, but, does this model need to be replicated or is it possible that, if clinics began to pro-actively screen people for symptoms, additional clinics would no longer be a necessity? Dr. Schachter proposes choosing a few parameters (tear volume, osmolarity, etc.) that are evaluated on every patient. In this way, alerts would be established and both preemptive diagnoses as well as treatments are simplified.
An Allergan study found that dry eye disease sufferers would “trade three years at the end of their life to not have dry eye.” If we, as practitioners, now recognize the disease as so traumatic, shouldn’t we consider it important enough to address before the symptoms become too symptomatic? The oral health care industry has a plethora of preventative care campaigns and said public awareness is hardly new. However, the ocular health care industry, with respect to dry eye, has not been as vocal. Dr. Schachter agrees that corporate and public health campaigns would not only support, but encourage doctors’ efforts to preemptively treat dry eye as A disease and not THE disease and more importantly, as a vision disease.
Three interesting developments are currently occurring that may further stimulate his objective: kids are being diagnosed earlier, potentially due to increased screen time, competitive drugs are in the marketplace, raising interest amongst doctors and patients, and a novel neuro-stimulation device may soon be available as a drug-free option to treat dye eye. According to Dr. Schachter “With the increase in digital device use by all demographics, we are seeing more and more patients at risk of eyestrain and dry eye disease. Of particular concern is the younger population, many of whom have grown up staring at smartphones, tablets, and laptops. Fortunately, between the medical community and industry alike, we are seeing more awareness, research into therapies, and hopefully lifestyle changes geared toward prevention.”
So, if this doctor, who boasts three dogs, a 100-pound tortoise, an aviary, alpaca, llama, cat, and 12 chickens in addition to being a Vision Source administrator, running a bustling practice and almost 15k Twitter followers doesn’t get overwhelmed by the prospects of treating dry eye disease, should you?
TFOS Staff Writer