By Jade Coats, OD, FAAO
Optometrists have been trained to look for the biggest sight-threatening conditions like glaucoma, macular degeneration and retinal disease. Although early detection of these diseases is critical, it should not come at the expense of overlooking common quality-of-life-limiting conditions such as dry eye disease (DED) and ocular surface disease (OSD).
I believe ocular surface screenings should be just as common as the glaucoma suspect workups we already do. We have the tools to diagnose DED and OSD, the treatments to improve signs and symptoms, and most importantly the patients who need help whether they realize it or not.
This belief comes from years of seeing how early detection changes lives. My first decade in practice was in a collaborative OD-MD setting, where I saw firsthand the impact of the ocular surface on cataract and refractive surgical outcomes. It became clear to me that if we wait until a patient is symptomatic to diagnose an ocular surface condition, we’ve already lost valuable time.
FORGING RELATIONSHIPS WITH PATIENTS
From a young age, I knew I wanted to work in health care. The thought of helping people solve their medical problems excited me, but my main draw to healthcare was the ongoing relationships I envisioned having with my patients. Early jobs in both an optical setting and as a pharmacy technician shaped my perspective, showing me the power of vision correction and the role pharmaceuticals play in patient care. Optometry brought those interests together, and I became fascinated by the complexity of the eye.
Seeing the role of ocular surface health in every outcome helped me develop a professional mission to make DED detection and management a routine and proactive part of optometric care.
Performing routine ocular surface screenings isn’t just good medicine, it builds trust. Patients know they can come to me as soon as a problem starts because I’ve already educated them on what to look for. I tell them the earlier we act to treat their signs and symptoms, the better their outcomes will be. This extends to comfort, vision quality, and surgical results.
Patient care starts with listening. Many of them have felt dismissed in the past, so validating their experience and concerns is just as important as the diagnostic workup itself. For DED, asking the right questions about things like computer use, CPAP machines, and medications often uncovers the real cause of their symptoms.
I keep my conversations with patients grounded in their personal needs. If someone is pursuing premium cataract surgery, I compare their eye to a windshield: You wouldn’t spend thousands of dollars on the lens behind it without first making sure the windshield is perfectly clear. If they’re a heavy computer user, I’ll talk about reducing digital fatigue. If they wake up with watery eyes, we’ll discuss why that happens and how to fix it.
TREATMENT PLANNING
My treatment plans are layered: lifestyle adjustments, prescription anti-inflammatories, thermal lid treatments, and punctal plugs all play a part in improving ocular surface health. I rarely rely on one intervention alone. Additionally, I always give multiple treatment options. This is done not to overwhelm them but to give them hope that, if one approach doesn’t work, we have others.
One favorite recent addition to my toolkit of treatments is cyclosporine ophthalmic solution 0.1% (VEVYE, Harrow). Previous cyclosporine formulations that were available when I started practicing were half the concentration. Cyclosporine ophthalmic solution 0.1% is dissolved in a semifluorinated alkane and works quickly. Data shows improvements in as little as 2 weeks,1,2 is comfortable upon instillation, spreads evenly over the ocular surface, and saturates the ocular surface for up to 8 hours.3 Additionally, it has an affordable cash price of $59 thanks to the Vevye Access for All program. This combination means patients are far more likely to stick with treatment.
THE FUTURE I’D LIKE TO SEE
Optometry needs a mindset shift. We should diagnose DED and treat ocular surface health with the same urgency and structure we bring to glaucoma and other sight-threatening conditions. By incorporating routine screenings into every exam, educating patients before symptoms begin, and using the full range of tools available to us, we can bring some focus to the ocular surface. We must catch DED earlier, improve everyday vision outcomes, and dramatically enhance quality of life for our patients. For me, that’s not just good optometry, it’s the kind of care I’d want for myself and my family.
REFERENCES
- Data on file, Harrow.
- Akpek EK, Wirta DL, Downing JE, et al. Efficacy and safety of a water-free topical cyclosporine, 0.1% solution for the treatment of moderate to severe dry eye disease. The ESSENCE-2 clinical trial. JAMA Ophthalmol. 2023;141(5):459-466.
- Agarwal P, Korward J, Krösser S, Rupenthal ID. Preclinical characterization of water-free cyclosporine eye drops – factors impacting ocular penetration ex vivo and in vivo. Eur J Pharm Biopharm. 2023;188:100-107.
Featured photo credit: Kawee Srital-on, Getty Images
