Treating dry eye is so much more complex than compresses and cleanser, in-office treatments and take-home follow-up care. When your patients go home, dry eye can often leave a great impact on their lives and decision making. And while there can be many joyous moments after finally finding a successful treatment on a long road of dry eye suffering, the earlier moments of diagnosis and managing expectations can present a challenge. “It can be so overwhelming; you can see it on their face,” says Hardeep Kataria, OD, FAAO. “Their eyes are glazed over, and they are not paying attention anymore because the information about inflammation is a difficult concept to understand.”
Mahnia Madan, OD, FAAO, recalls a pair of patients—a soon-to-be husband and wife—who had postponed their wedding day because the bride- to-be was suffering from dry eyes and had constantly red and itchy eyes. “They were both crying, and you just have to empathize with them as you go through the steps of how to manage it.”
Here are a few suggestions on navigating these challenging conversations.
Set boundaries. Just as these encounters are overwhelming for the patient, they are tolling on the doctor and staff, as well. Dr. Madan has customized her schedule so that she can emotionally manage the unique situations that arise. “You are put in a position where you are often the patient’s last hope. To go down that journey with patients, it’s important to be aware of your own mental health.” She limits her schedule to see 2 new dry eye consultations in the morning and 2 in the afternoon.
Don’t over promise. Dr. Kataria says that while you may have a full toolkit of diagnostic and treatment options, keep from over promising on results. “Be careful with your language,” she says. “If they come in and want multifocal IOL, and you have to break it to them that it’s not a good option, that is a hard conversation to have.”
Realize the impact on the entire family. “I have an elderly patient who comes in with her son, and he has to help her with everything including putting drops in 10 times a day because she has arthritis,” Dr. Madan says. “It’s heartbreaking.”
Take on the educational challenge. You never know what questions may come up. Plan your time with patients accordingly. Dr. Kataria recalls a patient asking about her diagnosis of demodex, inquiring, “Do I have bed bugs in my eyes? Is this contagious? Can I be around my children?” Dr. Kataria says, “This opened up a whole new can of worms. This is why I need 30 minutes for these conversations.”
Education is also important for patients who are having trouble accepting what is causing their issues. For example, Dr. Kataria has seen that patients who use high-end cosmetics often don’t want to put the blame on the quality product. Be careful in your choice of words and tone during these conversations. “It doesn’t occur to them it could be affecting their ocular surface when they paid $50 for it,” Dr. Kataria says. “I don’t want to come across as demeaning or judging; I approach it with education. ‘These ingredients have not been regulated,’ is a factual standpoint, rather than leaving someone feeling attacked or on the defense.”
Wrap it up with a summary. Dr. Kataria and Dr. Madan recommend utilizing a written checklist, a physical paper that patients can take home with appropriate options from orals to eyedrops checked off for each patient. It sums up details from the exam that may need further clarification at home after so much information has been digested.
Treating dry eye disease has been an eye-opening experience, says Dr. Madan. “You have to be empathetic, and the only way to do that is to have knowledge about the condition,” from understanding how much it impacts quality of life and how devastating it can be to the ocular surface, as well as how to design a treatment plan that is backed with genuine and personalized care. The options and education available are continuing to evolve, so consider getting started on educating yourself first and then expanding your services today.