Saturday, July 22, 2017

Getting good dry eye care

It's the weekend, and I'm a day late anyway, so I'm going to keep this short and sweet! Well, relatively.

A couple of "oldies but goodies"....

Many years ago I wrote a couple of lengthy articles about dry eye medical care, particularly as regards navigating dry-eye specific pitfalls of the doctor-patient relationship. There have been a lot of changes in the dry eye world since then, but there is still a great deal in those articles that's directly relevant to patient needs today, so I decided to post the links here.

How to get better care from your dry eye doctor, covering:
  • Is my current eye doctor worth investing in?
  • How are my goals and measuring sticks different from my doctor's?
  • What should I expect, or not, from my doctor?
  • What is my doctor expecting from me?
  • How do I bridge communication gaps?
  • Resolve to be a Truly Great Dry Eye Patient
  • Consider both MDs and ODs
  • Determine what you want, or rather need, from a new doctor
  • Where and how to look, and whether to travel to a specialist
  • Preparing for the first appointment

Navigating current trends

Things are changing all the time. Treatments that hardly anyone even knew about ten years ago are being kicked around online frequently and while they definitely aren't all being scouted in non-specialist eye care practices, awareness is clearly on the rise. Demographics are also putting heavy pressure on eye care practitioners to bone up on the latest and greatest dry eye tools.

Each change brings its own issues along for the ride, of course. I'm going to highlight here random current issues to supplement the previous articles.

The "Dry Eye Specialist" phenomenon and how to beat it

In the aftermath of the 2008 recession, which drained Americans' discretionary income for things like LASIK, a curious trend followed. Clinics that primarily advertised as laser surgery centers in the past gradually began hanging out a new shingle. The wording varied, but the bottom line was they were starting to tout themselves as a the local go-to dry eye clinic. This trend continued and picked up speed in ensuing years, fueled by things like demographics, Lipiflow emerging as a much-needed replacement cash cow, and increasingly demanding consumers who are suffering enough to not settle for the "Ye Olde Schirmer, Plug-n-Drop, oh, and Restasis too because we might as well" school of dry eye diagnosis and treatment.

Unfortunately a lot of these new self-described dry eye specialists and dry eye clinics really don't offer much more than increased advertising. Step right up, folks, get your Xiidra script here!

Would the real dry eye specialists please stand up?

Technically, there's no such thing (it's not a formal subspecialty as far as I know), so anyone can label themselves a specialist. Trying to find a truly helpful doctor is extremely challenging unless you already know the dry eye landscape and its craters quite well AND are social media savvy.

My rules of thumb have always been that many people can benefit from a really smart optometrist on their team for regular visits, because optometrists by and large are more accessible and will spend more time with you than most ophthalmologists. But you also want a good cornea specialist ophthalmologist with a specific professional/scientific (as opposed to financial) emphasis on dry eye, particularly when you're in the worst stages and/or don't yet have a really super-thorough and accurate diagnosis, and also if you have special medical needs.

Finding the right kind of optometrist is all about hunting on social media, unless you're lucky enough to have access to the pooled knowledge of a good local support group. Finding a cornea specialist ophthalmologist? Scour the resumes. The problem with cornea specialists is that a significant majority aren't actually interested in corneal disease. They're interested in corneal surgery, probably refractive (take a bow, LASIK industry, you have transformed the profession). The ophthalmologist gem you are looking for is a cornea specialist that really digs disease, as opposed to just snatching at and sporting the dry eye diagnostics and treatments du jour as announced from a podium somewhere.

The "Micro-Manage Your Doctor" trend

So here's another thing I'm seeing more of these days. The hyper-educated patient who goes to their doctor with a lengthy shopping list of (a) tests they want done, (b) potential diagnoses they want to discuss, and (c) potential treatment options they want full-on support for, including but not limited to drugs (manufactured and compounded), devices, surgeries, consumer products, dietary plans and oh yes a long litany of dietary supplements.

I am absolutely all for educated patients and partnering with our doctors.

But... moderation in everything, folks. 

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