Chapterized Indication & Important Safety Information
Xiidra is indicated for the treatment of the signs and symptoms of dry eye disease.
Please refer to the Important Safety Information and Full Prescribing Information regarding taking Xiidra that may include that it is contraindicated in patients with known hypersensitivity to lifitegrast or any other ingredients, as well as the common adverse reactions, such as instillation site irritation, dysgeusia, and reduced visual acuity.
Hello, my name is Maria Vasilopoulos. I am a Certified Ophthalmic Assistant at the Illinois Glaucoma Center in Mokena, Illinois.
Welcome to Tech Talks…DED DE-TECH-TIVE, Identifying the Dry Eye Patient. Today, I will be discussing the role of technicians in identifying patients with dry eye disease.
As a technician in a busy practice, I am often one of the first people to communicate with patients. This is why I consider my role to be part “De-TECH-tive” when it comes to assisting with the proper screening and identification of dry eye disease patients. In my opinion, this means that we should be very familiar with dry eye risk factors, as well as the appropriate questions to ask our patients, in order to effectively screen for dry eye disease.
Before we dive into screening, let's think about how many potential dry eye patients may already be sitting in our waiting rooms.
According to the Beaver Dam Offspring Study in 2008, it was found that approximately 14.5% of adults 21 to 84 years of age had symptoms consistent with dry eye disease.1
Using that prevalence and the estimated adult population from the US census in that same year, we extrapolated that approximately 30 million Americans had symptoms consistent with dry eye disease.1,2
Given that estimation, I believe that there are likely more dry eye patients in our offices than we think. In addition, dry eye disease is one of the most common reasons that patients seek medical eye care.3
At my practice, the first step in dry eye screening typically happens during the patient workup before the Ophthalmologist or Optometrist enters the room. During this time, a technician may perform the initial dry eye assessment, which includes a patient history. I've found that taking a thorough patient history provides certain cues and clues to be mindful of when assessing the patient.
There are several potential dry eye risk factors to look for when conducting a patient history. For example, age and gender are two of the potential risk factors for dry eye.3 The topical or systemic medications a patient is taking and their existing medical conditions are important to cover during the workup. For instance, epidemiological studies have identified anti-depressants and antihistamines as potentially increasing the risk of developing dry eye.3 Additionally, according to TFOS DEWS II, conditions such as diabetes and thyroid disease may be potential risk factors for dry eye.3
Certain disorders, such as meibomian gland dysfunction, blepharitis, and rosacea – which I commonly see in our practice – are also potential risk factors for dry eye.3,4 Finally, we should take note of any modifiable risk factors – these can include things like environmental conditions, contact lens wear, and digital device use – all of which may contribute to dry eye disease.3
As you can see, there are numerous risk factors associated with dry eye disease. In my opinion, our ability to uncover this information is an effective way for us to help screen patients during the preliminary workup. In my experience, this information may trigger the need for further evaluation of dry eye.
In our practice, we always look at a review of systems and medication. There could be other conditions or instances that may be contributing to the occurrence of dry eye disease – things like diabetes, can be part of the reason for dry eye disease. It is also important to closely review their medication list, so we always ask questions about any systemic medications or topical drops they are currently taking, as some can potentially cause dry eye.
Listening is an important skill when it comes to dry eye. I've found that asking the right questions can help to fully understand the patient's ocular health.
Patients may not realize that the symptoms they are experiencing can be attributed to dry eye disease. I have had patients believe that their symptoms were just a “normal” and acceptable part of aging. This is where we come in. Asking the right questions during the patient workup can help us to tease out and identify potential symptoms. There are several ways to assess symptoms that may suggest dry eye. One of which can be a simple questionnaire at intake, such as the OSDI or SPEED questionnaires.3
There are several symptoms commonly associated with dry eye. When listening to the patient describe their eyes during the work up, you may want to be mindful of hearing things like: a scratchy or gritty feeling (like something in the eye)5, red or irritated eyes5, or burning feeling in the eyes5. Recognizing the symptoms of dry eye disease helps to identify dry eye patients and aids in a timely diagnosis.
In our practice, we first identify why the patient is coming in to the office. Then we continue with specific questions related to their complaint or symptoms. For example, we ask how many hours a day are you on the computer, use a smart phone or reading? If they are a contact lens wearer, we ask…“Do you sleep with contact lenses?” and “What is your average wearing time?”
Based on their symptoms, here are a few questions you may want to consider asking your patients. These questions are interpretations from various guidelines and questionnaires that help identify patients with dry eye disease:
How frequent and severe is your eye discomfort? Asking about symptom frequency and severity can give insight into the potential chronic nature of dry eye disease.3
How long have your symptoms lasted and was there a triggering event? Dry eye disease can be chronic, and may generally worsen by the end of the day.7 Additional follow- up questions can help identify the trigger.
Are you taking artificial tears to reduce symptoms? If yes, ask additional questions, including how often and document the answer.8 Artificial tear use is a mainstay of dry eye therapy and attempts to replace or supplement the natural tear film.8 In my opinion is it important to pay attention to specifics when asking patients about their artificial tear use. If a patient is not responding to their current therapy, another option may be needed, such as Xiidra.8
Another question you may consider asking…Is your vision affected and does it clear with blinking? Prolonged staring can dry eyes and reduce visual quality. Vision generally recovers with blinking.7
Do you wear contact lenses? Contact lenses may worsen dry eye disease.7
In my opinion, it is very important for us, as technicians, to document this information in the patient's chart. Documenting potential dry eye risk factors and the answers to these questions allows me to not only accurately convey this information to the prescribing physician, but also serves as a record to detail what is happening with the patient.
In my clinical experience, knowing common dry eye risk factors, asking questions, and listening carefully are important components for screening patients for dry eye. Once you have identified a potential dry eye patient – what's next? If dry eye disease is suspected during the workup through a questionnaire or patient history, this may trigger further evaluation.7 This evaluation is likely based upon what diagnostic tools are available in your practice and what the physician deems appropriate. Once the Ophthalmologist or Optometrist determines what tests should be performed, it is important to document the outcome clearly so a plan can be determined, and progress can be measured.
Speaking from my own experience, I think that these steps will pave the way for you to become an expert dry eye de- TECH-tive within your practice.
Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the Beaver Dam Offspring Study: Prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806.
US Census Bureau. Current Population Survey, Annual Social and Economic Supplement, 2008. Accessed October 5, 2020. https://www.census.gov/data/tables/ 2008/demo/age-and-sex/2008-age- sex-composition.html.
Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II epidemiology report. Ocul Surf. 2017;15:334.365.
American Optometric Association. Dry eye. Accessed October 5, 2020. https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/dry-eye.
Sullivan DA, Rocha EM, Aragona P, et al. TFOS DEWS II sex, gender, and hormones report. Ocul Surf. 2017;15:287-333.
Starr CE, Gupta PK, Farid M, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45:669-684.
Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II diagnostic methodology report. Ocul Surf. 2017;15(3):539-574.
Jones L, Downie LE, Korb D, et al. TFOS DEWS II management and therapy report. Ocul Surf. 2017;15:575-628.