How to improve a dry eye practice

[Rebecca Petris]

The majority of those who responded to our "How many eye doctors" poll indicated that they had been to three or more eye doctors since being diagnosed with dry eye.

If you have moved on from one or more doctors due to dissatisfaction with their response to your dry eye condition, take a moment to think back over the specific reasons why.

What could they - the doctor and/or their staff - have done differently that would have made you more likely to stay with their practice?

Post your suggestions, please!

[Guest]

On a comical note, I wish the DR had have said to me that I wasn't suitable for laser surgery. That would have made my day - knowing what I know now.

On a serious note, a little more compassion and a better understanding of the serious implications dry eyes has on ones lifestyle.

Oh and dropping the patronising "have you tried any atificial tears" may have made me go back for another visit.

Ian

[20/20_Hindsight]

One particular doctor comes to mind on this question for me. He was angry I had Lasik surgery and told me so every time I went into the office. He repeatedly told me I was not a candidate. He repeatedly told me "I don't know what you want me to do - there is nothing more I can do to help you". Well, he didn't help me at all. Just gave me a bag of sample drops every time I went there. He angrily dispensed a Restasis prescription.

I think a nicer bedside manner could have gone a long way. And not lecturing someone who had a disasterous Lasik outcome that they should have not had the surgery sure didn't help the depression aspect of it either. LIke I hadn't figured out by now that I'd been lied to when I was told I was a "perfect" candidate.

Luckily, I found a compassionate doctor after that. He has not really helped me with dry eye, but at least he understands the pain and devastation of it all and tries to suggest new things to try. He never blames me for it. I think compassion and true understanding of how miserable a severe dry eye can be goes a very long way in my book.

[YGB]

1) Understand that "dry eye" is a garbage can term and have thorough knowledge of the various types of dry eye.

2) Effectively communicate with the patient as to what the problem is (i.e. water, oil, mucin, etc.) and what the proposed next steps are.

3) Do a TBUT and Schirmer test periodically and communicate the results so that the patient can see where they are at in terms of scores. Also, listen to the patient in terms of symptoms since scores and symptoms do not always correlate.

4) Allow the patient time to ask questions and give thoughtful consideration and responses since many dry eye patients are suffering more than many people (including many ophthalmologist/optometrists) realize.

5) If the MD does not like LASIK and the dry eye is LASIK induced, then the MD should communicate to the patient as to what the MD has done about changing LASIK within his/her profession and not vent unjustly to the already damaged LASIK patient.

6) Give timelines for next steps and discuss possible known outcomes. For example, if giving a Restasis prescription, discuss that in approx. 20% of patients, restasis can burn and discuss what the patient should do if this happens.

7) Discuss the proper follow-up recommendations (ex. I recommend that you see me every 3 months if you are seeing progress or sooner if your condition worsens).

8) Properly inform the patient of the potential pros and cons of various treatment options.

9) Give the patient a prognosis of possible final outcomes if known at the time based on the MD's clinical experience. If the MD lacks experience/knowledge in the dry eye field, then the MD should refer the patient to a more experienced/knowledgable MD.

[kitty]

Don't address complaints of burning pain with "Well, your eyes LOOK nice and white today".

When an experienced DES patient presents with concerning symptoms, your first question should NOT be, "are you lubricating?"

My response to both is,

Well, duh!

[Lucy]

As disastrous as my lasik surgery was--and have been to many, many doctors in the years following, my best dry eye doctor is the doc who did the damage. He spends time with me, which other docs have you in with a possibility of 2 minutes total chair time. He also lets me bring my ideas to him and he will help, investigate, obtain meds etc. Sort of like dancing with the devil. But, I am where I am, and my doc is the only one who will give me adequate care on the dry eye front.

[shells]

My recent visit at Wilmer was to see a specialist, since my current doctor was running out of options. My current doctor is wonderful though, and I am very lucky to have found her. Here is why I like her:

1. She starts every visit with allowing me a chance to tell her how things have been. What the pain has been like, how bad, etc.? How I feel whatever new treatment we started has been working (she actually ASKS about my comfort, instead of just looking at my eyes or my tear scores to tell).

2. She answers ALL my questions, and not just with a yes or no. She goes into detail and never makes me feel like I asked a dumb question. After some questions, she will even go back and look in my eyes again.

3. She lets me offer suggestions and then shares her input as to the pros and cons.

4. I NEVER feel like I'm being rushed out of the office.

5. She understands that how my eyes look is not always how my eyes feel. She understand that dry eye pain is tricky (i.e. someone with no tears might feel fine, while someone with a ton of tears might be in constant pain).

6. She is optimistic. I think it was Flick who was talking about how taking away hope from someone with our conidition can really crush the spirits. She truly thinks that I will get my tears back someday with some new treatments. For me, I NEED to believe that there is something that will someday make me more comforatble, and it is nice to have a doctor that is optimistic as well.

6. Maybe this is a bit too much to ask for from most doctors, but just to point out how WONDERFUL my doctor is - She tries to keep me extra comfortable when I'm in for treatment. Before she puts plugs in, she tells me to sit back and rest my eyes because they are going to have to be open for a while when she does the plugs. How many doctors would think of that?? It is like she knows I'm there because I'm in pain, and I'm probably in pain at that very moment, and she understands that. I remember one of my old docs offices where they gave a new technician the job of doing that fun little air puff test...it took her forever just to get anywhere near my eye, and she just kept saying, stop blinking, I need you to stop blinking. Like I could just sit there for 60 seconds straight with my eyes wide open while she figured out this machine, and then shot a nice blast of air into my already bone dry eye. My new doctor checks my eye pressure in a more dry eye friendly manner.

Basically, I feel that I plan out alot of my treatment. She knows that I visit this website and have done other research online, so she knows that I have a good idea of what the options are. My corneas generally look decent, and at this point she is not afraid of any permanent damage or scarring. So, in terms of treatment we can do as much or as little as I like, since it really comes down to trying to improve my comfort.

[Jeff]

I think the obvious is:

Really care about how I am feeling.
Don't treat me like someone who is not up to speed with what is going on with their own eyes, I know how bad my eyes feel more than you do at least give me credit for that much.
I sense a game when I go in, its like if we pretend theres nothing wrong, then there won't be anything wrong. I am all for a positive outlook on life and given my current circumstances know its what has helped me get to this point in my life. I don't like being patronized, how about positvely admitting that it was not as successful as you pretend it was or like the statistics imply to other people. The only thing worse than no information is bad information. Tell the truth and if you really don't care about how I am feeling then don't ask. We know the problem exists stop treating it like it dosen't.
Jeff

[Jade9923]

Invent doctors who have an interest in treating dry eyes. Seems most don't as it is a tedious and time consuming problem for doctors with little compensation for their time and effort.

[Rebecca Petris]

Invent doctors who have an interest in treating dry eyes. Seems most don't as it is a tedious and time consuming problem for doctors with little compensation for their time and effort.

That's it in a nutshell.

[calli66]

Invent doctors who have an interest in treating dry eyes. Seems most don't as it is a tedious and time consuming problem for doctors with little compensation for their time and effort.

This is something I just don't understand. Maybe I'm naive, but I thought doctors charged for patient visits, checkups, etc. So why is a dry eye patient less lucrative? Do you mean the doctors have to be doing lasik, or retina repairs, or cataract surgery, or other drastic procedures, in order to make money? They get an office visit fee for the dry eye patient just like their other patients.

So what IS the big money producer? And is this the reason to be an ophthalmologist?

I just don't get it.

C66

[Rebecca Petris]

So what IS the big money producer?

Surgical fees.

Dry eye patients are undesireable financially because they require more chair time and produce less revenue than other conditions.

They are also generally unsatisfactory as a treatment group because... their condition is difficult to quantify (discomfort does not always correlate well with clinical signs) and they walk in miserable and leave miserable and the doctor often knows - or rather, believes - s/he really can't help.

Thankfully, there are many-many 'hidden gems' out there - doctors who really do put in the effort to try and help us.

[shoemama]

I think that the dr that annoyed me the most put my dry eye down to "Being a woman, and getting older". Well, thanks bud, I had a handle on both those conditions already, now what are we to do about the dry eye? Needless to say the doc & I parted company quite quickly.

[Lucy]

Shoemama, that's what all the lasik docs said in the early days of lasik when it became apparent the surgery was causing dry eyes. Any female (probably with an age of 35+) was told "you know you're getting older...."

That got them by for awhile, although not long. It was when men (both younger and older) and women in their early 20's began having the same problem that the old standby just didn't cut it any longer. As we know from this board, dry eye cuts through all stereotypes.
Lucy

[Julie1]

Refrain from telling a patient that if s/he "is going to have an eye problem, dry eye is the one to have." That's definitely not what a patient wants to hear when s/he has just been diagnosed and is going through the acute phase of severe chronic dry eye.