An orthoptist-led dry eye clinic established in Sydney is proving orthoptists have the skills and knowledge to improve patient education and achieve better outcomes for patients with dry eyes.
Dry eye disease (DED) is a complicated and pervasive ophthalmic condition that, while frequently diagnosed, is poorly categorised, understood and managed by both patients and professionals.
“We have found the orthoptic led dry eye clinic to be a valuable service that fills what was a niche gap in the services we provide.”
This frequently stems from the fact that for many years DED has been an oversimplified diagnosis. Many patients have been left sifting through the shelves of drops at their local chemist, feeling overwhelmed and frustrated.
In a large ophthalmic practice, many of these patients present to us highly symptomatic. Despite potentially possessing more visually debilitating ocular co-morbidities, their main concern is the constant burning, pain and other symptoms of DED.
The case history is often long and complicated with the patient having seen multiple health practitioners and trialling many different eye drops, yet the resounding conclusion is ‘but nothing works’.
At Marsden Eye Specialists in Castle Hill, Penrith and Parramatta in NSW, we came to the realisation that better avenues for the assessment, education and treatment of dry eyes were necessary for our patients and our practice.
Patients have high expectations when being seen in a private ophthalmology practice and if their concerns are insufficiently validated, they will leave the practice dissatisfied. We have seen first-hand how this has led to poor reviews and complaints.
Fortunately, DED has seen a recent resurgence of interest. Work by the Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop II has helped improve our understanding of the pathophysiology of DED and provide evidence-based management guidelines.
In March 2020 we established an orthoptist led dry eye clinic at Marsden Eye Specialists. Importantly, this means the burden of DED management is shared in our practice with excellent use of orthoptic skills.
Orthoptists have the skills and knowledge base to improve patient education and achieve better outcomes for patients with dry eyes thereby increasing satisfaction within their work environment.
Our orthoptic led dry eye clinic was established as a service to existing patients that aims to:
- Improve patient education
- Enable comprehensive assessment and accurate diagnosis
- Provide an avenue for in-clinic dry eye treatments
- Allocate a large amount of time to each patient
- Ensure patients feel their concerns are heard
The benefits of the dry eye clinic include improved patient understanding of their condition, improved compliance and more customised treatments.
The Marsden Eye Specialists dry eye clinic runs fortnightly and new patients are given one hour appointments. We use Ocular Surface Disease Index (OSDI), keratography and tear osmolality for our diagnostics.
The orthoptist then explains the results to the patient and spends time educating the patient on their type of DED and associated diagnoses such as meibomian gland dysfunction (MGD) and blepharitis. This includes providing a tailored home treatment regime.
We have created our own Marsden Eye Specialists education and treatment handouts based on the outputs from the TFOS Dry Eye Workshop II reports including which products relevant to the diagnosis are easily available for patients to source.
Finally, the orthoptist performs any necessary treatments including warm compress and massage, lid hygiene, eyelid debridement and meibomian gland expression.
Despite the impacts of the COVID pandemic, patients continued to present to the dry eye clinic. In the two years since its inception, we had 110 new patients attend, resulting in 170 treatments being performed by the orthoptists.
On presentation, 6% of our patients had aqueous deficiency DED, 30% had evaporative DED and 64% had combination DED. Of great significance was the fact that 94% of patients had MGD and therefore required in-clinic treatments.
After initial assessment in the dry eye clinic, patients return to the care of their referring ophthalmologist or are requested to return to the dry eye clinic if further management is required. Patients who have an inadequate response to dry eye clinic interventions are referred back to their ophthalmologist for more specific treatments or further investigations of underlying systemic disease.
At Marsden Eye Specialists we have found the orthoptic led dry eye clinic to be a valuable service that fills what was a niche gap in the services we provide. This internal collaborative approach to DED management has reduced the DED burden on often time poor ophthalmologists and increased the skills and autonomy of our orthoptic team.
Our patients are also happier with 80% of patients experiencing an improvement in symptoms on their OSDI after only one visit to the dry eye clinic. If our patients, orthoptists and ophthalmologists are happy then it is clear that there is a need for more ophthalmology practices to offer this type of DED management.
About the Author: Mitchell Bagley is Orthoptic Team Leader at Marsden Eye Specialists and Research Centre Parramatta, Castle Hill and Penrith. He completed a Master of Clinical Vision Sciences at University of Technology
Orthoptics Australia strives for excellence in eye health care by promoting and advancing the discipline of orthoptics and by improving eye health care for patients in public hospitals, ophthalmology practices, and the wider community. Visit: orthoptics.org.au