Eyeworld

C ORNEA Patient instructions Pearls for better tear use •Pull the lower lid out and put the drop in behind the eyelid. •Lay down flat to ensure the drop gets into the eye. •Aim for the inner corner of the eye. •Allow for the shape of the orbit bones to act as a natural funnel to get the drop into the eye. Source: James Schumer, MD by Vanessa Caceres EyeWorld Contributing Writer Contact information Nolan: markn@revisioneyes.com Park: lp2736@cumc.columbia.edu Petris: rebecca@dryeyecompany.com Rock: drrock@wangvisioninstitute.com Schumer: schumer@revisioneyes.com Wang: drwang@wangvisioninstitute.com brands that still contain benzalkonium chloride. "The safest rule of thumb is to purchase pre- servative-free lubricant drops," she said. Newer preservative-free multidose bottles can help economize the costs of preservative-free tears, Ms. Petris said. At ReVision LASIK and Cataract Surgery, doctors give patients their eyeComfort box, which contains a 60-day supply of products they have found work well for dry eye. The box contains Oasis artificial tears (Oasis Medical), Retaine Flax (OCuSOFT), HypoChlor Spray (OCuSOFT), and a Bruder Moist Heat Eye Compress (Bruder Healthcare Company). "At the end of the 60-day supply, the patient's progress is evaluated. If the patient is getting relief and symptoms are effectively managed, they can choose to replenish the eyeComfort box supplies for another 60 days and continue on with that treatment plan," Dr. Nolan said. A rtificial tears are often the first line of defense for dry eye. Because they are so ubiquitous in eyecare, oph- thalmologists and optometrists must regularly evaluate what's new to the artificial tears market and what tear- use practices are most effective for patients. Although some patients already use artifi- cial tears, they may decide to visit their eye doc- tor because the drops don't seem to be enough. They may think they need to try a different kind of tear or treatment. Some may realize the value of getting to the root cause of their dry eye. "There are a number of reasons that pa- tients can experience dry eye, including prob- lems with the eyelids and systemic conditions," said Lisa Park, MD. "It is important to treat these underlying causes in addition to using arti- ficial tears to address symptoms of dry eyes." Product choice Though some eye doctors may have strong ar- tificial tear preferences, many think the majority work well. Ming Wang, MD, tends to recommend tears when he has samples available for patients. With the easy availability of Refresh (Allergan) and Systane (Alcon)—along with related coupons he can pass on to patients—he tends to recom- mend those tears to patients. "Systane Balance, Systane Ultra, Refresh Plus, and Refresh Optive are typically my top recommendations in [those] families," he said. "Other good brands include Soothe [Bausch + Lomb], Blink [Johnson & Johnson Vision], and TheraTears [Akorn]," he said. A newer tear called Refresh Repair (Aller- gan) provides symptomatic relief but also helps heal the surface of the eye, he said. Preservative-free tears have many fans. "Preservative-free artificial tears are recom- mended, but for maximum coating of the ocu- lar surface, I have been leaning toward gel drops or Refresh Celluvisc," said Mark Nolan, OD. Rebecca Petris has an online dry eye store and is in daily contact with dry eye patients. She advises customers to steer clear of generic Artificial tears playbook for dry eye About the sources Mark Nolan, OD ReVision LASIK and Cataract Surgery Columbus, Ohio Lisa Park, MD Associate professor Department of Ophthalmology Columbia University Medical Center New York Rebecca Petris Dry Eye Company Poulsbo, Washington Nathan Rock, OD Wang Vision 3D Cataract and LASIK Center Nashville, Tennessee James Schumer, MD ReVision LASIK and Cataract Surgery Columbus, Ohio Ming Wang, MD Wang Vision 3D Cataract and LASIK Center Nashville, Tennessee continued on page 56 54 | EYEWORLD | AUGUST 2019

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