Eyeworld

18 February 2018 EW NEWS & OPINION by Eric Donnenfeld, MD, EyeWorld chief medical editor As more and more patients will be interacting with both optome- trists and ophthalmologists, I would note that there is common ground for us all to work together in educat- ing each other and our patients on the management of dry eye disease. O ne unwritten etiquette rule tells us to avoid starting discussions on certain topics that tend to create ill will, not to mention awkward situations. The general consensus is that a conver- sation during which you're trying to change a person's mind about topics that people are passionate about, like religion or politics, will not be constructive. For eyecare profes- sionals, discussing the relationship between ophthalmology and op- tometry can easily be added to this short list of impassioned topics. In my conversations with both oph- thalmologists and optometrists, the dialogue about key issues facing our field tends to be monodimensional, with an emotional take-it-or-leave-it attitude that allows little room for discussion. Regardless of our passionate discussions, it's clear there is an epidemic of dry eye disease today in the U.S. Dry eye is the most common reason patients go to their eyecare providers. It also impacts almost every aspect of our patients' eye health, from standalone dry eye disease reducing patients' quality of life, to glaucoma medication toxic- ity inducing dry eye, to the direct impact of dry eye disease on cataract surgery and LASIK outcomes. Under these circumstances, ophthalmology and optometry can undoubtedly work together in the management of dry eye disease. For decades, dry eye disease was the back pain of our profession in that there were no good treatments, patients did not get better, and very few ophthalmologists cared for these patients despite an overwhelming need. Thankfully, over the last de- cade this has changed as improved diagnostic tests and a deeper under- standing of the role of inflammation and meibomian gland dysfunction have resulted in better treatment options. Topical immunomodula- tors, procedures to treat lid margin disease, punctal plugs, and the role of nutrition have all resulted in bet- ter patient management. The demographics of patients living longer with appropriately higher standards regarding quality of vision and quality of life com- bined with a shortage of ophthal- mologists results in today's situation that demands our specialties work together to improve patient care. With the increased need to manage dry eye disease and optimize the ocular surface and educate patients prior to cataract surgery, many surgeons and optometrists have already decided the best way to meet their patients' needs is to form joint practices. This collaborative work allows for the seamless division of tasks that optimizes everyone's time and brings superior outcomes to pa- tients. Outside such joint practices, optometrists in corporate and pri- vate practice settings refer patients to ophthalmologists when needed. Optometric societies are providing leadership to help educate them on best practices and the importance of optimizing the ocular surface prior to a surgical referral. Dry eye, optometry, and ophthalmology Chief medical editor's corner of the world As it should always be, the patient comes first. EW Contact information Donnenfeld: ericdonnenfeld@gmail.com " With the increased need to manage dry eye disease and optimize the ocular surface and educate patients prior to cataract surgery, many surgeons and optometrists have already decided the best way to meet their patients' needs is to form joint practices. "

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