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Karen Fernandez, Gui-Shuang Ying, Giacomina Masssaro-Giordano, Stephen Orlin, Michael Sulewski, Ilaria Macchi, Kristin Hammersmith, Parveen Nagra, Christopher Joseph Rapuano, Vatinee Y Bunya; A Survey of Dry Eye Practice Patterns. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2651.
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Dry eye disease (DED) is highly prevalent and is one of the most common reasons patients seek care from an ophthalmologist, with an estimated 11% of dry eye patients having underlying Sjogren's syndrome (SS). However, there is no standardized approach to evaluating DED patients or for deciding which patients to refer for SS work-ups. Our goal was to survey ophthalmologists to assess current practice patterns regarding the evaluation of dry eye patients and referrals for SS work-ups.
An on-line survey was sent to ophthalmologists affiliated with the Scheie Eye Institute or Wills Eye Hospital using REDCap in August 2015.
There were 474 survey invitations sent out and 101 ophthalmologists completed the survey (21.3%), with the majority being cornea specialists (42.6%). The top 3 most common traditional dry eye tests performed were corneal fluorescein staining (89%), tear break-up time (78%) and anesthetized Schirmer’s test (51%). Conjunctival lissamine green and/or rose bengal staining were performed by less than 25%. The top 3 most common newer dry eye tests performed were tear osmolarity assessment (23%), MMP-9 testing (17%) and Lipiview (13%).Half of participants report that they refer less than 5% of their dry eye patients for SS work-ups, with 18% reporting that they never refer any patients. The majority (83%) felt that there is a need for an evidence-based standardized screening tool for dry eye patients to decide who should be referred for evaluation for SS. The most common reasons for referrals included positive review of systems (60%, most common: dry mouth), severe dry eye symptoms (51%) or signs (47%), or dry eye that is refractory to treatment (42%). The most common ocular sign that would cause a referral for a SS work-up was severe corneal staining (59.4%).
Despite the introduction of several new diagnostic dry eye tests in recent years, our study suggests that ophthalmologists continue to prefer the use of traditional dry eye tests in practice, with the most common test being corneal fluorescein staining. There continues to be an under-referral of dry eye patients for SS work-ups, which may be contributing to the continued under diagnosis of the disease. The majority of respondents felt that there is a need for an evidence-based standardized screening tool for dry eye patients to decide who should be referred for SS evaluation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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