Implement Dry Eye Care Into Your Practice

Whitney Hauser, OD, speaks with Gary Wörtz, MD, to address some unanswered questions regarding dry eye disease. Listen as Dr. Hauser discusses her efforts to improve physicians' understanding of this condition and learn about Dry Eye Coach-an educational resource for ophthalmologists and optometrists seeking information on the ocular surface.

Gary Wörtz, MD: Open. Outspoken. It's Ophthalmology off the Grid—an honest look at controversial topics in the field. I'm Gary Wörtz.

Dry eye disease—it's an increasingly prevalent yet vastly underdiagnosed condition. For a large number of practitioners, many sweeping questions remain. Which patients need additional evaluation? What test should I perform? How do I implement this into my practice? I recently spoke with Dr. Whitney Hauser, a true expert in dry eye disease, to learn more about her efforts to boost our understanding of this condition through a project called Dry Eye Coach.

Speaker 1: Ophthalmology off the Grid is an independent podcast supported with advertising by Alcon.

Well, welcome back to Ophthalmology off the Grid, and today, a special treat: We have Dr. Whitney Hauser with us from Southern College of Optometry. Whitney has been a friend for a little while. Every time I get a chance to talk to Whitney, I learn something. She's very passionate about education. She's passionate about dry eye, and those passions are really coming together in a new project that is really her baby. It's her idea. She's implementing this and starting to roll it out very soon. It's called Dry Eye Coach. Whitney, thank you so much for spending some time talking to us about your vision for this. I’d just love to get a little bit of background on your career. Maybe where you started, how this idea really generate in your mind and where you see this project going?

Whitney Hauser, OD: All right. Well, thank you so much for having me, Gary. I really appreciate it. It's a great opportunity for me. I have been eye care for about 15 years, and I started my career in ophthalmology working at a practice in Memphis, Tennessee for about 10 years and did a lot of preop and postop work with cataract surgery, LASIK surgery, but we also did a lot of dry eye. My attention throughout my career from the beginning was to be in education and I took a tenure detour into ophthalmology, which is great. Because I got a lot of patient care experience and it was really phenomenal for giving me a really firm background. After that, I decided to go back into education and when I did, I realize that there was a big gap between what students were learning in colleges. Whether it be optometry schools or med schools and what we were doing in clinical practice.

You can only learn so much at one time. I started lecturing a lot. I go out and lecture, do workshops particularly focused on dry eye, as you mentioned. What I found was, a lot of practitioners really just didn't have the basics down. Because when you're in the trenches and you're doing what you do everyday, it's hard to focus on anyone given thing. I thought, I really want to make dry eye care accessible to all practitioners, ophthalmology, optometry, technicians. In doing so, it just natural to put it on the Internet. I mean, if you're looking for a car, if you're looking for a restaurant, what do you do? You Google that. We want to make that educational opportunity accessible at the doctor's fingertips.

Dr. Wörtz: Well, I think that's tremendous. This is confession time for me. I, previous to working with Paul Karpecki who everyone knows as a dry eye guru like yourself, I was really that ophthalmologist who did not really appreciate dry eye for what it is. I didn't really look for it. As a matter of fact, I just, my funny joke is I just tried to throw our official tears samples at patients until they would leave.

Dr. Hauser: You're in good company, Gary.

Dr. Wörtz: All right. Confession time with that out of the way. I did have the opportunity to work with Paul Karpecki who is a true friend and a true mentor. Anyone in the industry who knows Paul, loves Paul. He was gracious. He's such a gracious guy to take a cataract surgeon like a cowboy like myself who really just was, at that time, more focused on perfecting and improving my surgical skills, patiently and quietly and systematically, helped me appreciate dry eye. It's hard.

Dr. Hauser: It has a huge impact on your outcomes. No matter how good a surgeon you are, if the ocular service is a mess, your outcomes don't reflect it.

Dr. Wörtz: That's exactly what I started to notice. Really, surgeons are, in many ways, creators of dry eye.

Dr. Hauser: Absolutely.

Dr. Wörtz: We're severing the nerves. We are creating dry eye, whether it's LASIK, whether it's cataracts. We are going to take people from mild to severe or mild to moderate if it's there. If it's not there, we may put them in a little bit of jeopardy. Walk me through a little bit about maybe some common mistake you see practitioners making. You're in an interesting situation. You're really at the intersection between the professorial role at Southern but also with your past experience in the real clinical world of refractive and cataract surgery. You have a unique perspective on this because you've see it from both sides. What's missing? What's that gap in maybe the education from docs who are out 10 to 20 years versus what maybe your students are learning now? Where do you see some of the key pearls in maybe how dry eye thinking has changed?

Dr. Hauser: There's really a lot of disconnects. There's disconnects on a clinical level. There's disconnects on a practice management level. The patients are perceived as a nuisance for both optometry and ophthalmology, and that's hard. It's hard for the patient. It's hard for the doctor. As you said about throwing artificial tears at patients, you're among good company. I think 97% of people leave with artificial tears, and 82% want more. If they're wanting more, more is deliverable now. For many years, we didn't have any pharmaceuticals to speak of. I mean, very few choices. We had very few choices in terms of any treatments we may be able to offer in office. That's really just booming right now.

I think having those tools accessible really opens it up. That's new for the doctors that are emerging. They see that, whereas doctors who've been out in practice for many years hust perhaps really aren't aware of what's available to treat dry eye. As I said, a lot of doctors really just wanted to go away. The opportunity is that there's over 30 million people who have dry disease, but only 3 million, say, have glaucoma. There's a huge unmet need, and I think there's a lot of doctors who are catching wind to that.

Dr. Wörtz: Well, I think that's very interesting from a number of levels. I found personally as I was going through this I guess metamorphosis in terms of what I enjoyed treating. I found dry eye to be very ... at first, it seems like it's a simple thing, and then I realized, okay, it's not really a simple thing. It's a multifactorial process that has just been dubbed dry eye, but we really are talking about a multitude of different conditions that have been lumped together. Then, it seemed really confusing to me. It went from simple to complex to confusing. In that process, what I realized was, okay, it's a process.

You're not going to always come up with the exact mechanism of dry eye the first time you treat someone. Not every patient is going to respond to every treatment the same. You just have to walk patients through and give them your best. What I realized was, honestly, if someone comes in to your office with dry eye, you almost can't make them worse. Now, maybe ... so that the pressure to actually make someone worse is actually very, very low when someone has dry eye. I realized, you know what? If this doesn't work, I'll try something else. Honestly, that's how I approach it.

Dr. Hauser: To your point, from a clinical perspective, the only thing we can make worse is how they feel about it in a lot of ways. The eye itself, it's very unlikely to be vision threatening most cases and that's part of why eye doctors can defer it so much. It's really more quality of life, but that is such an opportunity to build a practice by reaching out to those patients of being a service. Because being that practice in your community is a standout opportunity. You just really reach out to the patients you already have and grow from there.

Dr. Wörtz: This is also a little bit of a mindset change, especially for ophthalmologists, I think, who are very surgically focused. Because, as a surgeon, what really lights me up and what gets me excited is fixing things. I'm so addicted to that reward we get when we take out a cataract or we fix someone who's been wearing glasses forever. We do LASIK, and we say they're great. We have this instant gratification with a lot of the things that we do. Dry eye is just ... it's almost on the other side of that paradigm where you're going for improvement. You're going for management. You're going for incremental improvement.

Dr. Hauser: It's like retina surgery.

Dr. Wörtz: Yeah, yeah. Exactly.

Dr. Hauser: It's not as gratifying as cataract and LASIK, certainly. Yeah, you're absolutely right. You're just going for the feel-good moment that you get, and those feel-good moments are sometimes few and far between. It's a tough row to hoe, as my mother would say.

Dr. Wörtz: I will say, if you change your mindset though from we are going to have a one cure-all for dry eye, and I'm going to give you this thing. Then, you're going to come back and tell me how great I am. That's not the mindset. If you change your mindset to, I just need to get this patient a little bit better and a little bit better. Also talk to them about what's realistic and what are the realistic expectations for what you have. Explain a little bit about maybe what's going, why this is occurring if you have some good diagnostics to help them. Also, to just help them understand what is possibly achievable and let them know, it's not going to be an overnight improvement. I think that helps a lot. What do you think about that?

Dr. Hauser: I totally agree. I parallel dry eye care to low vision care a lot of times. We're not really going to go in and then just fix the root of the problem. Occasionally, we can, but more often than not, it's a process. More often than not, it's a puzzle that winds up having to be reworked 6 months later. That's what I talk to my patients about, and I tell them, "Look, we're going to do the best we can. We're going to make you feel better, but we're not going to make this go away." Then, I parallel it to diabetes, high blood pressure, things that they understand. Like you said, there's no magic bullets, no magic cures. Once we as both doctors and patients can set that aside, we can really chip away at it slowly.

Dr. Wörtz: Absolutely. I think that's incredible. Talk to me a little bit about more on the Dry Eye Coach vision. Some of the initiatives of the things that you wanted to get out there. It's so funny when you Google something, what comes up. Before this, I was just Googling, and there are people talking about curing their dry eye with acupuncture. There are people talking about castor oil. This is not unique to this topic. You can find anything you want on the Internet. It does seem like there is no shortage of misinformation on the Internet about dry eye. It also just seems like a lot of the—and this is not a knock on the trade journals or anything else—it just didn't seem like there's that one hub you can go to, to get real practical pearls on new dry eye patients. It sounds like as we've talked in the past, what you're trying to create is really that hub for information, for simple, effective pearls for treating a dry eye patient. Talk to us a little bit more about what your vision is.

Dr. Hauser: You really summed it up beautifully, Gary. That's exactly it. I was coming back from a meeting I had done to our lecture on dry eye, and I had done it to our workshop. I have all these doctors coming up to me and asking me. You know, they're not asking me the high level questions. They're asking me intermediate level questions at best. I've been in the trenches seeing patients, and I know how hard it is to stay up on details and things like that. I thought, "You know, I can't be everywhere, and you can't be everywhere," and a lot of my colleagues that go out and do these things.

We can only touch so many people. The trade journals offer a lot of information, but, like you said, unless, it just happens to be on your desk, you may not actually pick it up and read it. How can we provide accessible, reliable information to doctors? I thought, like I said before, just the Internet's the place to go but reliability is the key. As you said, when I had the sort of epiphany after that meeting, I got on the Internet and started Googling things about dry eye. I got on YouTube. The average video in the first two pages of YouTube on dry eye is 2 years old.

Dr. Wörtz: Wow.

Dr. Hauser: You're not getting fresh information. It's a mix of industry, patient encounters. Things that they've wanted to talk about, vent about or perhaps a couple of practitioners things but really nothing that you can really sink your teeth into. What I wanted with Dry Eye Coach is to have bite-size videos from people that really know dry eye who are passionate about it, who could just say, "Here's what I'm looking at. Here's what I'm thinking," and make them 2 to 3 minutes, not really long, editorialized, things that go on and on and you just click off of them. You have 30 seconds to capture someone's attention. If you don't capture it in 30 seconds, they're on to the next thing.

Dr. Wörtz: Really, it sounds like what you're doing is leveraging the accessibility of the Internet with the credibility of thought leaders inside of dry eye. It really gives you the best of both worlds.

Dr. Hauser: Right, right. Well, the great thing about the Internet is, or the bad thing is, you can reach just about everybody. We've had responses from people all over the world about what we're doing. I think that's exciting too. You just think in your own little fishbowl sometimes, but just to think that we could be beneficial to people in other countries I think is pretty exciting.

Dr. Wörtz: It sounds like the launch of this is going to be more or less video-based. There's going to be short clips. I'm talking about various topics all over the map. Do you see a time when this also may be an interactive experience, or when people can post questions about a patient that they have? Or maybe something along those lines?

Dr. Hauser: There's a lot of evolutions of what we're planning for Dry Eye Coach. Just to start, it will be video-based, small clips from key opinion leaders. As you said, there's also going to be a read section that we cherry picked articles from other publications. We'll give summaries and have links to those. Later on, we'd like to have some original works. We'll have email blasts that go out every week about new things, new treatments, whatever is innovative in terms of dry eye.

There will also be a test drive section. When a new piece of equipment comes out, a new pharmaceutical comes out, we'll have one of our contributors go in and talk about it. This is not a sales pitch. I've told anyone who wants to be on the test drive section, we're going to give the good and the bad, the opportunities and the challenges for whatever it is. Because that's real life, and that's what you want in practice. Beyond that, we hope to have some podcast, not unlike what you're doing, some live interactive experiences with the contributors, and perhaps hopefully next year, the latter part of next year, maybe some live programs where people can actually meet some of the coaches and get live education.

Dr. Wörtz: Well, Whitney. That's incredible. Also, just an aside, this is not an industry-led venture. Whitney, this is your baby. This is your thing, right?

Dr. Hauser: Yes. It's 100% my thing. 100% for good or for bad, this is all something that came up and it's a passion project. A friend of mine said that's what it is, and she very well defined it, and I'm very passionate about the educational aspect, the disease process. The doctors that I want to reach out to are my colleagues as well as the patient. From every angle, I'm just passionate about what we're doing.

Dr. Wörtz: Well, I think that you have really hit on a topic that needs better education, and I don't want to say that in a way that the education out there isn't good. Maybe a format for more understandable education, and this really gets my wheels turning about this as a platform for education on other topics. I'm happy to, you know, play a small role in this as well. I'll be doing a couple short contributions as time allows in the future. Whitney, I actually think this could be a platform that you are actually defining and creating that could go well beyond Dry Eye Coach. I see a lot of potential here.

Dr. Hauser: That has occurred to me as well, Gary.

Dr. Wörtz: Yeah. Kudos to you for trying and doing. It doesn't have to be perfect to make an impact, but I am so impressed with how this is being rolled out and kudos to you for doing it.

Dr. Hauser: Yeah. I really appreciate it. It's exciting, and it's going to be in its infancy when we do ultimately roll out. Hopefully, everyone will stay tuned and watch us grow and evolve and really hopefully continue to capture the attention of the practitioners.

Dr. Wörtz: All right. Give us a link. Let us exactly where can find Dry Eye Coach.

Dr. Hauser: If you go to dryeyecoach.com, you can subscribe right now. We have several hundred subscribers. The site hasn't opened yet, but we plan to open later this fall. I encourage you to just go ahead and jump on and get a subscription. This is going to be for optometry, ophthalmology. It's going to be for technicians. There's also going to be some practice management things. We didn't really touch on that. I have a really great contributor in terms of practice management. I'm excited about what she's bringing to the table about how you can just implement premium service in your practice, and I think it's going to be great.

Dr. Wörtz: Awesome. Whitney, thank you so much for taking some time to talk to us about your project. I really, really cannot wait for this to launch, so thanks so much.

Dr. Hauser: Awesome. Thank you, Gary. I appreciate it.

Dr. Wörtz: All right, absolutely. If you're looking to learn more about the ocular surface and how to build a dry eye practice, be sure to follow Dry Eye Coach on Twitter @dryeyecoach. This has been Ophthalmology Off the Grid with Dr. Gary Wörtz. To check out more episodes, visit iTune.net/podcast. Thanks for listening.