August 16, 2013
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BLOG: Measuring dry eye symptoms

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Read more blog posts from Darrell E. White, MD

Whether or not you agree with our SkyVision philosophy that patient symptoms are the most important dry eye metric, it’s still vitally important to have some way to record and measure symptoms in a repeatable, systematic manner.

Most of us are data driven in the rest of our practice. We measure cylinder 3 different ways before we pull the trigger on a Toric IOL. Macular thickness is parsed to the micron when we evaluate cystoid macular edema. In a perfect practice world we would do the very same thing with all things dry eye, including symptoms.

I think the narrative is still very important, and the better we and our staff members are at recording the exact words our patients use to describe their symptoms the better we will be able to evaluate the results of our treatment. Having said that, it’s really difficult to put some kind of number on “my eyes don’t burn as much” so we can track that. Noting the spoken symptoms will drive the conversation in subsequent visits, but it’s hard to graph that like tear osmolarity.

Thankfully, we have dry eye symptom surveys. We use the Ocular Surface Disease Index or OSDI. Other practices have found success using the FAST survey.

Both use a set of standardized questions that allow a patient to rate their level of discomfort in very specific areas. These patient responses are then tabulated to give a score which can be tracked over time. The OSDI has been a very accurate measurement for us in deciding when to treat as well as evaluating the effectiveness of our treatment.

Having a number to put with symptoms allows us to be even more data driven with the dry eye practice. Trends become readily evident: It’s really easy to predict seasonal patient volume once you have a hundred or so patient’s OSDI on the graph.

The OSDI or FAST number also is a very useful teaching tool when discussing progress with our patients. All in all, whichever survey you decide to use, it is more than worth the time and effort necessary to get the value.

That’s a lot on symptoms. Let’s get to some doctor-type stuff and chat about testing next week.