BLOG: Simple treatments can bridge gap between Rx medications, patient access
Dry eye is an increasingly recognized and common condition, and complaints of burning and itchy eyes or impaired vision drive patients to seek relief from their eye care providers.
While prescription medications such as Xiidra (lifitegrast, Novartis) and cyclosporine (Restasis, Allergan, and Cequa, Sun) are clinically proven to help, there are barriers to access and patient compliance issues that may interfere with our ability to prescribe and treat patients.
To fill this gap and bring relief to our patients, we can look to alternative treatment options such as dietary supplements, warm compresses or cleansing products developed specifically for dry, sensitive eyes.
Challenges of prescription medications
Navigating the labyrinth of insurance can prove cumbersome for both the patient and provider. Insurance companies have placed strategic obstacles to discourage doctors from prescribing new or expensive medications, and every plan varies. This places an added burden on the doctor and staff to verify coverage and submit preapproval documentation or appeal denials.
Low-income patients may apply for medication assistance programs, but this requires providing income verification and going through an approval process. Cash-pay prices for new and name brand medications can add up to hundreds of dollars each month, discouraging patients from refilling prescriptions. Although I never recommend this, some of my patients have even sourced their medication from another country just to bypass the hassle.
Patient compliance with topical ocular treatments is notoriously low. A 2019 study looked specifically at prescription claims for dry eye patients and reported that over 60% discontinued their ophthalmic medications within the first year (White et al). Additionally, we must consider patients’ dexterity, hand-eye coordination and the inconvenience factor. I do inform patients that they may experience common side effects, such as burning and stinging, but that these will subside over time. However, some patients cannot tolerate the side effects and discontinue use, and others may dread or even skip dosing.
Before we find ourselves tangled in the insurance web, we can offer effective alternative therapies to our patients. Quality products provide immediate relief and target inflammation, the root cause of the problem. For the convenience of my patients, I stock several tried-and-true products available for purchase in the office so that I can be sure they select quality products.
Reducing inflammation through the use of omega fatty acids has proven a highly effective treatment for many of my patients. This approach targets inflammation, allowing the body to produce its own, natural tears. I recommend HydroEye (ScienceBased Health) because it is clinically proven and offers a satisfaction guarantee. HydroEye has a proprietary combination of omega-3 fatty acids (eicosapentaenoic acid, docosahexaenoic acid and gamma-linolenic acid), antioxidants and other key nutrients that reduce inflammation, support a healthy tear film and soothe the ocular surface.
When starting patients on the supplement approach to treatment, it is important to set correct expectations. Supplements are not an overnight fix, and it can take up to 60 days to notice an improvement. I suggest that my patients continue topical therapies, such as artificial tears, until they become less reliant on them. If patients understand that it takes time to heal, they are more likely to stick with it.
For more immediate relief, there are a number of products available. Warm compresses work well and feel good. I like the OcuSoft Dry Eye Mask Premium because it has a removable “pillowcase” that is easy to clean. We also offer the Pure&Clean (Vision Source) line of hypochlorous acid treatments to help with antibacterial and antiviral issues, and the optometrist-developed We Love Eyes line of eyelid and eyelash cleansers and eye makeup remover.
Appointment spacing is also an incentive for patients to be consistent in taking their supplements or medications. I have my patients return in 1 month for a follow-up visit, which tends to hold them accountable. If there is too much time between appointments, it is easier for patients to fall off the compliance wagon. They are also encouraged when I can show them improvements in their tear film or ocular surface.
We have a variety of effective, affordable and accessible treatment options available to all patients. We must become familiar with these and offer our patients the choice to pursue treatment therapies that speak to their specific needs.
White DE, et al. Clin Ophthalmol. 2019;doi:10.2147/OPTH.S226168.