Article

DRY EYE DX AND TX

WHO’S TAKING CARE OF YOUR EYES?

A 44-year-old female optometrist presented with complaints of ocular pain for the past week—a deep ache above her right eye that turned into a boring, right-sided headache on a daily basis. This was accompanied by variable vision and slight, diffuse conjunctival injection. Anterior chambers were deep and quiet; however, she had significant central keratitis with mild edema (no infiltrates). Of note, she was a “compliant” and successful orthokeratology wearer of 10 years who cleaned and soaked her lenses daily and replaced her case monthly. She was asked to discontinue lens wear, use copious nonpreserved artificial tears, and begin a topical ophthalmic antibiotic-steroid combination drop.

She returned a few days later with her lenses, and inspection revealed severely warped, scratched, and hazed lenses, with iron-colored deposits over most of the front surface (Figure 1). This was somewhat unexpected, as she reported diligent lens care habits and lens replacement within the past 18 months. A look at her order history, however, indicated that lenses were last ordered in 2015.

Figure 1. Warped, scratched, and hazed orthokeratology lens with front-surface deposits.

How could this possibly be? I could have sworn that I ordered lenses more recently than that. Yes, that’s right, this patient is me. I didn’t deliberately neglect my care; however, time flies much faster than we think it does. I chose to write this embarrassing column about my own neglect to encourage you to take a look at your status as a patient.

Stop the Double Standards

Many practitioners fail to practice what they preach and often neglect their own nutrition, exercise, and sleep habits (Wiskar, 2012; Gardner and Ogden, 2005). One self-healthcare survey reported that 49% of general practitioners neglect their own health, while another survey estimated that only 10% of practitioners have routine check-ups, a preventative health practice strongly advised by most doctors (Richards, 1999; Uallachain, 2007).

Why is this? One probable excuse is simply “no time”; however, patients also have busy lives, and their physicians certainly expect them to come for regular care.

Another possibility might be that physicians have the ability to consult with their colleagues informally whenever they have a free minute. These so-called “hallway consults” are practiced widely in medicine. It is certainly something of which I am guilty—a dilation here, a refraction there. One group of researchers looked into this practice and found that records are kept in only 36% of such consultations (Richards, 1999; Peleg et al, 1999). Colleagues are being asked to perform exams piecemeal, sometimes over the course of several years, without maintaining a record.

Practitioners would never make patient care decisions based on an isolated exam element, nor would they ever neglect to keep a record of the visit; yet, many practitioners unfairly ask this of their work partners all the time.

I was curious about this phenomenon in optometric practice, but I couldn’t find anything in the literature specific to optometry. So, I polled 40 of my closest optometry friends, asking one simple question: “When was the last time you had a comprehensive, dilated eye exam?” Suffice it to say, at least within my personal cohort of friends, we very much resemble medical practice. Only one in five have had an eye exam within the past year, and it’s been more than three years for almost half of the others. This begs some serious self-reflection of all of us: How are you taking care of you? CLS

For references, please visit www.clspectrum.com/references and click on document #273.