Dry Eye Disease Management in Portugal - Online Survey Results

Authors

  • Filipe Gouveia-Moraes Centro de Responsabilidade Integrada de Oftalmologia do Hospital Garcia de Orta
  • Sandra Rodrigues-Barros Hospital Garcia de Orta, Centro de Responsabilidade de Oftalmologia, Almada, Portugal; Clínica CUF Almada, Departamento de Oftalmologia, Almada, Portugal; Clínica CUF Cascais, Departamento de Oftalmologia, Cascais, Portugal
  • Tomás Loureiro Hospital Garcia de Orta, Centro de Responsabilidade de Oftalmologia, Almada, Portugal
  • Ana Rita Carreira Hospital Garcia de Orta, Centro de Responsabilidade de Oftalmologia, Almada, Portugal
  • Diogo Lopes Hospital Garcia de Orta, Centro de Responsabilidade de Oftalmologia, Almada, Portugal
  • Paul Campos Hospital Garcia de Orta, Centro de Responsabilidade de Oftalmologia, Almada, Portugal
  • Inês Machado Hospital Garcia de Orta, Centro de Responsabilidade de Oftalmologia, Almada, Portugal; Clínica CUF Almada, Departamento de Oftalmologia, Almada, Portugal; Clínica CUF Tejo, Departamento de Oftalmologia, Lisboa, Portugal
  • Nadine Marques Hospital Garcia de Orta, Centro de Responsabilidade de Oftalmologia, Almada, Portugal; Clínica CUF Almada, Departamento de Oftalmologia, Almada, Portugal; Clínica CUF Sintra, Departamento de Oftalmologia, Sintra, Portugal
  • Nuno Campos Hospital Garcia de Orta, Centro de Responsabilidade de Oftalmologia, Almada, Portugal; Clínica CUF Almada, Departamento de Oftalmologia, Almada, Portugal; Clínica CUF Tejo, Departamento de Oftalmologia, Lisboa, Portugal

DOI:

https://doi.org/10.48560/rspo.24602

Keywords:

Dry Eye Syndromes/diagnosis, Dry Eye Syndromes/therapy, Ophthalmologists, Portugal, Surveys and Questionnaires

Abstract

Introduction: With growing prevalence, reduced quality of life, significant socioeconomic burden and a definite impact in cataract and laser vision correction surgeries, dry eye disease (DED) is currently a hot topic in ophthalmology. In recent years, several guidelines have been carried out to standardize the diagnosis and improve treatment approach. We intend to characterize current practices in Portugal, identify opportunities for improvement and delineate strategies to address them.

Material and Methods: Cross-sectional online survey designed to assess the diagnostic approach and treatment of DED and made available to ophthalmologists across the country. The survey included 5 questions on ophthalmological profile of participants, 4 questions on DED diagnosis and 3 questions on DED treatment. Statistical analysis was made using SPSS version 26.

Results and Discussion: One hundred twenty two ophthalmologists answered the survey (about 10% of practitioners in Portugal). A percentage of 48% observe between 20-40 patients with DED per month. A total of 67% always examine ocular surface of laser vision correction candi- dates, whereas only 30% always do it for cataract surgery patients. The most frequently identified DED symptom is foreign body sensation. The most commonly used diagnostic methods are fluo- rescein staining and tear break up time. Regarding treatment modalities, almost 50% of participants never used lacrimal plugs and very few recommended contact lenses or autologous serum. Mild DED treatment is considered to be very effective by 80% of ophthalmologists, while in severe DED by only 0.01%. 36% believe available treatment options are ineffective in severe DED.

Conclusion: DED represents a high volume of patients seen in ophthalmology clinics. Our results mimic others in Europe and the United States. Overall, diagnosis and treatment practice patterns are in agreement with the current recommendations. However, there is still room for improvement. All patient prior surgery should be examined for DED, symptoms should be considered more as part of diagnosis and follow-up, and some easily available treatment options should be considered more often. Our findings also highlight the concern with treatment in severe DED, in which more effective therapies are needed.

Downloads

Download data is not yet available.

References

Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15:276-83. doi: 10.1016/j.jtos.2017.05.008.

Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Ma- let F, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017;15:334-65. doi: 10.1016/j.jtos.2017.05.003.

Lemp MA. Advances in Understanding and Managing Dry Eye Disease. Am J Ophthalmol. 2008;146: 350-6.e1.

Moss SE, Klein R, Klein BK. Long-term incidence of dry eye in an older population. Optom Vis Sci. 2008; 85: 668–74.

Buchholz P, Steeds CS, Stern LS, Wiederkehr DP, Doyle JJ, Katz LM, et al. Utility assessment to measure the impact of dry eye disease. Ocul Surf. 2006;4:155-61. doi: 10.1016/s1542-

(12)70043-5.

Milner MS, Beckman KA, Luchs JI, Allen QB, Awdeh RM, Berdahl J, et al. Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagno- sis and treatment. Curr Opin Ophthalmol. 2017;27:3-47. doi: 10.1097/01.icu.0000512373.81749.b7.

Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017;15:539-74. doi: 10.1016/j. jtos.2017.05.001.

The epidemiology of dry eye disease: report of the Epide- miology Subcommittee of the International Dry Eye Work- Shop (2007). Ocul Surf. 2007;5:93-107. doi: 10.1016/s1542- 0124(12)70082-4.

Craig JP, Nelson JD, Azar DT, Belmonte C, Bron AJ, Chauhan SK, et al. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017;15:802-12. doi: 10.1016/j.jtos.2017.08.003.

Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, et al. TFOS DEWS II Management and Therapy Re- port. Ocul Surf. 2017;15:575-628. doi: 10.1016/j.jtos.2017.05.006.

Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, Lin A, Rhee MK, et al; American Academy of Ophthalmology Preferred Practice Pattern Cornea and External Disease Panel. Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology. 2019;126:P286-P334. doi: 10.1016/j.ophtha.2018.10.023.

Barabino S. Dry eye management: the point of view of italian ophtalmologists. Ital Rev Opthalmol. 2018.

Asbell PA, Spiegel S. Ophthalmologist perceptions regarding treatment of moderate-to-severe dry eye: Results of a physi- cian survey. Eye Contact Lens. 2010; 36:33–8. doi: 10.1097/ ICL.0b013e3181c739ad.

Toda I, Asano-Kato N, HoriKomai Y, Tsubota K. Laser-assisted in situ keratomileusis for patients with dry eye. Arch Ophthalmol. 2002;120:1024–8.

Konomi K, Chen LL, Tarko RS, Scally A, Schaumberg DA, Azar D, et al. Preoperative characteristics and a potential mechanism of chronic dry eye after LASIK. Invest Ophthalmol Vis Sci. 2008;49:168-74. doi: 10.1167/iovs.07-0337.

Liang L, Zhang M, Zou W, Liu Z. Aggravated dry eye after laser in situ keratomileusis in patients with Sjögren syndrome. Cornea. 2008;27:120–3.

Maychuk DY. Prevalence and severity of dry eye in candidates for laser in situ keratomileusis for myopia in Russia. J Cataract Refract Surg. 2016;42:427–34. doi: 10.1016/j.jcrs.2015.11.038.

Trattler WB, Majmudar PA, Donnenfeld ED, McDonald MB, Stonecipher KG, Goldberg DF. The Prospective Health Assessment of Cataract Patients’ Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol. 2017;11:1423-30. doi: 10.2147/OPTH.S120159.

Chuang J, Shih KC, Chan TC, Wan KH, Jhanji V, Tong L. Pre-operative optimization of ocular surface disease before cata- ract surgery. J Cataract Refract Surg. 2017;43:1596-607. doi: 10.1016/j.jcrs.2017.10.033.

Gibbons A, Ali TK, Waren DP, Donaldson KE. Causes and correction of dissatisfaction after implantation of presbyopia- correcting intraocular lenses. Clin Ophthalmol. 2016;10:1965– 70. doi: 10.2147/OPTH.S114890.

Courtin R, Pereira B, Naughton G, Chamoux A, Chiam baretta F, Lanhers C, et al. Prevalence of dry eye disease in visual display terminal workers: a systematic review and meta-analysis. BMJ Open. 2016;6:e009675. doi: 10.1136/bmjo- pen-2015-009675.

Cardona G, Serés C, Quevedo L, Augé M. Knowledge and use of tear film evaluation tests by Spanish practitioners. Optom Vis Sci. 2011;88:1106–11.

Lemp MA, Bron AJ, Baudouin C, Benítez Del Castillo JM, Geffen D, Tauber J, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011;151:792-8.e1. doi: 10.1016/j.ajo.2010.10.032.

Potvin R, Makari S, Rapuano CJ. Tear film osmolarity and dry eye disease: a review of the literature. Clin Ophthalmol. 2015;9:2039-47. doi: 10.2147/OPTH.S95242.

Bunya VY, Fuerst NM, Pistilli M, McCabe BE, Salvo R, Mac- chi I, et al. Variability of Tear Osmolarity in Patients With Dry Eye. JAMA Ophthalmol. 2015;133:662-7. doi: 10.1001/ jamaophthalmol.2015.0429.

Tashbayev B, Utheim TP, Utheim ØA, Ræder S, Jensen JL, Yazdani M, et al. Utility of Tear Osmolarity Measurement in Diagnosis of Dry Eye Disease. Sci Rep. 2020;10:5542. doi: 10.1038/s41598-020-62583-x

Leonardi A, Van Setten G, Amrane M, Ismail D, Garrigue JS, Figueiredo FC, et al. Efficacy and safety of 0.1% cyclosporine A cationic emulsion in the treatment of severe dry eye disease: a multicenter randomized trial. Eur J Ophthalmol. 2016;26:287-96. doi: 10.5301/ejo.5000779.

Correia FF, Ribeiro S, Silva R, Silva Á, Cruz C, Pinto C, et al. Aplicações clínicas da ciclosporina tópica em oftalmologia: revisão para oftalmologistas. Rev Soc Port Oftalmol. 2021;45.37–44.

Holland EJ, Whitley WO, Sall K, Lane SS, Raychaudhuri A, Zhang SY, Shojaei A. Lifitegrast clinical efficacy for treatment of signs and symptoms of dry eye disease across three rand-

omized controlled trials. Curr Med Res Opin. 2016;32:1759-65.

doi: 10.1080/03007995.2016.1210107.

Kangari H, Eftekhari MH, Sardari S, Hashemi H, Salamzadeh J, Ghassemi-Broumand M,et al. Short-term consump- tion of oral omega-3 and dry eye syndrome. Ophthalmology. 2013;120:2191-6. doi: 10.1016/j.ophtha.2013.04.006.

Bhargava R, Kumar P, Kumar M, Mehra N, Mishra A. A randomized controlled trial of omega-3 fatty acids in dry eye syndrome. Int J Ophthalmol. 2013; 6:811–6.

Hussain M, Shtein RM, Pistilli M, Maguire MG, Oydanich M, Asbell PA; DREAM Study Research Group. The Dry Eye Assessment and Management (DREAM) extension study - A randomized clinical trial of withdrawal of supplementation with omega-3 fatty acid in patients with dry eye disease. Ocul Surf. 2020;18:47-55. doi: 10.1016/j.jtos.2019.08.002.

Russo PA, Bouchard CS, Galasso JM. Extended-wear silicone hydrogel soft contact lenses in the management of moderate to severe dry eye signs and symptoms secondary to graft-versus-host disease. Eye Contact Lens. 2007;33:144–7.

Downloads

Published

2021-09-29

How to Cite

Gouveia-Moraes, F., Rodrigues-Barros, S., Loureiro, T., Carreira, A. R., Lopes, D., Campos, P., Machado, I., Marques, N., & Campos, N. (2021). Dry Eye Disease Management in Portugal - Online Survey Results. Revista Sociedade Portuguesa De Oftalmologia, 45(3), 141–149. https://doi.org/10.48560/rspo.24602

Issue

Section

Original Article