While dry eye patients have plenty of treatment options available to relieve their symptoms — from in-office treatments that focus on the lid margin and meibomian glands to prescription medications — some cases call for additional devices that can treat the underlying cause at home.
“When it comes to dry eye, I can never stress to my patients enough that … to get real relief you need to start treating the cause,” says Derek Ohlstein, MD, of St. Lucie Eye Associates in Port St. Lucie, Fla.
THERAPIES AND PATIENTS
At his clinic, Dr. Ohlstein says he has recently found a lot of success with the NuLids handheld treatment device (NuSight Medical), which is applied to each eyelid for 30 seconds and helps reduce inflammation, itching and other dry eye symptoms. These manual lid scrubs “really help tackle the underlying cause,” says Dr. Ohlstein.
His patients have also found success using sleep goggles, including Eye Eco’s Eyeseals hydrating sleep mask. Those have produced great results for patients with severe dry eye, floppy lid and C-PAP, says Dr. Ohlstein.
For Marguerite McDonald, MD, director of the dry eye center of excellence at Ophthalmic Consultants of Long Island, her patients frequently use heated masks to treat dry eye. Bruder’s Moist Heat Eye Compresses are heated via a microwave then placed on the eyes for 10 minutes; Dr. McDonald’s patients have found them very soothing, she says.
Another mask option is EyeGiene’s Insta-Warmth System; it uses sealed Warming Wafer packets, which warm on exposure to air. They are inserted into the cloth pockets of the mask and do not require heating. This benefits patients who are traveling, are low on time or want an immediate dry eye solution when they get home from work, says Dr. McDonald.
Dr. McDonald also recommends TrueTear (Allergan) to patients. This neurostimulator is placed into the nostrils to produce tears and has been a “godsend” for some of her patients due to its ability to create natural tears without pharmacological intervention.
BUILDING THE HABIT
For most at-home therapies, says Dr. Ohlstein, the time they are used does not matter — as long as patients keep up on their treatment. Compliance is the most important aspect, says Dr. Ohlstein. “These products are like brushing teeth; as long as they can remember to do it, it will help,” he says.
Building off that analogy, a good suggestion for patients is to do their at-home therapy the same time they brush their teeth, continues Dr. Ohlstein; if they can associate it with another task they do during the day, then patients are much more likely to remember it.
Dr. Ohlstein’s clinic usually gives patients using at-home therapies a call two weeks after they start to make sure there are no problems. While some patients with physical handicaps have trouble with the devices, Dr. Ohlstein says his patients who use at-home dry eye therapies have about a 90% success rate.
Demonstrations are an important part of compliance, say those interviewed. Dr. Ohlstein’s clinic has demo units on hand for any patient interested in at-home therapies. His staff provides demonstrations in the office along with handouts with step-by-step instructions for the devices.
Dr. McDonald says she talks to interested patients about the at-home therapies for a few minutes before passing the demonstration off to a clinic tech. Most of the at-home therapies, like the masks and NuLids, are pretty easy to explain, but the TrueTear requires a longer tutorial, she says. This demonstration can take upwards of 30 or 40 minutes, which includes answering patient questions and discussion of cost.
To limit the tech’s time, Dr. McDonald says her clinic lists the TrueTear’s price up front to interested patients. That avoids a scenario in which half an hour goes by only for the patient to back out upon hearing the cost.
For additional educational needs, Dr. McDonald provides brochures.
“I flip it open, hit the high points about the device and the treatment; I have a very short, well-crafted speech about each,” she says. “Then I let my technician fill in the details.”
The brochures may be “low-tech, but they really work.” OM