The Dry Eye Zone

Rebecca's Blog

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PICASSO - the Italian dry eye consensus

I really enjoyed the flowchart and other visuals in this recent study. If you click on the study link, it will go to the full text article rather than just the abstract (thank you, International Ophthalmology). 

I particularly liked that they made patient counseling - about practical tips and lifestyle factors - so prominent. The concern I have with that is all to do with how many doctors are equipped to address those things. There are some basic things that are common recommendations (humidifier, avoiding smoke, Omega 3s, etc) - but when you get a highly symptomatic patient, how many nonspecialist eye doctors have practical information to help their patients manage symptoms during the day or while sleeping? This is still a huge gap in current care standards.

Int Ophthalmol. 2018 Apr;38(2):875-895. doi: 10.1007/s10792-017-0524-4. Epub 2017 Apr 10.
The correct diagnosis and therapeutic management of tear dysfunction: recommendations of the P.I.C.A.S.S.O. board.
Rolando M, Cantera E, Mencucci R, Rubino P, Aragona P.

Abstract
PURPOSE:
To describe a standard approach to manage tear dysfunction (TD), in order to obtain a clinically favourable outcome. TD is a highly prevalent, yet largely underdiagnosed, condition that affects from 5 to 30% of the population above 50 years old. Left untreated, TD is associated with eye discomfort and ocular surface disease, substantially affecting quality of life. Although the prevalence of this problem is increasing significantly, a standard approach to its prevention and treatment is not available yet.
METHODS:
In September 2015, a team of Ocular Surface Italian Experts convened for a roundtable to discuss on the latest knowledge about diagnosis and treatments for TD and the real issues in the management of these patients. The discussion centred on the appropriate definition of TD, proposing a new classification of risk factors and how to identify them, how to make a correct diagnosis choosing the rational therapy (questionnaires, symptoms' time relation, seasonality, low tech diagnostic manoeuvres, specific tests for the detection of tear film disturbances leading to recognition of the level of disease and of the ocular system elements involved), which artificial tear matches the ideal profile for a rational therapy and which questions should be done to the patient.
RESULTS:
A multi-item flowchart for tear film dysfunction, with point-by-point explanatory guide, to better identify and manage the patient with this disorder is provided.
CONCLUSIONS:
The growing prevalence of TD demands increased attention. An appropriate prevention and a treatment pattern for the patient, combined with greater patient-practitioner interaction, and patient education is offered.