In recent weeks, Peeq Pro has been working to articulate what we hear from practitioners regarding their dry eye process. Step one was articulating what the DEWS II protocols actually state regarding how optometrists and other practitioners can implement dry eye procedures. Step two was using that framework to help ask our dry eye experts how they implement these recommendations.
Download the full image of the Standard Dry Eye Protocol here.
One significant tool that did not get mentioned often by practitioners but that aids in this process is the TFOS DEWS II Speed questionnaire. [This questionnaire is similar to the Ocular Surface Diseases Index (OSDI).] This blog post goes into more detail about why a quantifiable, objective questionnaire may be helpful to your office. These are not the only ways to triage potential dry eye patients, but they are pretty common and can be used off-the-shelf.
For example, the Speed questionnaire serves as a valuable preparatory instrument, enabling healthcare providers to gather essential information about a patient’s ocular surface health before they arrive at the clinic.
In the context of managing dry eye syndrome, gathering comprehensive information about a patient’s symptoms, lifestyle factors, and medical history can be useful. Traditionally, this information might be collected during the initial consultation or during the office visit with the pre-tester or doctor. However, the TFOS DEWS II Speed questionnaire takes a proactive approach by prompting patients to provide information about their symptoms before they even step into the clinic. The OSDI includes some questions that are tied into environmental stimuli that may be at the root of some symptoms.
We were surprised how often eye clinics were not starting their patients with a questionnaire about symptoms. In particular, when a patient calls to set up an appointment, asking a simple question - “why are you setting up an appointment?” can be helpful to triage. But, adding something that is pre-built can be easy and helpful when integrated into a dry eye protocol.
Both questionnaires are designed to be concise yet thorough, covering a range of topics that are pertinent to the evaluation and management of dry eye. Both are tied into deeper review of symptoms of dry eye - redness, irritability, dryness, grittiness, etc. OSDI digs into some factors - like contact lens use.
Many offices have their own questions. These questionnaires include a variety of questions that may overlap OSDI or Speed. But, in general, they cover the following types of questions. Ultimately offices, have to figure out which questions are desired.
- Symptoms Assessment: Patients are asked about the frequency and severity of symptoms such as dryness, burning, grittiness, and fluctuating vision.
- Environmental Factors: Questions explore the patient's exposure to potential triggers like air conditioning, heating, wind, and humidity levels.
- Medication and Health History: Information regarding current medications, previous eye surgeries, and systemic health conditions that could contribute to dry eye symptoms.
- Contact Lens Use: Queries about contact lens wear habits and any associated discomfort or dryness.
- Current Tools to Treat Symptoms: Speed asks if the patient uses lubricating drops regularly. This type of question can reveal action by the patient that may be helpful to the clinician.
These are useful questions regardless of whether or not the person is a dry eye suspect. However, the scale of the Speed (scored up to 28) questionnaire provides a mechanism to put some objective measurements around the patient’s experience. This objectivity can be utilized to communicate and to judge the relative extent of dry eye disease. In a space where there are relatively few structured frameworks (like dry eye diagnosis), both Speed and OSDI offer a framework for triage and to help communicate with patients.
Many patients walk in the door without any context about dry eye disease. At best, they have heard about it. But, many have never even considered that their eyes may be more than tools to see with - i.e. that they have a physiology beyond the quality of their vision. Thus, there only metric is 20/20 vision. So, building other eye health tools into their mental map is useful in and of itself.
The TFOS DEWS II Speed questionnaire or the OSDI offers several advantages for both patients and healthcare providers over a custom questionnaire. In particular, there are five key benefits:
- Efficiency: By completing the questionnaire beforehand, patients streamline their clinic visit, allowing healthcare providers to focus more on diagnosis and treatment planning rather than gathering basic information.
- Improved Patient-Provider Interaction: Armed with prior knowledge about the patient’s symptoms and history, healthcare providers can engage in more meaningful discussions with patients, addressing concerns more effectively.
- Enhanced Diagnostic Accuracy: Early access to relevant information helps healthcare providers to more accurately diagnose and tailor treatment plans to the individual patient’s needs.
- Patient Empowerment: Completing the questionnaire encourages patients to reflect on their symptoms and environment, potentially prompting them to notice patterns or triggers that they may not have previously considered.
- Patient Priming: Through the questionnaire, the patient also receives information about their own symptoms. Many patients are unaware that there may be a problem - thinking it is lack of sleep or allergies. So, preparing the patient for a conversation about an underlying condition can be valuable.
In conclusion, the off-the-shelf dry eye questionnaires represent a valuable tool in the management of dry eye syndrome. By prompting patients to provide useful information before their clinic visit, healthcare providers can better prepare to assess and treat ocular surface conditions effectively. This proactive approach not only enhances efficiency but also fosters a more collaborative patient-provider relationship, ultimately leading to improved outcomes in the management of dry eye syndrome.
Whether you're a healthcare provider or a patient experiencing symptoms, embracing tools like the TFOS DEWS II Speed questionnaire or the OSDI can significantly enhance the quality of care and overall experience in addressing dry eye syndrome.