Although dry eye disease (DED) awareness has grown tremendously over the past decades, a significant disconnect remains between diagnosis and treatment.
Approximately 16 million Americans have been formally diagnosed with DED, yet the true burden is likely much greater. An estimated 38 million people live with chronic dry eye disease, but only 1.5 million are actively treated. Even among those who eventually seek care, 40% wait six months or longer before doing so.
Diagnosing and treating dry eye earlier may improve quality of life, reduce productivity-related costs, and create more opportunities to identify systemic contributors.
Along with improving patient outcomes, offering dry eye management supports practice growth. We will explore treatment options in a future article.
First, let’s focus on the essential step—effectively diagnosing DED.
Start with a Questionnaire.
Several validated questionnaires are available to screen for and assess the impact of DED, including:
- National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25)
- Ocular Surface Disease Index (OSDI) and the newer six-item Ocular Surface Disease Index (OSDI-6)
- Standard Patient Evaluation of Eye Dryness Questionnaire (SPEED)
- Canadian Dry Eye Epidemiology Study questionnaire (CANDEES)
- Dry Eye Screening for Dry Eye Epidemiology Projects questionnaire (DEEP)
- Five-Item Dry Eye Questionnaire (DEQ-5)
- Symptom Assessment in Dry Eye questionnaire (SANDE)
The OSDI, DEQ-5, and SANDE demonstrate moderate-to-strong agreement. For the full OSDI, researchers found that three questions accounted for 89.1% of the variability in the overall questionnaire score.
The abbreviated OSDI-6 also correlated strongly with the full OSDI, with a correlation coefficient of 0.939. Similarly, two DEQ-5 questions accounted for 88.5% of the variability in the overall DEQ-5 score. These findings suggest that shorter questionnaires may efficiently identify clinically meaningful dry eye symptoms while reducing the time required for screening in practice.
There are many practical and clinical advantages of questionnaires. They provide quantifiable data, translating subjective symptoms into a concrete numerical score. When repeated at subsequent visits, these scores help practitioners monitor changes over time, assess disease progression, and evaluate the patient’s response to treatment.
Questionnaires also have a low administrative burden and can be incorporated easily into the clinical workflow. They may be sent electronically with the patient history form before the examination, or office staff can administer the questionnaire either electronically or on paper in the waiting room or during pretesting.
In addition, questionnaires provide important insight into quality of life. They help identify how dry eye symptoms affect daily vision-related activities, including reading, driving, computer use, and other tasks.
By consistently incorporating validated questionnaires into clinical care, practitioners can improve symptom detection, establish a measurable baseline, and more effectively track outcomes over time.
Continue With a Detailed Patient History.
The clinical team plays an essential role in identifying DED before the practitioner enters the examination room. Staff can obtain a detailed patient history by asking specific questions about lifestyle, visual demands, systemic health, medications, and product use.
Helpful questions include:
- What do you do for work and recreation?
- How much time do you spend using computers, phones, tablets, or other digital devices?
- How do your contact lenses feel at the end of the day?
- Do you experience dry mouth, arthritis, or other systemic symptoms?
- Have you been diagnosed with diabetes, a neurological condition, rosacea, or an autoimmune disease?
- Which systemic and ocular medications do you take?
- What eye drops are you using, and do any of your eye drops contain preservatives?
- Which facial products, skincare products, or cosmetics do you use around the eyes?
A detailed ocular and systemic history is essential for identifying conditions, medications, and lifestyle factors that may affect tear production, blinking, corneal sensitivity, and ocular surface inflammation. This information can be obtained throughout the patient visit, including during scheduling, pretesting, technician workup, and interactions with the optical team.
By asking detailed questions and documenting relevant findings, staff can help uncover potential contributors to ocular surface disease, improve examination efficiency, and support the practitioner in developing a more complete and individualized management plan.
A proactive approach to dry eye care can improve patient retention, generate appropriate medical examinations, expand treatment services, and support sustainable practice growth in a condition that remains widely underdiagnosed and undertreated.
Coming Next Month: Part two of Insight Media’s Decoding Dry Eye Practice Success series will provide takeaways on the dry eye clinical examination.
About the Author: Melissa Barnett, OD, FAAO, FSLS, FBLCA, ACC, is a doctor of optometry, podcast host, and founding board member of the Intrepid Eye Society. She is also an ICF Associate Certified Coach and the founder of Alpine Blue Coaching.