Our practice has always had a strong focus on cataract surgery, and from its inception has been at the forefront of treating patients with dry eye disease (DED). Early on, we realized the importance of having a healthy ocular surface for our patients prior to surgery. As such, all of us within the practice pay particular attention when treating patients with DED. We are very fortunate to have the most up-to-date equipment and tools available to help these patients.
In the past, when patients were not seeing results with treatments like Restasis® and Lotemax®, there was really nothing at the time to offer them. I would also see patients with superficial punctate keratitis (SPK) and would use Lotemax, or in more severe cases attempt to use Tobradex®, and nothing would resolve it entirely– a few weeks later the patient would be back in the chair.
When PROKERA® was made available, I was very excited. I always say it was like I had a “Rolodex in my head” of all the patients who would benefit. And sure enough, when I started using it, I immediately started seeing positive results. In cases of moderate to severe SPK that hasn't responded to typical treatment, I now recommend PROKERA. It provides a fresh start for patients, although I always stress that they still need to continue their dry eye regimen after treatment. This success has made me use PROKERA more, and positive patient referrals tell me that my patients are pleased with my therapeutic choice.
Patient Education and Expectation Setting
Many patients for whom I recommend PROKERA have moderate to severe dry eye, so it typically comes up early in our conversation. By the second visit if I don’t see improvement, particularly seeing most patients have tried other treatments but still have the signs and symptoms, we discuss having one inserted. The results have been amazing. Patients love PROKERA and they love me for introducing it to them. So, it’s definitely a win/win.
One of the keys to my success with PROKERA is a focus on patient education. I listen to everything patients have tried in the past, what worked, what didn’t work, and what they’re currently using. From there, we form a plan together. The “together” is vital as patients need to be a part of the plan and understand how I’m going to treat them, which ultimately helps with compliance.
Before inserting PROKERA, I also set expectations so patients know what to expect, how it may feel, and things they can do to be more comfortable. I want to make sure they understand how amazing this technology is and what it’s doing for them, but that it’s also a process. Patients will often endure a little discomfort, knowing how much they’re being helped and that they will feel better soon.
Take Home Supply Bags
As I’ve used PROKERA more, I started thinking about what would make the patient most at ease with having it inserted in their eye, then going home for days before returning to have it taken out.
Over time I’ve observed that taping the lid makes the patient feel better. I also cover their eye with an eye pad when they leave the practice, which helps them feel more comfortable, and particularly for my older patients, this helps them to feel more balanced. I have also found gel tears help to create a nice buffer between the lid and PROKERA.
I came up with the idea to put an extra supply of these items – eye pads, small roll of surgical tape and gel tear samples – in a bag with our practice logo on it as well as instructions for when they get home. This way, patients have a supply so when they wash their face or need to take off the tape or the eye pad, they have more. There is also the gel, which is a new addition I added to the bag. It’s a nice “take home” for the patient that has everything in one place and makes them feel more at ease, which helps with compliance. It’s like a security blanket for them so they don’t have to worry. You can also put your business card in there in case they have questions or concerns.
The more we can do to educate our patients, set expectations and help make them feel more at ease and secure, the more success we will have in treating their DED and helping to improve their quality of life.
Susan B. Janik, OD, practices at Solinsky EyeCare in West Hartford, CT where she is active in its Dry Eye Center. She is licensed in Advanced Optometric Care and is certified in Corneal Reshaping Therapy technology. Dr. Janik is an active member of the American Optometric Association including its Contact Lens and Cornea section and the Connecticut Association of Optometrists.