editor’s perspective

Be Proactive Rather Than Reactive

By Jason J. Nichols, OD, MPH, PHD, FAAO

Over the last several years, we have seen a tremendous amount of international progress in our understanding, identification, and management of ocular surface disease. This is particularly true for dry eye disease, such as aqueous deficient dry eye, in addition to diseases associated with evaporative dry eye such as meibomian gland dysfunction. We’ve seen practitioners implement both new (and old) techniques in practice, all usually with the intent of managing current active disease. However, I’ve recently become more focused on the concept of preventing disease, and I think this is something that eyecare providers need to do better. More specifically, I’ve started to emphasize this concept relative to the ocular surface, and particularly in contact lens wearers.

It is often insightful to draw analogies to other healthcare professions when thinking about common practices. I think an important comparison that the eyecare profession can make in terms of preventive care is to dentistry. For example, surveys show very high compliance with twice-daily teeth brushing regimens in the general population. Likewise, in North America, we’ve seen a shift in the frequency in which patients undergo regular teeth cleaning, which seems to now be relatively well accepted at twice a year. Interestingly, it could be argued that most people don’t implement these practices because their teeth or gums hurt—they do it as general day-to-day preventive care for their teeth.

Now, let’s take this back into eye care. Why is it that we are generally still trying, for the most part, to fix problems? Why don’t we prescribe products and practices (including both lens care and materials or modalities) that are associated with higher compliance to prevent problems from occurring? Further, why don’t we care for the ocular surface before patients have ocular surface disease? This could include regular meibomian gland expression or even the use of agents to promote ocular surface health, much in the way that we use toothpaste each day. It is interesting to consider that we use so many products to maintain and protect our hair, skin, and teeth, but we have yet to translate these concepts to the ocular surface.

Aren’t our eyes worth it?