Implementing a dry eye service in primary optometric care

Abstract

The aim of this thesis was to understand the demand and uptake of private optometric community services outside the scope of traditional services having the outcome of supplying spectacles, and of locally commissioned shared care schemes. Dry eye is known to reduce quality of life, be highly prevalent, underdiagnosed and clinically significant. Dry eye is a condition with poor association and discordance between signs and symptoms, and so is poorly managed. Dry eye does not command priority in secondary care where patients sometimes present when self-help measures fail, considering it is generally not sight threatening. The global consensus on dry eye have recommended a tiered management approach highlighting advanced pharmacological care options that could be applied by optometrists with an independent prescribing qualification. Emerging technologies also show promise in advanced dry eye diagnostics and management but the investments required means that practices need to develop a strong business plan to make them commercially viable. This research was based on a single independent optometric practice and two hospitals with a relationship to the practice. Service blueprinting was applied to the dry eye service to demonstrate its usefulness in optometric service innovation. Decision tree analysis and principal component analysis were used to discriminate between people self-reporting dry eye, to predict severity, and to identify clinical tests to explain the variability between those with predominately evaporative dry eye from a sample of patients. Despite having signs of dry eye, there were no differences in visual outcomes post-lens surgery based on dry eye sign status, and there were no strong trends to link discontinuation of contact lens wear to dry eye. Dry eye is a condition that presents to the local eye casualty department that can be managed within the community along with other conditions that may have an acute or recurring presentation.