Dry eye syndrome

It is my perception as an elderly ophthalmologist that changes in the practices of medicine are becoming more controlled, even possibly exclusively controlled, by the results of scientific publications. It is also my perception that, since studies cost money and that money is provided largely by drug companies, the direction of change in medicine is becoming more directed by drug companies than was so in the past. An example of this change came to my desk this week in the form of the AAO Preferred Practice Pattern on dry eye syndrome. I believe that somewhat fewer than half the patients who present complaining of dry eye do not have dry eye. They have ocular irritation. In fact, in the paragraph on epidemiology, the booklet quotes 14.6% of subjects aged 65 and over reported symptoms suggestive of dry eyes and that the study showed that 3.5% of individuals were symptomatic and had either a low Schirmer test score or high rose Bengal score. I think this supports my contention. I believe that a lot of the discomfort from chronic conjunctivitis, whether sicca or not, is due to environmental irritants. However, the authors, in describing the patient history, failed to suggest that it might be useful to ask if the patients smoke, where they work, or what their hobbies consist of. To put it simply, an individual who works in a saw mill, smokes heavily, and swims twice a week in a chlorine swimming pool is more likely to complain of dry eyes than someone who does none of these activities. I will admit that on page 9, the booklet describes under treatment techniques the elimination of exacerbating exogenous factors (e.g., medications, environmental factors), but I do not think that this goes far enough in emphasizing the important role of environmental factors in chronic conjunctivitis. I think that the reason for this oversight is that the elimination of environmental factors provides no opportunity for income for drug companies and is, therefore, unlikely to be the topic of a scientific study. When looking at the causes of disease, personal behavior is a cause of disease that gets less attention than it deserves. While it is not as important as infections or immune deficiencies, behavior does deserve some attention. Dry eye syndrome: author’s replyOphthalmologyVol. 106Issue 6Preview Full-Text PDF