I-Chan Lin MD, Paul P. Lee MD, JD Conformance to Preferred Practice Patterns in Caring for Patients with Dry Eye Preeya K. Gupta MD, I-Chan Lin MD, Paul P. Lee MD, JD Duke Eye Center Durham, NC Financial Disclosure: None of the authors have a financial interest in the subject matter of this poster. Dr. Paul Lee receives consultant, research, and travel reimbursement and/or is an investor in Alcon, Allergan, Merck, and Pfizer.

Background & Purpose Dry eye is one of the most frequent reasons for seeking eye care and has a significant impact on quality of life The potential economic burden related to dry eye is great and therefore it is important to examine the current process of care as it relates to dry eye Our goal was to evaluate documentation of physician evaluations of patients with dry eye for the presence of key elements, as defined by the American Academy of Ophthalmology’s Summary Benchmarks for Preferred Practice Patterns (PPP)

Methods Study was approved by the institutional review board 131 charts of patients seen at the Duke Eye Center from January 1998 to July 2008 with the diagnosis of dry eye were reviewed for documentation of the presence or absence of key elements as defined in the PPP Primary analysis: reviewed by 1998 dry eye PPP (all pts) Secondary analysis: reviewed by 2003 dry eye PPP (for those seen between 2004 and 2008) A total of 100 points was ascribed to each of the four sections (400 points overall) and then divided among each bullet point yielding an overall and individual section sub-score

AAO’s Dry Eye PPP Only level A recommendations were reviewed

AAO’s Dry Eye PPP (continued) Only level A recommendations were reviewed

Results Of all patient charts reviewed, the mean age was 60.3 ± 20.8 years and 84.8% of all patients were women The average total score was 62.9% for all evaluations, and 65.1% for those performed between 2003-2008 (Table 1) When analyzed by use of electronic medical record (EMR) compared to standard paper charting, the physical exam score increased from 73% to 84%

Results Ocular symptoms, signs, and use of topical medication was well documented Documentation of ocular history was variable, with few documenting contact lens wear, prior eyelid surgery, Bell’s palsy, or chronic ocular inflammatory conditions Systemic history including menopause, atopy, and trauma were documented in about 1/3rd of charts, while systemic medication use, inflammatory disease, and smoking history was better documented

Results Skin and cranial nerve function were less often documented TABLE 3. PHYSICAL EXAM SCORES Skin and cranial nerve function were less often documented compared to eyelid and adnexal examination Documentation of slit-lamp examination components was higher in those seen after 2003

Results Elimination of exacerbating medications occurred < 1/3rd of the time Documentation of environmental modification occurred in 4.6% Patients were often not counseled about work site intervention Most patients were given tear enhancement

Results Patients with dry eye were counseled about its natural history about 50% of the time Caution regarding LASIK in patients with dry eye occurred 1/3rd of the time Documentation of coordination with medical specialist occurred <50% of time

Conclusions In an academic practice, the process quality of care for dry eye does conform to the AAO’s PPP in some areas. There is room for improvement especially in the areas of patient education and care management. Greater attention is needed in assessing the range of factors that may underlie dry eye disease in different patients. EMR may have a potential role to aide in better documentation within the medical record. Additional data are needed from other practice settings to further evaluate the quality of dry eye care.