1. 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.

2. 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)

3. 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

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

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

6. 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 (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%

7. 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

8. 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

9. 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

10. 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

11. 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.