Survey on the Knowledge, Attitudes, and Practice Patterns of Ophthalmologists in the Philippines on the Diagnosis and Management of Dry Eye Disease
Margarita I. Echavez, MD1,2, and Ruben Lim Bon Siong, MD1,3
1Department of Ophthalmology and Visual Sciences
Sentro Oftalmologico Jose Rizal
University of the Philippines – Philippine General Hospital
2Adventist Medical Center-Iligan Eye Center
Andres Bonifacio Avenue, San Miguel, Iligan City 9200, Philippines
3Eye Institute, St Luke’s Medical Center
279 E. Rodriguez Sr. Blvd., Quezon City 1102, Philippines
Correspondence: Margarita I. Echavez, MD
Adventist Medical Center-Iligan Eye Center
Andres Bonifacio Avenue, San Miguel, Iligan City 9200
Disclosure: No financial assistance was received for this study. The authors have no proprietary or financial interest in any products used or cited in this study.
Objective: To determine the knowledge, attitudes, and practice patterns of ophthalmologists practicing in the Philippines on the diagnosis and management of dry eye disease through a survey using an online questionnaire.
Methods: A simple online survey was designed to determine the knowledge of ophthalmologists practicing in the Philippines on the definition, symptoms, diagnostics, as well as their management of dry eye disease. Respondents also provided information regarding setting and characteristic of practice, years of practice, field of practice, and number of new dry eye patients weekly.
Results: A total of 148 ophthalmologists responded to the survey with a 16% response rate. Most believed dry eye disease was associated with symptoms of ocular discomfort (99%), tear deficiency (98%), and tear film instability (97%). Symptoms believed to be associated with dry eye were dryness (97%), burning sensation (94%), foreign body sensation (93%), and discomfort/pain (93%). Most ophthalmologists diagnosed dry eye based on patient symptoms (99%), tear break-up time (93%), and fluorescein staining (91%). Very few tested for tear osmolarity to diagnose dry eye (6%). Only few used dry eye questionnaires (27%) and lissamine staining (32%). The most valuable tests included tear break-up time (92%), fluorescein staining (88%), Schirmer test (85%), and meibomian gland evaluation (83%). Treatments most commonly used were artificial tear supplements (100%), lid hygiene (94%), environmental modification (92%), and work and lifestyle modification (88%). Artificial tear supplements were the most valuable treatment (100%), followed by lid hygiene (89%) then environmental modification (85%). The most common first-line medications were carboxymethylcellulose (89%), propylene glycol (85%), and hypromellose (83%). Very few ophthalmologists classified dry eye by type (19%) and by severity (35%), but 80% tailored their treatment to the severity of the dry eye.
Conclusion: Dry eye disease is a common yet frequently underrecognized clinical condition whose etiology and management challenge clinicians and researchers alike. This study showed that ophthalmologists practicing in the Philippines who answered the survey lacked awareness on the new definition of dry eye disease, the newer diagnostic tests, and therapeutics available for diagnosing and managing dry eye disease.
Keywords: Dry eye disease, survey, knowledge, attitudes, practice patterns, Philippines, ophthalmologists