Implementation of the dry eye disease framework in the Malaysian clinical practice: perspectives from local dry eye experts

Purpose: Diagnosis and management of dry eye disease (DED) differ across clinics due to the variable diagnostic and treatment equipment and the lack of guidelines for managing DED. This study aims to understand the current landscape of DED diagnosis and management in the Malaysian healthcare setting, as well as to evaluate the feasibility of implementing a DED framework in local settings. Study design: A quantitative cross-sectional survey. Methods: A 12-question multiple-choice questionnaire was administered to 13 local cornea specialists from May 2023 to September 2023. The questionnaire comprised of six dimensions: guidelines utilisation for DED diagnosis and management; standardisation for DED diagnosis and management between clinics; administration of validated DED questionnaire to patient; availability of clinical and screening tests in their clinics; treatment availability in their clinics; and follow-up and patient education. Results: Most respondents (84.6%) use one or more international guidelines or national guidelines from other countries in their clinical practice. All respondents agreed that DED diagnosis and management should be standardised among ophthalmologists, while 92.3% would consider implementing a standardised DED diagnosis and management algorithm in their practice. More than two-thirds of the respondents (69.2%) do not have the resources for their patients to self-administer DED questionnaire. All respondents have slit-lamp examination, fluorescein tear film breakup time test and corneal fluorescein staining as screening tools, as well as ocular lubricants, cyclosporine A and corticosteroids as treatment options in their clinics. Most respondents (92.3%) were able to follow-up with their patients at least every six months. Less than half of the respondents (38.5%) were able to spend an average of 13 minutes for patient education. Conclusion: This study revealed that most of the local cornea specialists would consider implementing a standardised DED framework in managing their patients with DED. However, factors impeding its implementation (e.g. diagnostic and treatment equipment availability, cost and clinical workflow differences, and patient loads) in local settings should be identified and tackled to standardise DED management and improve the quality of patient care in Malaysia.