title: Comparing self-reported optometric dry eye clinical practices in Australia and the United Kingdom: is there scope for practice improvement?
abstract: OBJECTIVE
  The aim of this study was to compare the self-reported clinical practice behaviours of optometrists in Australia and the United Kingdom (UK) with respect to the diagnosis and management of dry eye disease (DED). We also sought to examine whether the reported practices of clinicians in each region were consistent with current evidence-based recommendations for DED.
  
  
  METHODS
  An online survey was distributed to optometrists (Australia, n = 654; UK, n = 1006). Respondents provided information about practice modality, years of optometric experience, preferred diagnostic and management strategies (stratified by DED severity) and the information/evidence base used to guide patient care.
  
  
  RESULTS
  A total of 317 completed surveys were received (response rates, Australia: 21%, UK: 17%). Optometrists in both regions demonstrated similarly strong knowledge of tear film assessment and adopted both subjective and objective techniques to diagnose DED. Patient symptoms were considered the most important, valuable and commonly performed assessment by both Australian and UK respondents. UK practitioners valued and utilised conjunctival signs and tear meniscus height assessments more than Australian optometrists (p < 0.05), who placed relatively greater emphasis on sodium fluorescein tear break-up time to diagnose DED (p < 0.05). Clinicians in both locations tailored DED therapy to severity. While practitioners in both regions predominantly managed mild DED with eyelid hygiene and tear supplementation, Australian optometrists indicated prescribing topical corticosteroid therapy significantly more often than UK practitioners for moderate (14% vs 6%) and severe (52% vs 8%) disease (p < 0.05). The major source of information used to guide practitioners' dry eye management practices was continuing education conferences.
  
  
  CONCLUSIONS
  This study highlights a range of parallels and divergences in dry eye clinical practice between Australian and UK optometrists. Our data identify both areas of strength in the adoption of evidence-based practice, as well as some potential to improve international translation of dry eye research evidence into practice.
authors.affiliation: Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Downie
authors.affiliation: School of Life and Health Sciences, Aston University, Birmingham, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Rumney
authors.affiliation: Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Gad
authors.affiliation: Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Keller
authors.affiliation: School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Purslow
authors.affiliation: Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia.
authors.forename: Algis J
authors.initials: AJ
authors.lastname: Vingrys
mesh_terms: D001315:Australia; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000628:therapy; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009907:Optometry / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006113:United Kingdom
keywords: cornea; dry eye; dry eye disease; evidence-based practice; meibomian gland dysfunction; optometrist; optometry; survey; tear break-up time; tear film