Knowledge, attitude, and practice of dry eye treatment by institutional Chinese physicians in Singapore

Abstract

Dry eye is a common health problem worldwide, causing significant discomfort and inconvenience to sufferers. The conventional treatment of dry eye via topical administration of eye drops is deemed palliative and unsatisfactory to many. Traditional Chinese medicine (TCM) has shown some promise in dry eye treatment; however, the extent of its use and acceptance is uncertain. We evaluated the knowledge, attitude, and practice of institutional TCM practitioners in the treatment of dry eye in Singapore. A questionnaire was generated to address the study aims and sent to TCM practitioners listed in the Singapore TCM practitioners' board database. About three quarters of respondents thought that dry eye was not severe enough to be a public health burden but most thought that TCM was effective in the treatment of dry eye. Acupuncture and herbal medicine were most commonly used TCM modalities in dry eye treatment, and a single TCM treatment session would be charged S$20-50 by the practitioner. The majority of surveyed institutional TCM practitioners in Singapore believe that TCM is relevant in dry eye treatment. Public awareness should be raised regarding the availability of TCM as alternative medicine for dry eye.

Figure 1

Demographics of surveyed TCM practitioners. Bar chart representing (a) number of years of practice among surveyed TCM practitioners and (b) place of practice of TCM practitioners. “Conventional hospitals” refer to places with mainly conventional medicine and diagnosis, for example, Singapore General Hospital, Tan Tock Seng Hospital; “TCM institutions” are places of TCM clinical practice and education, for example, Thong Chai Medical Institution, Chung Hwa Medical Institution, whereas “chain enterprises” are mostly commercially driven TCM clinics with several branches, for example, Eu Yan Seng, Ma Kuang, Beijing Tong Ren Tang; “private practice” are individual private clinics that usually include 1-2 TCM practitioners; not included are miscellaneous locations not described by above categories: for example, Nanyang Technological University TCM Clinic, clinics at spas and wellness groups, and so forth.

Figure 2

Knowledge of TCM practitioners about dry eye disease. (a) Bar chart representing modality of TCM treatment that practitioners believe to be effective in treating dry eye. “Herbal medication” represents oral herbal decoctions or patent pills; “external treatment” refers to modalities such as hot compress, external herbal wash and eye drops refer to conventional topical eye drops. (b) Bar chart showing the dry eye symptoms that TCM practitioners are aware of.

Figure 3

Attitude of TCM practitioners towards dry eye disease. Pie chart illustrating TCM practitioners' perception of (a) dry eye disease, and (b) efficacy of TCM in treatment of dry eye. Disagree: TCM is inappropriate to treat dry eye; slightly disagree: only some patients improve; slightly agree: most (>70%) patients show improvement; strongly agree: dry eyes can be symptomatically cured in most (>70%). (c) Pie chart showing the willingness of TCM practitioners to develop a special interest in treating dry eye.

Figure 4

Practice of TCM practitioners in treatment of dry eye disease. Bar chart representing (a) modalities of TCM treatment that practitioners have used to treat dry eye. “Herbal medication” represents oral herbal decoctions or patent pills; “external treatment” refers to modalities such as hot compress and external herbal wash and eye drops refer to conventional topical eye drops, (b) charges for acupuncture treatment per session, (c) charges for nonacupuncture TCM treatment per session, (d) period of time from the last TCM treatment of a dry eye patient, (e) average number of dry eye patients treated per week by TCM practitioners, (f) frequency of TCM treatment and follow-up visits for dry eye patients, and (g) entire span of TCM treatment course for dry eye patients. Wk: week, Mth: month. All charges are in Singapore currency.