dry eye

Be Spry With Dry Eye

The keys to providing ace dry eye disease care

KELLY NICHOLS, O.D., M.P.H., Ph.D.

If you focus on ocular surface disease (OSD), dry eye disease (DED) patients will find you. I recently received an e-mail from a West Virginia woman who is a long-time meibomian gland dysfunction (MGD) sufferer. She was well spoken and well educated about her condition and was seeking more information and management in addition to her cyclosporine ophthalmic emulsion 0.05% (Restasis, Allergan). She said she was willing to travel for care.

In my clinical experience, patients who seek help via the Internet understand DED is chronic, and yet are frustrated their care thus far hasn’t alleviated symptoms. They are often unsatisfied with the practitioner(s) providing care. I’m certain you don’t want a patient to obtain management elsewhere. In fact, if you provide optimal DED services, patients will come to you.

Here’s how:

Get the stuff.

Acquire the latest equipment and skills in DED management. In our OSD clinic, we use a topographer/meibographer/video slit lamp device (Oculus Keratograph 5M). Patients are curious about seeing their glands, and a quick view tells us the gland drop-out level. It’s easy to convince a patient that hot compress therapy and/or therapeutic intervention is necessary when he/she “sees” a clinical image.

Other instrumentation: a tear osmolarity device (TearLab), an ocular surface interferometer and an intermittent gentle pressure heat instrument that treats MGD (LipiView and LipiFlow, respectively). If you don’t have the budget to support all/some of these, plan to recoup instrument costs via billing a medically oriented exam and procedures (osmolarity and external photography), and commit your staff to recruitment efforts using milestones.

Sing from the mountaintop.

Let your community know you know what you are doing and that you cater to the “dry eye crowd.” Word of mouth is a valuable referral tool, but it shouldn’t be your sole patient source. Create patient newsletters, advertise with the local media, and search for local groups via the Internet that could benefit from DED talks, such as the elderly, and contact these groups.

We advertise DED studies in a local, free weekly newspaper. More importantly, your practice likely has many undiagnosed DED patients. Start with your contact lens patients, allergy sufferers and females older than age 50. Consider a reminder postcard to invite them to a DED exam. And if you’re in group practice, tell your colleagues you plan to step up this niche.

Keep it simple.

In a recent visit to a prominent M.D. practice that emphasizes DED and MGD management, I left with a one-page overview of the “standard” OSD management routine given to first-time patients.

That said, the primary physician is willing to alter the plan after a period of “office testing” new diagnostic tools or treatments. This “pick it and stick by it” approach resonates with me, especially for the initial visit. Incorporating this office management tip can save time and help in your quest for DED care excellence.

Now, you can start reaping the rewards of seeing these patients. OM

DR. NICHOLS IS A FOUNDATION FOR EDUCATION AND RESEARCH IN VISION (FERV) PROFESSOR AT THE UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY. SHE LECTURES AND WRITES EXTENSIVELY ON OCULAR SURFACE DISEASE AND HAS INDUSTRY AND NIH FUNDING TO STUDY DRY EYE. SHE IS ON THE GOVERNING BOARDS OF THE TEAR FILM AND OCULAR SURFACE SOCIETY AND THE OCULAR SURFACE SOCIETY OF OPTOMETRY AND IS A PAID CONSULTANT TO ALCON, ALLERGAN, INSPIRE AND PFIZER. DR. NICHOLS CAN BE CONTACTED AT KNICHOLS@OPTOMETRY.UH.EDU. TO COMMENT ON THIS ARTICLE, E-MAIL OPTOMETRICMANAGEMENT@GMAIL.COM.