allergy

The Itch Niche

Build a specialty in ocular allergy, and increase your revenue.

MARGIE RECALDE, O.D., FRESNO, CALIF.

Creating an ocular allergy niche is not something to sneeze at. For one, it differentiates your practice from others, enabling you to attract this patient population. (Upon satisfaction with your service, these patients become a patient referral source.)

Second, it allows you to segue from refractive to medical care, which increases your bottom line. In fact, an allergy niche practice may boost profitability to more than $90,000 a year.¹

Third, its effect on practice logistics is negligible: Ocular allergy requires a low-risk treatment plan that works quickly, and no new equipment or additional staff is needed.

Finally, it’s a service that’s in high demand. Specifically, 40% of the general population suffer from allergic conjunctivitis, indicate studies.² In addition, it is estimated that 20% of patients miss work, and 45% report decreased productivity due to allergies.³

So, how can you build an ocular allergy niche? Here are five strategies.

Become the expert.

Make certain you are up to date on all the treatment options and research findings by reading the various eyecare and allergy periodicals, talking with colleagues and by attending eyecare and allergy trade shows and conferences, at which new medications are presented and continuing education courses are available.

Important factors to consider with medications: onset and duration of action, dosage, side effects, contraindications, such as narrow angles when drugs have a mydriasis side effect, and patient tolerability.

It is estimated that 20% of patients miss work, and 45% report decreased productivity as a result of allergies. Translation: Your expertise as an eye doctor is needed.

Knowledge of the latest research and medications enables you to make the best management decisions.

Use your pharma reps.

Inform your pharmaceutical representatives of your interest in establishing an ocular allergy niche. They can provide educational tools, such as formulary coverage — something else that plays a role in your treatment choice — and workshops for you, your staff and your patients.

Screen all patients.

A total of 40% to 60% of patients have an overlap of both dry eye disease and allergic conjunctivitis, and it occurs more frequently together vs. separately, says a study.⁴ Furthermore, 90% of patients suffering from allergic rhinitis also have allergic conjunctivitis, a study reveals.⁵

Given these percentages, it’s obvious that creating an ocular allergy niche is contingent on screening all your patients for the condition. To accomplish this, provide patients with a fill-in questionnaire. (see http://odysseymed.com/downloadable/Odyssey_DryEyeAllergySurvey.pdf) Also, have patients fill out the Conjunctival Allergen Itch Score questionnaire. The original 1.0 increment scale is designed for use in busy practices, making it ideal for the primary care optometrist.

A grade 2 itch may warrant ocular medications, while a grade 3 or worse itch score definitely requires treatment. A grade 2 itch score patient may still need ocular medications if he/she suffers from additional symptoms of allergic conjunctivitis, such as tearing, redness, chemosis and/or swollen eyelids.

These questionnaires save you and your staff time, while also raising the patient’s awareness of the seriousness of ocular allergy and dry eye disease and your intention to carefully monitor and appropriately treat each condition.

Educate your patients.

Prove your worth by demonstrating your knowledge and skills. Specifically, briefly explain the patient’s diagnosis — everyone knows what allergy means — and treatment. Patient scripts:

► The mild allergy patient (symptoms are infrequent). “Based on your questionnaire answers and my exam findings, I believe you have mild ocular allergy. To relieve the condition’s signs and symptoms, I’m going to prescribe ___________, which I want you to use as needed.

► The seasonal allergy patient (symptoms are frequent, mainly during certain seasons). “Based on your questionnaire answers and my exam findings, I believe you have seasonal ocular allergy. To prevent the condition’s signs and symptoms, I’m going to treat the condition with ___________ prior to allergy season. I want you to use _________ every day, even if you feel fine. It’s easier to prevent ocular allergy’s occurrence than it is to treat it when it’s already set in motion.”

► The chronic allergy patient. “Based on your questionnaire answers and my exam findings, I believe you have chronic ocular allergy. To relieve the condition’s signs and symptoms, I’m going to prescribe ___________, which I want you to use every day.”

► The AKC or VKC allergy patient. “Based on your questionnaire answers and my exam findings, I believe you have (atopic or vernal) keratoconjunctivitis. To relieve the condition’s signs and symptoms, I’m going to prescribe ___________, which I want you to use every day. Non-compliance will result in ________.”

Market the niche.

Numerous cost-effective and simple ways exist to market ocular allergy. Internal marketing strategies: educational posters and video messages, creating an allergy brochure (comprised of the signs and symptoms and the ocular allergy services you provide) and sending promotional material, particularly in May to take advantage of “National Allergy Awareness Month.”

External marketing: networking with allergists and primary care physicians (e.g. sending them your CV, organizing lunch meetings, etc.) accessing social media (Facebook, Bebo, etc.) and local media (e.g. contacting your local newspaper to pitch a story), participating in local community groups, such as the chamber of commerce, and activities, such as vision screenings at health fairs. It also includes posting ocular allergy information on your website.

A final reason.

We, as optometrists, are best suited to help these patients because we have the passion, knowledge and expertise to manage ocular allergies. Take advantage of the opportunity to go above and beyond these patients’ expectations and make a positive difference. Patients present expecting to see better, but by providing the ocular allergy service, they will leave your practice also feeling and looking better. OM

1. Rumpakis J. Increase Profitability Through Accurate Billing and Coding. Optometric Management. www.optometricmanagement.com/articleviewer.aspx?articleID=1026 27 (Accessed 1/11/13)

2. Rosario N, Bielory L. Epidemiology of allergic conjunctivitis. Curr Opin Allergy Clin Immunol. 2011 Oct;11 (5):471-6.

3. Improving the treatment of ocular allergies. ASCRS Eyeworld. www.eyeworld.org/ewsupplement article.php?id=401 (Accessed 1/5/13)

4. Hom MM, Nguyen AL, Bielory L. Allergic conjunctivitis and dry eye syndrome. Ann Allergy Asthma Immunol. 2012 Mar;108(3):163-6.

5. Abelson MB, Chambers WA, Smith LM. Conjunctival allergen challenge. A clinical approach to studying allergic conjunctivitis. Arch Ophthalmol. 1990 Jan;108(1):84-8.

Dr. Recalde practices in Fresno, Calif. She is a consultant to Allergan and has received past honoraria from Alcon and Bausch & Lomb. E-mail mrecalde@eyeqvc.com, or send comments to optometricmanagement@gmail.com.