CLINICAL

  ANTERIOR

DEVELOP A DRY EYE CLINIC

FOLLOW THESE FOUR TIPS TO GROW DED AWARENESS AND YOUR PRACTICE REVENUE

JOSH JOHNSTON, O.D., F.A.A.O.

DRY EYE disease (DED) is on the rise due to the aging population, high prevalence of other conditions, such as diabetes, that affect the eye’s normal function, the increased use of digital devices, which decreases blink rate, and an increased awareness of the condition, among the public. Yet, those who have the chronic condition are underserved. Possible reasons for this: Many patients choose to self-medicate, several dismiss their DED symptoms as a normal part of aging, and many are unaware of the potential long-term damage DED can cause and, thus, fail to report it to their physicians until it’s unbearable.

To increase awareness of the seriousness of DED among patients and, thus, help those who fall under one of the aforementioned categories, you should consider developing a DED clinic in your practice.

Here, I explain how you can accomplish this.

1 GET STAFF ON BOARD

Hold a clinic kick-off meeting where you educate your staff on why you are launching the clinic, introduce a clinic-training program and indicate its duration, clearly define each staff member’s role in the clinic and provide a launch date.

In regard to staff training, I recommend that you schedule a few days for training sessions that are comprised of the clinical symptoms and signs of DED, basic ocular anatomy — with a focus on the ocular surface, lids and lashes, currently available treatments and the diagnostic tests. If you are too busy to oversee training yourself, consider outsourcing it to the company representatives of the DED diagnostic tests and treatments you commonly prescribe. They will be happy to help train your staff.

Also, establish effective and efficient testing protocols that can be used to train staff members of all levels. Specifically, you’ll want staff members to take a clear case history (current systemic and ocular medications, autoimmune disease history, DED risk factors, surgical history, etc.), provide a DED questionnaire, such as The Dry Eye Ocular Surface Disease Index or SPEED Questionnaire, to hone in on a patient’s symptoms, and know how to operate certain diagnostic tests, such as interferometry, meibography, blink evaluation, topography, tear osmolarity, tear production tests and MMP 9 detection testing.

In the matter of clearly defining each staff member’s role, front desk staff, for example, should be instructed to avoid playing doctor by recommending the purchase of OTC products to patients who report DED symptoms and, instead, triage DED patients, so they can be scheduled in the designated DED clinic time slots for exams and, ultimately, a definitive diagnosis and specific treatment plan.

2 READY YOURSELF

To ensure you’re prepared for DED suspects and, thus, can provide an accurate diagnosis and appropriate treatment plan, create a checklist of diagnostic tests to perform. Also, prepare easy-to-understand patient education regarding DED and the treatment plans.

Your checklist should contain:

1. Gross examination of the periorbital area, nose and ocular adnexa

2. Slit lamp examination of the lids, lashes, meibomian glands, conjunctiva (bulbar and palpebral) and cornea

3. Corneal NaFl staining

4. TBUT using NaFl viewed with blue light

5. Lissamine green conjunctival staining under white light

6. Meibomian gland expression

7. Meibomian gland evaluation via transillumination of the lower lids with a penlight (in case you don’t have meibography)

8. Examination of the location of the mucocutaneous junction/Marx line with lissamine green

9. Lagophthalmos check via the lid seal test with a penlight

In the matter of patient education, many optometrists opt to delegate all patient education to staff to save time. When it comes to DED, I’ve found that when I, the doctor, provide the education, patients are more likely to comply with my prescribed treatments because I, not my staff, am the expert. My advice: Carve out some time in the exam lane to educate patients about their DED diagnosis, and allow them to ask questions:

“You have dry eye, which is a chronic and progressive disease. Dry eye is multi-factorial and is caused by inflammation, which decreases your ability to make natural tears. The glands along the eyelid also get obstructed and can’t secrete the oil layer of the tears, making symptoms worse. There is no cure for this, but the personalized treatment plan I have created for you will help. This will be a gradual process, and you will get better over the next few months”.

Finally, before DED patients leave your exam chair, give them a treatment summary sheet and review the prescribed treatment plan. The sheet is helpful in making the time you spend educating patients more impactful.

3 MARKET EXTERNALLY

While your DED clinic will get a lot of patients via internal marketing from you and your staff, don’t forget about external marketing, as several undiagnosed patients exist outside your practice.

My practice’s external marketing efforts: Google AdWords and educating other local doctors via CE events and email blasts. All have worked well.

Assessing lipid layer thickness.

4 CREATE A RETAIL CENTER

In some DED cases, you’ll prescribe non-prescription treatments, such as artificial tears. To increase the likelihood of your patients buying exactly what you prescribe vs. similar, yet inferior, products from their local pharmacy, consider selling the non-prescription products you prescribe in your practice. Specifically, highlight to patients the convenience and the fact that they won’t have to worry about buying “the wrong thing” from a pharmacy.

The most common DED products sold in an O.D.’s practice are artificial tears, lid hygiene foams/sprays, heat masks and nutritional supplements, such as omega fatty acids, which often can only be purchased online.

A retail center will create happier patients, due to the convenience and expected alleviation of clinical symptoms and signs.

Tear osmolarity testing.

GET STARTED

Although awareness of DED has increased, due to the radio, TV, print and web advertising of treatments, many patients remain unaware of the seriousness of the condition and the fact that various treatments are available to alleviate the bothersome symptoms and signs. Why not consider developing a DED clinic to increase awareness, while helping to improve patient care and your practice revenue? OM

DR. JOHNSTON practices at Georgia Eye Partners. He focuses on ocular surface disease and has extensive experience in co-managing cataract and refractive surgery patients. Email him at drj@gaeyepartners.com, or visit tinyurl.com/OMcomment to comment.