O.D. to O.D.

EXAMINING THE 4^th AND 5^th

WHY IS THERE A “DISCONNECT” IN HOW WE TREAT OCULAR SURFACE DISEASE?

Scot Morris
O.D., F.A.A.O.
Chief Optometric Editor

HAVE YOU considered: What are the most common disease states that you see in your office? We all know the top three are myopia, astigmatism and presbyopia. We listen to the symptoms (“my vision is blurry”), perform a few diagnostic tests (auto refraction and manifest refraction), make a diagnosis, design a treatment plan (glasses, contact lenses, refractive surgery or some combination of these) and then write a prescription that patients fill with you or take elsewhere. Pretty simple right? You treat disease every day, all day long.

IDENTIFYING A “DISCONNECT”

Yet, there seems to be a disconnect between the number of patients who have the next two diseases, both of which deal with the ocular surface, and the number of these patients actually managed in our practices. Let me explain:

Depending on the research cited, ocular allergies affect more than 30% of the U.S. population, and dry eye affects upwards of 40% of the U.S. population. Why the disconnect? Both diseases have clear symptoms (ocular itch, fluctuating vision, red eyes, foreign body sensation). We perform diagnostic tests (vital dye staining, MMP-9, tear osmolarity, etc.), make a diagnosis, design a treatment plan (artificial tears, antihistamines, decongestants, steroids, immunosuppressants, omega-3s, etc.), write prescriptions that patients fill with you or take elsewhere. Right?

WHAT ABOUT YOUR PRACTICE?

Now, look at your practice. Choose any interval — at the end of today, at the end of the week or at the end of the month — and determine how many patients in whom you actually made a primary diagnosis of one of the two primary ocular surface diseases and wrote a prescription? Is it 20%? 30%? No? Why not?

Let me answer the question. We, as a profession, need to get our medical decision making out of the patient’s pocketbook. Through the last two decades of speaking, writing, etc., one thing has been made abundantly clear: We, as a profession, seem to be more worried about not making a patient pay out of pocket for a medical service — one that he or she needs and wants — than doing the right thing and treating the disease states sitting in our chairs. Yet, few of us have an issue charging $500 to $1,000 for a pair of glasses. We seem to completely pause when we need to charge patients $75 to treat a disease that affects their vision and a huge chunk of their every day lives. Why is this?

ONLY YOU CAN ANSWER

I can’t answer for you, but it may be worth taking a few minutes to consider it. The issue likely isn’t that we don’t have the disease in our office, but that we decide to judge what is important by who is paying for the exam. STOP.

Treat what is in front of you. Solve the patient’s issue. If we do so, many of our other issues might go a way too. OM.