Because dry eye can be a consequence of ocular surgery and best eliminated prior to surgery to foster the best outcomes, we decided to make treating it a priority in our practice. To do so effectively, we incorporated new diagnostics and treatments and made available to our patients various over-the-counter products to help them care for their eyes. Essentially, we created a practice within our practice. We did this first and foremost to provide better care for our patients, but there are many other good reasons, too. Developing a strong dry eye component in a practice bolsters the patient perception of the practice as a leader in the field, reduces the contact lens dropout rate, and generates referrals. In addition, treating this chronic, progressive disease is a significant contributor to the bottom line.

POINT-OF-CARE TESTING IS A RECENT DEVELOPMENT

Point-of-care testing for dry eye has been a positive development. Two tests we use in our practice are the TearLab Osmolarity System (TearLab) and InflammaDry (RPS). Technicians can perform either of these tests efficiently as part of the patient workup, and both companies help with all aspects of adopting the technology, including practice logistics and marketing. For Medicare patients, these tests are 100% reimbursed as long as the practice obtains a Clinical Laboratory Improvement Amendments (CLIA) waiver, which isn’t difficult to obtain in most states. Optometrists should embrace point-of-care testing as a means to achieve more accurate diagnoses and treatment plans. Not doing so could lead to eventual exclusion from insurance panels.

In addition to point-of-care tests, meibography and anterior segment imaging, including new features on some topographers and tomographers, can be used to help detect and document the signs and causes of dry eye. The LipiView II interferometer (TearScience), for example, takes meibography to a new level with its ability to measure lipid layer thickness, evaluate blink rate, and allow visualization of the structure of the meibomian glands. The clarity provided by the LipiView II was recently enhanced with the addition of Dynamic Meibomian Imaging. Used in conjunction with the LipiView, the Korb Meibomian Gland Evaluator (TearScience) enables standardized, repeatable evaluation of meibomian gland function at the slit lamp.

All of the tests related to dry eye and meibomian gland dysfunction (MGD) are revenue generators for a practice, some more so than others. However, overall, they fuel the dry eye segment of the practice by allowing us to identify more dry eye, schedule more patient visits, and provide more treatments.

RE-APPOINTING PATIENTS FOR TREATMENT

Scheduling dry eye treatments separate from routine exams and dry eye testing, i.e., re-appointing patients for subsequent visits, is key to ensuring not only that you have adequate time to spend with the patient, but also that you will receive appropriate payment for services. Re-appointments are a staple in most medical care models, in which patients are rarely if ever diagnosed and treated in the same day. The subsequent appointments for patients diagnosed and treated for dry eye can be level II, III, or IV encounters, depending on the extent of the history, exam, and medical decision making.

The dry eye treatment armamentarium is more extensive than it used to be. In addition to treatments that have been used for years, such as manual meibomian gland expression and punctal occlusion, we can also use newer in-office options that take into account the relationship between dry eye and lid disease, MGD, and demodex. These include BlephEx treatment (Rysurg), LipiFlow thermal pulsation treatment (TearScience), MiBoFlo Thermoflo (MiBO Medical Group), and the Cliradex Complete eyelid- and eyelash-cleansing treatment (Bio-Tissue). For patients with advanced, chronic, or recurring ocular surface disease, the Prokera cryopreserved amniotic membrane (Bio-Tissue) can be used to reduce inflammation and promote healing.

As mentioned previously, we also sell a variety of dry eye care products to help patients manage their signs and symptoms, such as eyelid cleansing pads, warm and cool compress gear, moisture chambers, artificial tears, and HydroEye nutritional supplements (ScienceBased Health). Although our original intent was to bolster patient compliance by making carefully chosen products easily available, we learned that the merchandising adds to our profit margin for dry eye care.

LET’S OWN DRY EYE

Making dry eye diagnosis and management a priority in the practice is an excellent opportunity to do more for the patients who are already in the exam chairs by providing them with much-needed services. The patients are definitely there. We have become increasingly more aware that millions of people suffer from dry eye. Millions of baby boomers, a large percentage of whom are post-menopausal women, are now joining Medicare. Furthermore, the majority of eye exams are performed by optometrists. All of these factors leave no reason why ODs shouldn’t own dry eye care for the benefit of their patients and practices.

Dr. Devries is a co-founder of Eye Care Associates of Nevada. The majority of his clinical practice involves surgical comanagement and treatment of disease, particularly ocular surface disease.