Optometrists who actively look for DED know that a large number of patients either have it or are, at least, at risk of developing the chronic disease. Given the high number of patients affected, optometrists are obligated to address DED. That means talking about DED with every patient (either discussing prevention or treatment), an endeavor that can put a significant dent in clinic time. This may be the reason some providers aren’t diligent about addressing DED. It’s true that having these discussions can slow optometrists down; but there are ways to reduce this. Our office has found that utilizing staff to help carry some of the DED load is one such way.

Here, I provide tips on how this can be achieved.

1 START AT THE TOP

Before optometrists can educate patients about DED, and even before O.D.s can educate staff, they must first educate themselves about the chronic condition. DED knowledge is always expanding, so optometrists should make a commitment to get up to speed on the latest evidence-based management options to provide the best care.

To obtain this education, O.D.s can:

• Read the journals, especially the landmark studies. Regarding the latter, get familiar with the TFOS DEWS II to start. (See https://bit.ly/2QuPsZC .) Another great resource devoted to DED is the Journal of Dry Eye Ocular Surface Disease. (See www.jdryeyedisease.com )
• Go to industry-sponsored educational programs. The industry is heavily invested in DED, so take advantage of their hospitality and free education. But remember: There is no silver bullet for diagnosis and treatment. It is a multifactorial disease and, therefore, requires a comprehensive approach and tailor-made treatments to address it case-by-case.
• Take DED CE courses. A tremendous number of experts are available to educate and learn from as many as you can. These days you can find a CE course about DED nearly everywhere, especially while attending large meetings, such as your state optometric association meetings or national meetings, such as the AOA or Vision Expo.
• Attend hands-on seminars. Multiple high-quality programs exist across North America and are held multiple times per year. As is the case with CE, strive to attend as many as you can. Some of these seminars encourage attendance from administrators and support staff along with the physicians. At my practice, we find this is a great way to jump start and continue learning about DED with the entire staff. Some popular examples of these include Dry Eye University (dryeyeuniversity.com ), Dry Eye Boot Camp (dryeyebootcamp.com ), the Twin Cities OSD Symposium (twincitiesosd.com ) and the Canadian Dry Eye Summit (dryeyesummit.ca ). A quick internet search can yield more information on these and other seminars.
• Subscribe to web-based educational and practice management resources focused on DED. A few high-quality web-based platforms are available that are specifically designed to keep optometrists and their staffs updated on DED and, they can even provide resources for O.D.s to use in their clinics to train staff and educate patients. Two examples of these are DryEyeCoach.com and DryEyeAccess.com .

2 EDUCATE WITH EXCITEMENT

DED is an exciting field with high-tech equipment that optometrists and their staffs get to utilize. Additionally, it is personally and professionally fulfilling to see patients who have been able to achieve symptomatic relief.

Optometrists should consider starting the education process (passing their DED education on to staff during a staff meeting) with these facts because I have found that if staff sees the doctor’s enthusiasm regarding offering DED services, they will also get excited and, thus, be more open to the added responsibilities that go along with it.

3 BUILD A TEAM

Once optometrists inform their staffs about offering DED services and provide education on its diagnosis and management, they should build a team. I have found that keeping staff heavily involved can increase enthusiasm of additional services.

My advice:

• Choose a champion. This is usually the physician who is the driving force behind the implementation and eventual growth of the DED practice. The champion will develop the clinic flow for the practice and ensure it is being followed. Additionally, he or she will determine administration needs. With DED comes the need of some level of investment, such as the possibility of additional employees.
• Choose a director of DED services. This can be a head technician or counselor. This person will be tasked with helping to train other staff, keeping inventory of DED products, such as artificial tears, warm compresses and lid scrubs, helping create clinic documents/forms and helping the champion to ensure the clinic flow is being followed and maintained.
• Recruit the remaining needed team members. This includes technicians trained to know when and how to use the related equipment and front desk personnel well-versed in the DED services, to assist patients who call in with questions or who wish to purchase DED products offered in your clinic.

4 DEVELOP A CLINIC FLOW

To maximize exam efficiency and provide the best information about the patient’s DED status, optometrists should have the director of DED services train the other technicians to do some/or all diagnostic testing, and have technicians or counselors provide basic patient education on the chronic condition, such as its causes, symptoms and treatments.

My practice’s DED clinic flow:

• Diagnostic testing. Our technicians start every comprehensive eye health exam with the SPEED questionnaire (See https://bit.ly/2VZeUHE ). If the patient is positive for DED symptoms, or if she presented with a previous diagnosis of DED, she undergoes DED testing. Technicians perform tear osmolarity testing, MMP-9 testing, lipid layer thickness testing and meibography prior to a physician seeing the patient. Having that vital information ready and available for me when I see the patient allows me to assess the diagnostic evidence, quantify it, correlate it with my exam findings, prescribe appropriate treatment(s) and, in follow-up exams, determine whether the condition is stable, worse or improved.
• Patient education. In my practice, we use DED counselors, who are trained to explain the nuance of DED with each patient. They use resources, such as models, brochures and videos to educate and answer patient questions. We have the DED counselor see the patient after the technician has worked the patient up and before his exam. After my exam, the patient again sees the DED counselor to review my prescribed treatment(s) in greater detail — the counselor will demonstrate the correct use of example dry eye products and schedule any ordered procedures or follow-up visits. This greatly improves patient compliance to my prescribed treatments, all while keeping me on schedule.
• DED treatments. Some in-office DED treatments can be performed by a well-trained staff member. In my practice, these include lid debridement treatments. This, again, allows the doctor to continue to see patients while the patient receives the ordered treatments.

5 SHARE KNOWLEDGE CONSISTENTLY

Optometrists should consistently pass their DED education on to their staffs, as it is an evolving area. In my practice, we hold quarterly staff meetings, at which we close the office for a day and have our entire staff (front desk, optical, technicians, scribes, counselors, management, administration, physicians) meet. We update the group on anything new, such as diagnostic devices and/or treatments or changes to our clinic flow, and, together, we address problem areas, such as possible patient bottlenecks or areas that we see needed growth.

HELP NEEDED

Because lack of time may be a reason some optometrists aren’t actively looking for DED in all their patients and so many patients unknowingly have the chronic disease, it makes sense for optometrists to utilize well-trained staff to assist with the related diagnostic testing, patient education and in-office treatments.

A final note: Consistency and accountability ensure patients don’t get undertreated or missed, while building the DED clinic. OM

DR. ROBBEN practices at Bowden Eye & Associates. His interests: glaucoma, dry eye and anterior segment disease. Disclosures: Allergan, Johnson & Johnson Vision, Novartis, Sun Pharma, Tangible Science and X-Cel Specialty contact lenses. He founded Dry Eye University and is the Clinical Director of DryEyeAccess.com .