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DR. JADE COATS |
DR. VIN DANG |
DR. JACOB LANG |
DR. NATE LIGHTHIZER |
The FDA recently approved pilocarpine HCI ophthalmic solution 1.25% (Vuity, Allergan/AbbVie) for the treatment of presbyopia. Several other pharmacologic solutions are in the pipeline. (See “The Presbyopia Drop Pipeline,” p. 34.) As a result of these developments, Drs. Jade Coats, Vin Dang, Jacob Lang, and Nate Lighthizer weigh in on the effect this new treatment category will have on optometric practices. Dr. Coats practices in Fayetteville, Ark., Dr. Dang practices in Barkersfield, Calif., Dr. Lang practices in St. Paul, Minn., and Dr. Lighthizer practices in Tahlequah, Okla.
OM: WHAT ARE YOU MOST EXCITED ABOUT WITH THIS NEW CATEGORY OF PRESBYOPIA CORRECTION?
JC: I am most excited about having an alternative option to treat presbyopia. This new treatment category provides the opportunity for discussion with patients on the importance of routine eye care and normalizing the inevitable progressive loss of near vision.
VD: I am most excited about having another tool to help this aging population. Not everyone qualifies for a clear lens exchange or wants to have surgery. Eye drops are familiar for patients and provide a good alternative to these other treatments.
JL: I’m most excited that our presbyopia patients are going to have a treatment option they can use for specific activities, such as computer work, or to see their scorecard when golfing, because it is during such activities that these patients have the most visual complaints.
NL: What I am most excited about is the fact that this treatment category provides our presbyopia patients with another treatment option.
OM: WHAT PATIENTS (SPECIFIC AGE OR DEMOGRAPHIC) MAKE IDEAL CANDIDATES?
JC: Ideal candidates seem to be ages 40 to 55, who have upwards of +2.00 D at near and who have realistic expectations, in terms of the fact the drops will not cancel the use of all eyewear.
VD: I would say patients ages 40 to 60 who are either emmetropes or latent hyperopes.
JL: I’m targeting 150 to 175 add patients, who tend to be between the ages of 40 and 50. I think they are the real heart of this because they require correction to perform some of their near tasks.
NL: Emmetropes ages 40 to 50 who have never worn glasses, never worn contact lenses and don’t want to start OTC readers, prescription eyewear, or contact lenses, make ideal candidates.
OM: WHAT SPECIFIC EDUCATION SHOULD PATIENTS RECEIVE ABOUT THE DROPS AND WHY?
JC: Patients should be educated on the potential side effects. If someone is not made aware of what they may experience, they may not feel comfortable with long-term use.
VD: With the only currently available presbyopia drop, patients should be informed they may experience a headache or brow ache that should subside.
JL: We want to let patients know whether they have any anatomical variations that may be a contraindication, describe how the drop works, and what the side effects are to manage our patients’ expectations.
NL: I think it’s important to educate patients that this option is available, its effect on vision, possible side effects, and the fact that it is not a perfect solution, meaning it’s not going to work at all distances.
OM: WHAT TESTS SHOULD BE PERFORMED RELATED TO PRESCRIBING THESE DROPS AND WHY?
JC: A dilated eye exam with BIO and a thorough review of the retina would be helpful. In addition, an assessment of the angle of the eye would be warranted with possible gonioscopy of any patient suspicious for pupillary block.
VD: A dilated fundus exam is a must to make sure the patient isn’t at high risk of developing a retinal tear due to the low, but possible, risk of developing a retinal detachment.
JL: I think a thorough case history, a comprehensive eye exam and listening to patients’ visual complaints covers all the necessary bases regarding prescribing these drops. These items let you rule out any contraindications.
NL: I believe a thorough comprehensive exam, with a particular focus on the retina, along with acquiring the patient’s desire for vision is warranted: What are the patient’s near-vision needs? What is the patient’s add for up close?
OM: HOW WOULD ONE SEE THESE PATIENTS? FOR EXAMPLE, AN INITIAL EXAM VISIT, AND THEN A FOLLOW-UP VISIT FOR THE DROPS?
JC: I see the patient for an initial exam, during which they can be educated on all of their possible treatment options available. If they express an interest in proceeding with drops, I recommend they return for a presbyopia examination to further determine whether they would make an ideal candidate. After a review of expectations and in-office instillation during the follow-up visit, patients could be sent to the optical to browse for backup glasses.
VD: At the practice at which I work, we keep the original exam as their medical visit with a dilation. Then, we have the patient return for a presbyopia visit.
JL: I see these patients in regular clinic with comprehensive eye exams during which we talk about their presbyopia treatment options, and I prescribe the currently available drops, if the patient is deemed a good candidate and wants to go with this option. A Follow-up appointment is then scheduled to see how the patient is faring with the drops. Telehealth can be used for this visit.
NL: I would see these patients for an initial exam, where presbyopia and the treatment options are discussed, and then have them schedule a follow-up visit in about a week or two to see how the drops are working for the patient.
OM: CAN YOU PROVIDE ANY IDEAS ON HOW TO CHARGE FOR THE PRESBYOPIA DROP VISIT?
JC: If a patient has already completed the vision portion of their exam with their vision insurance, you could offer to bring them back for an out-of-pocket flat fee (similar to a contact lens evaluation). In some cases, depending on chief complaint, I could see how medical insurance may provide coverage for the follow-up visit. However, I think the self-pay route may be better understood by patients, as this is a quality-of-life drop.
VD: Currently, our office isn’t charging for the presbyopia drop visit because we want to get as much clinical experience for it as we can. Eventually, we will probably charge a fee for the visit in the range of $50 to $95.
JL: Currently, we are integrating this into our normal coding procedures based on the time and complexity of the exam and not charging anything separate or doing anything different.
NL: I agree completely with Jake on this one, as it depends on the complexity and time, and we are doing our normal coding procedures based on that.
OM: WILL YOU SELL THE DROPS OUT OF YOUR PRACTICE?
JC: No. In many states, including Arkansas, optometrists are not allowed to sell prescription pharmaceuticals for profit.
VD: We will, since we carry other prescription products in the office. In California, MD offices can carry and sell prescription products; OD offices cannot.
JL: We have not explored selling the drops in our office. We leave that to our pharmaceutical counterparts and colleagues.
NL: We would potentially sell the drops out of our practice for a cost that makes sense for our practice. Being in academia and serving a patient population that does not have to pay for health care services, our cost would likely be a bit lower based on patient expectations and experiences.
OM: HOW DO YOU PLAN ON MARKETING THE DROPS INTERNALLY AND EXTERNALLY?
JC: The best marketing seems to be word of mouth. No external marketing is planned because the launch of the currently available presbyopia drop has created its own external marketing. Internally, I plan to continue mentioning this option to ideal candidates as I see fit.
VD: We plan on mentioning the drops to our own patient base and doing social media posts to encourage patients to come learn more about the presbyopia eye drops.
JL: We market all our presbyopia treatment offerings internally and externally. Internally, having staff, whether it be a front desk technician, clinical assistant, or scribe, who has experience with the drops is effective at championing them.
NL: Our marketing will be word of mouth as well and the external marketing done that is already out there. I just had one of our staff at one of our satellite clinics communicate with me via email saying she would like to try “the new eye drop that helps with near vision.” So, external marketing and word of mouth brought a patient in wanting to try “the new drop.”
The Presbyopia Drop Pipeline
Listed are presbyopia-correcting drops in the pipeline by company name and formulation:
For additional information on these treatments, see “Getting the Drop on Presbyopia,” at https://bit.ly/3HIOJwP .
FINAL THOUGHTS
Drs. Coats and Lang say they expected women patients to comprise most of the patients interested in the currently available drop, yet Dr. Coats has experienced a 50/50 split, while Dr. Lang has prescribed them mostly to men.
“I don’t know whether that’s because men don’t remember to bring their reading glasses as often as women do, or what,” Dr. Lang offers. “But, the men, in particular, really like these drops.” OM
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