Advanced, in-office dry eye disease (DED) treatment devices have changed the landscape of care by allowing optometrists to improve symptoms and signs by targeting the root causes of the disease. These devices provide treatments including intense pulsed light (IPL), radiofrequency (RF), thermal pulsation, and blepharoexfoliation.
To help understand the decision-making process for acquiring these technologies, Optometric Management (OM) posed several questions to Janelle L. Davison, OD, and Jason Besecker, OD. Dr. Davison owns Brilliant Eyes Vision Center and the Visionary Dry Eye Institute, in Smyrna, Ga., and co-owns Paradeyem Optical Solutions. Dr. Besecker is the optometrist and dry eye specialist at Envision Specialty EyeCare & Dry Eye Center, located in Boise. What follows are their answers.
OM: How did you identify that you needed in-office treatment devices for DED?
Dr. Davison: In 2016, when I began treating DED, I utilized what resources I had on hand. I crafted an in-office protocol to screen, educate, and provide treatment as needed. Over time, during patient follow-up exams, I observed that some patients would benefit from complementing their at-home treatments with in-office ones. Initially, I referred these patients to colleagues. However, I soon realized this disrupted the care continuity for my patients: My patients preferred staying in my clinic.
In 2018, I decided to invest in myself and establish a DED suite. Today, 100% of DED care occurs within my practice. My DED practice has grown over the last five-plus years. Over time, the consultations and treatments were beginning to interfere with my primary care practice.
In April 2024, I opened a 1,500-square-foot dry eye institute within a medical complex. This location is a referral and comanagement center where we only diagnose, treat, and manage patients with dry eye and ocular surface disease. Now, I have the space to expand both my diagnostic and treatment abilities.
Dr. Besecker: I run a specialty dry eye clinic. Essentially, 100% of my patients are here because of dry eye. I believe that dry eye should be a specialty of the optometry world — just like in the ophthalmology world where you have subspecialities for retina, cornea, and glaucoma, I think dry eye is incredibly complex and should be treated by a specialist. When looking at it from that perspective, I think we need to be able to offer many treatment options.
OM: How did you evaluate DED treatment devices before acquiring them for your practice?
Dr. Davison: When reaching out to equipment companies, I make sure to ask for information on how effective and safe their units are. I request literature, and I delve into peer-reviewed articles to understand the treatment’s efficacy. Additionally, I keep my patient population in mind. For instance, considering my patient base consists of 60% people of color, any device I introduce in my practice for treating advanced DED and ocular rosacea must cater to patients who have diverse skin types and tones. That’s why I bought my initial IPL device — research showed it was effective with all 6 Fitzpatrick skin types.
Dr. Besecker: I look at dry eye as a symptom of other conditions as opposed to being the primary diagnosis. For that reason, it’s imperative that I have multiple options to treat the many conditions that my patients might have, which are resulting in their dry eye symptoms. The two main criteria that I look at when evaluating a treatment option are whether the device is FDA-approved and patient outcomes of use. Specifically, I’m looking at whether the treatment is backed by clinical trials and what those results show.
PROMOTING IN-OFFICE DEVICES
OM: How do you market the DED treatment devices?
→ Dr. Davison: When I know I am bringing in new treatments, I educate the patient on the anticipated arrival date and make sure I have a diagnosis code in the EHR that corresponds with the new device. By selecting the appropriate ICD-10 codes, the EHR can identify all patients who would benefit from the device’s treatment and provide the corresponding patient name, email address, and cell number. Next, I send messages to these patients noting the arrival and offer a promotional discount to incentivize the patient to schedule a treatment.
Secondly, I use Google AdWords, Social Media ads, and boost posts on Facebook and Instagram. I have also used billboards, podcast interviews, and print advertising in local magazines.
→ Dr. Besecker: My practice is built on referrals from other optometrists. I have 100 doctors who refer to me in my area — and being able to offer the most in-office treatment device options is a big reason for that. Whenever I add a new device or technology, I visit the practices that refer to me most often to educate them on what I’m now offering. I also make social media posts and send emails to existing patients. Specifically, I let them know that I now have a new treatment that might benefit their condition.
OM: How did you determine how the device would integrate into your practice?
Dr. Davison: To ensure the successful implementation of a new device, my approach involves meticulous mapping of the patient’s journey from check-in to the provider. To accomplish this when onboarding a new technology, I dedicate half-a-day to comprehensive staff training sessions to ensure office-wide understanding. This training encompasses covering the device’s benefits, ideal candidates, proper usage, pricing, and effective communication of price and payment options. Currently, my conversion rate from ocular surface evaluation to treatment is approximately 80%.
OM: How did you project return on investment (ROI)?
Dr. Davison: For large equipment acquisitions, I typically finance my purchase. Specifically, I work with lenders who make it easy to get lending with good rates and repayment options. Once I know my monthly bill, it is easy to calculate the number of treatments needed per month to break even and realize a profit. For example, an average monthly bill for IPL + RF device runs approximately $2,400 to $2,800, and the treatment price ranges from $500 to $750 per treatment. I have been successful in promoting bundled pricing ranging from $1,900 to $2,900, which includes a patient discount ($100-$200 savings) on bundled services. Therefore, I need only two bundled treatments per month, or five to six individual treatments per month to cover the cost of the bill.
Dr. Besecker: I know that for many, ROI is the biggest factor in whether they might add a new device or technology. However, my number one consideration is how it will benefit my patient base. In fact, ROI is usually the last thing I look at. Of course, we can’t add a device or technology that will lose us money. But if it’s something that is going to benefit patients, the ROI usually follows.
OM: What other considerations should doctors keep in mind when treating DED?
Dr. Besecker: I believe that our field needs more doctors specializing exclusively in dry eye. I think this could make a huge difference in improving patient outcomes. It’s about looking at the whole picture. It’s often not a single solution that helps patients but a combination of solutions and inter-professional (e.g., rheumatology, endocrinology, etc.) collaboration. OM
