Demodex blepharitis is nothing new to optometrists, but lotilaner ophthalmic solution 0.25% (Xdemvy, Tarsus) is new to the OD’s treatment armamentarium for the troublesome condition. As a result, optometrists Mark Schaeffer, of MyEyeDr, in Birmingham, Ala., and Douglas K. Devries, of Eye-care Associates Nevada., in Reno, Nev., introduce the treatment, in terms of patient education and seamless integration.
(See “Demodex Blepharitis: Diagnostic and Practice Management Considerations,” below.)
Educating patients on its value
To educate patients on the value of Xdemvy, optometrists must first communicate the diagnosis, say both doctors.
Dr. Devries says he stresses sensitivity, as he’s found that diagnosed patients become immediately embarrassed.
“I say, ‘this has nothing to do with your hygiene. Most patients who have blepharitis, or the irritation, discomfort, and eyelid and lash flakes you’ve been experiencing, have Demodex, which are an overpopulation of mites that naturally reside on the skin,’” he explains. “I find that explaining the diagnosis this way removes the distraction of any embarrassment, so the patient is primed to hear about the benefits of the new treatment,” he explains.
Dr. Devries says he then tells patients that Xdemvy is a recently FDA-approved eye drop that directly and safely targets and eradicates the mites via twice-a-day dosing, 12 hours apart, for six weeks of use.
Dr. Schaeffer says he takes a similar approach.
“I explain to these patients, ‘We have organisms that live on our face and skin as part of our natural, healthy environment. The condition you have is an overgrowth of these organisms, which is ex- acerbating the symptoms you’ve reported,’” he offers. “Additionally, I offer to show the patient a photo of their Demodex, so they can have a clear picture of the diagnosis.”
In terms of discussing the value of Xdemvy, Dr. Schaeffer says that he’s going to prescribe a drop to get rid of these organisms and to help reduce the symptoms patients may be experiencing.
Demodex Blepharitis: Diagnostic and practice management considerations
Indicators that Demodex blepharitis may be at play include eyelid and eyelash rubbing, general eye awareness, foreign-body sensation, and stye recurrence, Dr. Schaeffer explains. Underlying conditions, such as lid redness and Rosacea, can also indicate the condition, he says. Once the condition is suspected, both doctors say they examine the patient’s eyelashes via slit lamp to visualize collarettes, or the telltale sign of an overpopulation of Demodex mites. Dr. Schaeffer says he documents the visit and bills to insurance for coverage of blepharitis and Demodex (ICD-10 codes, such as B88.0). Additionally, he says he documents and codes anterior-segment imaging (92285) for the initial visit, and then 92213 for documenting change. In terms of patient follow-up, both doctors cite between six and 10 weeks.Seamless integration
In acknowledging that offering any new treatment can cut into the appointment schedule, both doctors suggest the following action steps, which they say have enabled them to both help these patients, and stay on schedule.
“I have my scribe begin pulling out manufacturer-provided patient handouts on Demodex blepharitis and how Xdemvy helps, as this literature answers most, if not all patient questions about the value of the treatment,” Dr. Devries says.
Dr. Schaeffer says he provides the patient with one or more names of digital pharmacy services that facilitate prior authorizations, and provides patient assistance options, if needed. OM
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