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Article Date: 10/1/2012

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dry eye
dry eye

Distinguish Your Dry Eye Clinic

Use these five ideas to make your care the best in town.

Kelly Nichols, O.D., M.P.H., Ph.D.

These days it seems like so many practitioners I come in contact with tell me they've started dry eye clinics in their practices and have, therefore, transitioned their patients into a medical dry eye exam. If you're like these doctors, way to go! You're not only meeting a very prevalent patient need, you're also simultaneously growing your practice. But, how can you ensure you remain the go-to eyecare practitioner for dry eye disease (DED) in your area?

Here are five options:

1. Add specialty equipment

Having the following recent technology can enable you to stand out from the competition and garner patient referrals:

The LipiFlow System (Tear-Science). This device treats meibomian gland disease (MGD)-induced evaporative dry eye by opening and clearing blocked glands via controlled heat to the inner upper and lower eyelids simultaneously along with intermittent pressure. (Visit www.lipiflow.com.)

The Oculus Keratograph (OCULUS Optikgeräte GmbH). This instrument has tear film scan software that non-invasively measures the quality and quantity of the tears. Also, you can actually show the patient his meibomian gland dropout, for instance, via photo documentation to set your clinic apart from others in your area. (Visit www.oculus.de/us/sites/detail_ger.php?page=531.)

TearLab Osmolarity System (TearLab Corporation). This instrument measures tear osmolarity via a “test card” and Reader. The Reader computes the tear osmolarity from the test card and reveals it on the device's LCD screen to aid you in the DED diagnosis. (Visit www.tearlab.com.)

High-magnification cameras. Nothing is as effective in the management of lid disease than showing a patient a picture of his/her eyelid via high magnification. An assortment of cameras are available that accomplish this. You can even build your own iPhone slit lamp attachment by visiting www.instruct ables.com/id/An-easy-adaptor-for-connecting-your-iphone-4-to-op.

RPS InflammaDry Detector (Rapid Pathogen Screening, Inc.) This device detects MMP-9, an inflammatory marker shown to be increased in the tears of DED patients. This technology is currently not available in the U.S., but stay tuned. It is expected within a year. (Visit www.rpsdetectors.com.)

Create education/treatment forms

Much of the time ocular surface disease management takes is spent counseling patients on understanding its chronic nature, how to use drops and how to perform lid hygiene and warm compress therapy. Stand out from the other DED clinics in your area by developing forms that provide this information along with clear step-by-step treatment instructions and images.

Recently, I was reminded of the impact of good explanatory educational material. Specifically, a male patient who has Parkinson's disease was referred internally for a DED workup. Anterior blepharitis and possible MGD were noted at his general eye exam. In educating both the gentleman and his wife about his DED, I could tell they were experiencing “information overload.” So, the couple expressed great appreciation when I handed the gentleman a DED education/treatment form. She said she'd be referring to it to administer his prescribed eye drops and ensure he complied with the explained lid hygiene and warm compress therapy.

3. Seek your target group

Many clinicians who have a passion for ocular surface disease management give lectures on DED to specific populations particularly at risk for the condition. These include elderly care and assisted-living facilities, women's library groups, book clubs, gardening groups and more. Search for these populations in your area via the Internet, create a general PowerPoint presentation on DED, and contact these populations to schedule a presentation. From personal experience, I can tell you that this action goes a long way toward attracting additional patients and cementing yourself as the dry eye expert.

4. Use the routine eye exam

We have all been drawn in to the “deal” on teeth whitening or discount hair cuts/styling when used as a patient recruitment tool. Consider offering a dry eye screening as part of a routine exam. The screening would work to refer “at risk” patients internally for a medically billed ocular surface exam. To do this, advertise it in your monthly or quarterly newsletter to your patients, and see where this might lead. Of course, you likely are most aware of the needs of your patient population, but prepare to be surprised.

5. Provide exceptional care

The dry eye patient can be with you for a very long time, and you can expect improvement, exacerbation or even worsening of the condition. Through all this, be attentive and aggressive. The most critical part of a dry eye clinic is listening to the dry eye patient. Studies have shown that we, as clinicians, often underestimate the impact of dry eye on a patient's quality of life, and it isn't just new patients who should be queried.1 The existing dry eye patient also should be asked about changes, short- and long-term, as well as treatment successes and failures. No patient is satisfied with a practitioner who provides him/her with the same treatment with which they walked in the practice. If you are going to effectively manage ocular surface disease, write prescriptions, recommend specific artificial tears, and be sure to follow-up on your medical therapies and advice. DED patients have a tendency to slip through the cracks, which is why there can be a lot of changeover in your DED patient pool. A patient is less likely to seek care elsewhere, however, if he/she perceives the clinician as actively involved in his/her care. Check-in (newsletter information on dry eye), check-up (pre-schedule follow-up visits) and man-up (be aggressive on your care plan) as you grow your dry eye clinic.

No longer the case

Once upon a time, DED was a niche that few eyecare practitioners paid much attention to. With the recent influx of both DED research and products, however, its diagnosis and management have fast become offered services. By following the five aforementioned tips, you can remain the go-to dry eye expert in your community. OM

1. Chalmers RL, Begley CG, Edrington T, et al. The agreement between self-assessment and clinician assessment of dry eye severity. Cornea. 2005 Oct;24(7):804-10.

DR. NICHOLS IS A FOUNDATION FOR EDUCATION AND RESEARCH IN VISION (FERV) PROFESSOR AT THE UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY. SHE LECTURES AND WRITES EXTENSIVELY ON OCULAR SURFACE DISEASE AND HAS INDUSTRY AND NIH FUNDING TO STUDY DRY EYE. SHE IS ON THE GOVERNING BOARDS OF THE TEAR FILM AND OCULAR SURFACE SOCIETY AND THE OCULAR SURFACE SOCIETY OF OPTOMETRY AND IS A PAID CONSULTANT TO ALCON, ALLERGAN, INSPIRE AND PFIZER. DR. NICHOLS CAN BE CONTACTED AT KNICHOLS@OPTOMETRY.UH.EDU. TO COMMENT ON THIS ARTICLE, E-MAIL OPTOMETRICMANAGEMENT@GMAIL.COM.


Optometric Management, Volume: 47 , Issue: October 2012, page(s): 52 54

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