By JeanMarie Davis, OD
Spring brings seasonal allergies, but it also is important to provide eyecare for patients with perennial allergies unrelated to seasonal changes. You will be rewarded with loyal patients who let others know of your services.
Allergies related to the change of season in the spring and fall is so common that many think exclusively of it when the topic of ocular allergies comes up. Providing for seasonal allergy patients is essential, but don’t overlook another segment of allergy suffers–those with allergies unrelated to these common factors. Here are key points to keep in mind to serve patients with allergies that don’t go away with the passing of spring or fall.
May Be a Systemic Reason for Allergies
Most nonseasonal, ocular allergies are associated with dust or dust mites, animal dander or mold. Another chronic ocular allergy called vernal conjunctivitis worsens In warm weather, but is not due to typical seasonal triggers such as pollens. Instead it is an IgE mediated mechanism found in some patients who also have a family history of other atopic diseases such as asthma, eczema or hay fever. GPC (giant papillary conjunctivitis) may also result as a form of ocular allergy to long-term buildup of deposits on contact lenses worn for a prolonged period of time. Acute reaction to some forms of cosmetics is also not uncommon. In my former practice in the Miami metropolitan area, I saw an average of two to four patients per month diagnosed with non-seasonal allergies.
Bill Medical, Rather than Vision, Insurance
I would bill the patient’s medical insurance for each office visit. The amount of reimbursement varies from one insurance company to the next, but I would generally receive approximately $90 to $110 for the initial visit and $39 to $65 for each follow-up visit. I would typically see the patients an average of three times to diagnose, begin treatment and follow up until their symptoms were resolved and they were stable, and then again several months later to make sure they were still OK.
A Potentially Significant Group of Patients
I had not noticed an increase in incidence of non-seasonal allergies over the years, but I did see an increase in the number of referrals–from patients and PCPs in the area over time once I became established as a doctor who treated these conditions.
Anyone can be affected by these allergies, particularly to dust and dust mites. The more severe cases were chronic allergies. Chronic allergies often can be inherited and/or the patient has a history of hay fever, asthma or eczema. Patients are typically younger–early 20s or younger. It is more common in males than females. Many of these cases are children. Practicing in the tropics also had an impact with warm weather often worsening the symptoms. Long-time contact lens wearers who wore extended wear lenses without frequent replacement, who then developed GPC, also were common. Middle-age females would account for most of the cosmetic reactions leading to allergies.
Know the Signs of Non-Seasonal Allergies
Most of the time these patients would come in complaining of discomfort and show clinical signs such as moderate to severe injection, minimal to moderate lid edema or just heaviness of their eyelids. Other common signs of this form of allergies include mucus discharge, itching and/or burning eyes. At times these patients also would experience concurrent rhinitis. Other times they would complain of contact lens intolerance and come in wanting a new contact lens prescription thinking that is what they need. Although less common, I would occasionally pick up on some clinical signs of these allergies during a routine examination.
Prepare to Treat Non-Seasonal Allergies
There is no special equipment beyond the typical instrumentation needed to diagnose this form of ocular allergy. Most of the examination can be done directly and with the aid of a slit lamp. Corneal dyes are often used to aid in the examination.
Understanding the pathology and clinical picture of these conditions and the differential diagnoses is important. There are several courses I have seen offered at optometric conferences that could be helpful in preparing an OD to recognize this pathology and the points for diagnosis. Along with taking advantage of ocular allergy learning opportunities at conferences, keeping up with the related medical literature is also extremely helpful.
Educate Your Patient
Helping the patient understand what is happening to their eyes and explaining both the realistic short- and long-term expectations are what most patients want, in addition to the most rapid relief possible. This will provide the patient piece of mind. If there is something the patient can do to improve their situation and prevent issues in the future, such as more frequent replacement of contact lenses (like daily replacement), then explain why this change is necessary and how a change in their contact lens routine may lead to greater comfort.
Provide Treatment for Perennial Allergy Patients:
Action Plan
Get educated by attending seminars at optometric conferences and familiarizing yourself with related literature. Know your differentials. Understand the clinical picture and history of these conditions and be able to differentiate from other anterior surface disorders such as viral conjunctivitis, dry eye, etc.
Initiate treatment as quickly as possible once you are certain of the diagnosis. These patients need fast relief. If they don’t receive it from you, they will look elsewhere potentially leaving your practice.
Take the time to educate the patient. Let them know when they can expect to feel better, along with the regimen they will need to follow to get relief.
Follow the patient closely until the symptoms are resolved and they are stable. Then, see patients for at least three to six months depending on severity.
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JeanMarie Davis, OD, is global head, technical, Global Performance Development for Alcon. To contact her: drdavis2020@yahoo.com.
