By Mark Schaeffer, OD
Nov. 14, 2018
Dry eye is an increasingly common condition, with the aging population, the large amounts of time people spend on digital devices and the drying impact of many common medications. My practice has addressed this need by launching a dry eye specialty. Here are the key points we think about as we continue to improve our care of these patients.
About 15 percent of my annual eye exam patients are diagnosed with dry eye. This number is increasing as screen time continues to increase. We are seeing that contact lens wearers with discomfort, especially toward the end of the day, have early ocular surface disease. Those diagnosed with dry eye also are getting younger. Dry eye used to be thought of as a condition that mostly affected middle-aged women, but now it’s common for people of both genders in their twenties to complain of symptoms of dry eye, or to show signs of dry eye when examined.
In addition to helping patients, revenue growth from the diagnosis and treatment of dry eye can be substantial, tied to procedures like TearScience’s LipiView and LipiFlow and the TearLab diagnosis and treatment systems. You also can generate additional revenues with procedures like the insertion of punctal plugs, and can sell products like Bruder masks, and other therapeutic products. You also have the opportunity to move patients with dry eye into daily disposable contact lenses, which is usually the best option for the patient, and generates more revenue for the practice than other modalities.
Screen All Patients
The first step to building a dry eye practice is accepting that dry eye can happen to any patient, and to screen all patients for dry eye during comprehensive eye exams. Our practice utilizes the dry eye SPEED (Standardized Patient Evaluation of Eye Dryness) score in comprehensive eye exams. It’s a simple survey that can alert us to early symptoms of dryness.
Educate on Quality Products to Treat Dry Eye
It’s important to remember that many patients with dry eye have been self-treating for while, using over-the-counter products that can make the problem worse, such as eye drops that constrict the blood vessels in their eyes. So, after you make the diagnosis, you may have to explain to the patient why the products they found themselves are not the best way to treat the condition.
Invest in Instrumentation
We have added equipment, like the TearLab, LipiView II and LipiFlow, as well as the MiBoFlow and TrueTear, at our main office location, but those systems are not yet available at all of our 16 locations.
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The investment for all of these instruments, in total, can run as high as $300,000, but keep in mind that you don’t have to invest in all of them at the same time to launch a dry eye specialty. You can ramp up slowly, investing in instruments such as the LipiView and LipiFlow for around $60,000, and then adding the other instruments as your number of dry eye patients grows.
Our return on investment so far has been far beyond what we have spent, with the dry eye segment of our practice growing consistently, by as much as 10-15 percent, over the last five years in revenues generated. The gain in revenue can be attributed to our consistent messaging to the patient in trying to make their ocular surface better.
You can also find someone in your area who has the piece of needed dry-eye equipment and set up a referral system until you grow large enough to sustain your own technology. Also, try reaching out to industry partners, vendors who sell dry eye-related treatment systems. Many of these vendors are excited to help an OD find ways of making their systems part of the OD’s practice, sometimes offering affordable leases with manageable monthly payments.
The advantage of adding advanced technology is not only can you better diagnose and treat the patient, but you can offer different treatment options to different patients, providing care through use of one dry eye care system versus another, and can prescribe differing products.
You can individualize your treatment plan, so every patient understands that the combination of treatments you prescribe for them is especially for them, and will probably differ from what you have prescribed for their friend, who also has dry eye.
Show Patients What Their Disease Looks Like
It’s easy for patients to minimize the importance of dry eye, thinking of it as nothing more than discomfort. Advanced instrumentation can show patients images of their eyes that allow you to educate about the impact of ocular surface disease. That means a patient who may have shrugged off your diagnosis of dry eye can see that the condition is a disease process that has signs that are visible to the doctor, which can be pointed out to them.
Even better, we can show patients images of their eyes that indicate progress is being made as they follow the treatment plans we prescribe. Patients feel the difference you’ve made in their lives, and they see it, too, from a scientific perspective, when you show them the results of your examination.
Win Long-Term, Loyal Patients
Many dry eye patients have struggled for years with doctors neglecting to diagnose dry eye, or for not being able to treat it effectively. If you can identify these patients, and offer them a solution to their discomfort, you will win a loyal patient who refers others.
For example, we have a contact lens patient in her twenties who was unable to wear her contacts, and it was affecting her job and her overall outlook. She had “tried it all,” and was relatively young to have been this symptomatic. We discussed all the therapeutic options, but ended up doing amniotic membranes to rejuvenate her ocular surface. It took us two membranes on one eye and one on the fellow eye to get her inflammation down. We also switched her contact lenses to daily disposables. The happiness she showered us with when she could wear her lenses without having to think about her eyes was priceless, and will doubtless result in many referrals of friends and family.
The long-term maintenance of dry eye is key. Most dry-eye therapies are single-use therapies, but the patient needs a long-term treatment plan, such as Restasis, Xiidra, or soon-to-be-available Cequa and oral supplements.
We also recently started treating patients with HydroEye, which not only helps the patient in treatment and aids in compliance because you know what they are getting, but also can generate significant income to the practice. The oral supplements give you a tool prior to prescription medications/procedures that the patient may feel more comfortable with trying first. They are sold within the practice, and can generate near $120 per patient per year. If you’re doing the math at a conservative figure of 10 percent of total patients on supplements, in an average practice, can be $24,000 profit (10 percent of 2,000 eye exams). A few of my colleagues have had great experience with PRN (Physician Recommended Neutraceuticals), as well.
Each time the patient comes into the clinic, we’re thinking about ways to continue to improve on the ocular surface. Dry eye is a chronic condition that requires chronic treatment to help restore and maintain the eye’s natural balance.
Mark Schaeffer, OD, is an optometrist at Schaeffer Eye Center, a 16-location practice in Alabama, founded by his father, Jack Schaeffer, OD. The practice recently was acquired by MyEyeDr. To contact him: firstname.lastname@example.org