Photo: Courtesy of Dr. Christopher Wolfe. Dr. Wolfe is shown here performing an intense pulsed light (IPL) procedure. Dr. Wolfe says the data on IPL usage reveals strong clues on how to improve patient acceptance of treatment.
Dry eye
By Christopher Wolfe, OD, FAAO, Dipl. ABO
May 7, 2025
In October 2024, I introduced a fresh set of key performance indicators (KPIs) in Review of Optometric Business for evaluating the medical side of optometric care.
These KPIs—like revenue per OD hour, Level 3-to-Level 4 ratio and anterior segment photography to refraction ratio—were designed to help us better understand how effectively we’re managing chronic ocular disease. And, perhaps more importantly, they showed us where meaningful gaps exist between what we think we’re doing and what we’re actually doing.
Recently, we applied that same KPI lens to dry eye disease (DED) and Intense Pulsed Light (IPL) therapy, using insights gathered from a pre-workshop survey of optometrists preparing for a Vision Source private practice improvement course.
The findings? Let’s just say the data didn’t whisper—it shouted.
What the Data Shows: A Gap Between Beliefs and Actions
1. DED Evaluations Are Rarely Scheduled
Only 5.05% of comprehensive eye exams (CEEs) result in a dedicated DED evaluation. Most practitioners are attempting to manage dry eye within the CEE—despite knowing that best practices call for separate, focused visits.
This isn’t just a clinical oversight—it’s a systems issue. It’s the difference between a practice that “checks for dry eye” and one that has a DED protocol built into its workflow.
Without that structure, even the most well-intentioned practitioners end up under-diagnosing and under-treating. This is most likely because there is simply too much to do during a CEE to dedicate appropriate time to thoroughly evaluate and discuss treatment options related to DED.
2. IPL is Barely Recommended
Only 1.50% of CEEs result in an IPL treatment. That’s right—just 1.5%. This tells us that even when dry eye is acknowledged, IPL is not being accepted by the patient as a solution. Whether it’s discomfort with presenting the treatment, lack of team integration, or fear of being perceived as “salesy,” the result is the same: missed opportunity for the patient and the practice.
3. But When We Actually Evaluate, Patients Say Yes
Here’s the kicker: when a dedicated DED evaluation is performed, the conversion rate to IPL jumps to 29.78%. That’s not a typo—that’s a 20x increase in conversion.
Why? Because when we take the time to listen, explain and educate, patients understand the value. They’re not just given a therapy—they’re invited into a care plan. That difference matters.
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Applying the KPI Mindset to Dry Eye
Much like the KPIs we use for glaucoma or diabetic retinopathy—optic nerve OCT to refraction ratios, gonioscopy to refraction rates, visual field to refraction utilization—we need measurable ways to evaluate our dry eye protocols.
Start by tracking:
- DED Evaluation to CEE Ratio
- IPL Rate per DED Evaluation
These metrics will tell you more than your gut ever could. They’ll show where your systems are breaking down and where patients are slipping through the cracks—not because you don’t care, but because your workflow doesn’t make it easy to care consistently.
For Those Who Weren’t in the Room
Although these insights originated from a workshop focused on helping Vision Source practices grow, the lessons are relevant to every optometric practice. This isn’t about promoting a course—it’s about sharing what we’ve learned from real-world data and conversations with real-world practitioners.
If we say we believe in the importance of IPL for treating MGD and DED, then it’s time our systems reflect that belief. That means:
- Structuring dedicated DED evaluations outside of CEEs
- Normalizing IPL recommendations among other treatment options when clinically appropriate
- Tracking the behaviors that actually move the needle for patients
Because at the end of the day, belief without action is just branding. But belief paired with process? That’s practice transformation.
Read another article by Dr. Wolfe
Christopher Wolfe, OD, FAAO, Dipl. ABO, is the founder of EyeCode Education , co-founder of Practice Performance Partners and the owner of Exclusively Eyecare, a Vision Source practice in Omaha, Neb. To contact him: Chris@
