Northwest Eye Clinic Bellingham doctors Riya Paranthan, OD (medical optometrist), Vincent Matteucci, MD (cataract surgeon), Ira Perszyk, MD (glaucoma specialist) and Jonathan Crews, DO (cornea specialist) at the 136th annual Northwest Washington Medical Society Physician Dinner.
By Riya Paranthan, OD
August 14, 2026
When I joined a comprehensive multidisciplinary eyecare clinic with three ophthalmologists and myself as the sole optometrist, I recognized both the opportunity and the challenge of practicing within a shared medical model. Optometry and ophthalmology bring complementary skill sets to patient care, but establishing a clearly defined role for optometry within a medical practice requires intentional leadership, collaboration and innovation.
For me, that opportunity became dry eye disease management.
By developing a dedicated dry eye clinic, I was able to create a specialty service line that expands optometry’s role within our practice, improves patient outcomes and demonstrates the value of optometric leadership in medical eyecare.
A HIGH-PREVALENCE OPPORTUNITY
Dry eye disease, also known as keratoconjunctivitis sicca, is one of the most common conditions encountered in eyecare today. In our clinic, approximately one in three patients presents with dry eye symptoms or clinical findings. These patients are already seeking care within our practice, so the opportunity becomes recognizing their needs and creating a structured approach to address them.
Optometrists are uniquely positioned to lead dry eye management because we are often the first point of contact for patients experiencing visual discomfort, fluctuating vision and ocular irritation. We can diagnose, treat, educate and longitudinally manage these patients throughout their care journey.
A successful dry eye clinic is not simply an additional service—it is an opportunity for optometry to demonstrate its clinical value within a broader healthcare model.
IDENTIFYING AN UNMET NEED
One of the greatest lessons I have learned in developing a dry eye program is that successful specialty services begin by identifying unmet patient needs.
Many patients with dry eye disease have adapted to their symptoms and do not realize that treatment options exist. They may describe their vision as “inconsistent,” report discomfort after screen use or assume that irritation is simply part of aging. Without intentional screening and education, many of these patients remain undertreated, if at all.
Building a dry eye clinic should start with creating awareness throughout the practice. All staff members should understand common symptoms and recognize opportunities for referrals. Technicians can play a critical role by incorporating targeted symptom questions into patient intake.
DRY EYE MANAGEMENT AS MEDICAL EYECARE
Beyond patient discomfort, dry eye disease can significantly impact clinical outcomes.
This is especially important in cataract surgery patients. A healthy ocular surface is essential for obtaining accurate preoperative measurements, including keratometry and biometry used for intraocular lens calculations. Untreated dry eye can affect measurement accuracy and contribute to postoperative dissatisfaction.
Additionally, cataract surgery and postoperative medications may temporarily worsen ocular surface symptoms. Optimizing the ocular surface before surgery is an important component of comprehensive surgical care.
Dry eye disease also frequently overlaps with glaucoma management. Many glaucoma patients experience ocular surface symptoms related to chronic exposure to topical medications, particularly preserved formulations. Discomfort and irritation may negatively affect medication adherence, while ocular surface inflammation can complicate examination findings.
By incorporating dry eye management into comprehensive eyecare, optometrists contribute to better patient outcomes across multiple areas of ophthalmology.
DEVELOPING A CLINICAL PATHWAY
The foundation of a successful dry eye clinic is consistency.
A structured evaluation may include:
- Symptom assessment using validated questionnaires such as OSDI or SPEED
- Tear break-up time evaluation
- Corneal and conjunctival staining
- Tear volume assessment
- Meibomian gland evaluation
Advanced diagnostics—including meibography, tear osmolarity and inflammatory marker testing—can further guide treatment decisions when appropriate.
Treatment should be customized based on disease severity and underlying cause. Initial management may include lifestyle modifications, warm compresses, lid hygiene, preservative-free artificial tears and omega-3 supplementation when appropriate.
For patients requiring additional therapy, prescription treatments such as cyclosporine ophthalmic emulsion (Restasis), lifitegrast (Xiidra) and varenicline nasal spray (Tyrvaya) address inflammation and tear production.
For patients with meibomian gland dysfunction, ocular rosacea, posterior blepharitis or recurrent chalazia, management may include lid-directed therapies, in-office procedures and oral doxycycline when appropriate.
Advanced therapies such as thermal pulsation, IPL and radiofrequency offer solutions for carefully selected patients seeking procedural care.
THE BUSINESS IMPACT OF SPECIALTY CARE
While improving patient outcomes remains the primary goal, developing a dry eye clinic also creates a sustainable practice model in both optometric and ophthalmic practices.
Dry eye disease is chronic. Unlike episodic care, these patients require ongoing monitoring, treatment adjustments and long-term management. This continuous touchpoint naturally deepens patient trust and fosters strong, long-term relationships.
A successful dry eye program can:
- Increase medical eyecare visits
- Improve patient retention
- Expand diagnostic services
- Create additional treatment opportunities
- Differentiate the practice from retail-focused vision care models
The financial value of dry eye management is not simply in individual procedures or visits. It is in building a loyal patient population that trusts the practice for ongoing care.
ELEVATING PRACTICE AND PROFESSION
My experience building a dry eye clinic within an ophthalmology practice has reinforced an important lesson: Optometry does not need to compete for space in medical eyecare—we need to demonstrate the value we bring.
The future of optometry lies in embracing our role as medical providers, identifying opportunities for innovation and developing services that address real patient needs.
Dry eye disease is one of those opportunities. By creating dedicated programs, educating our teams and delivering evidence-based care, optometrists can elevate patient outcomes while simultaneously strengthening the role of optometry within multidisciplinary healthcare.
A dry eye clinic is not just a business investment. It is an investment in the future of patient care and the future of our profession.
Read more on dry eye & aesthetics here.
Read more on co-management here.
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Riya Paranthan, OD, is an optometric physician and clinical leader with extensive experience in medical eyecare, ocular disease management and healthcare leadership. She practices in a multidisciplinary ophthalmology setting, where she has focused on expanding optometry’s role in collaborative care models and developed a dedicated dry eye clinic to improve patient outcomes. Dr. Paranthan serves as Chair of the National Board Examination and Regulatory Committee (NBERC) through ARBO and is a Governor-appointed member of the Washington State Board of Optometry. |
