Rachel Carver, OD, of Mohawk Eyecare in New Castle, Penn., is holding the hand piece for a Lumecca IPL instrument which is used in the treatment for dry eye.
Trends in dry eye treatment practices across optometry practices
Part one of a two-part article that explores the variability in dry eye treatment.
By James E. Grue, OD,
Ronald P. Snyder, OD, FAAO,
and Michael J. Lipson, OD, FAAO, FSLS
Nov. 13, 2024
Variation in dry eye management practices raises important questions about the factors influencing treatment decisions.
Despite similar diagnostic rates across practices, the divergence in the provision of advanced treatments like intense pulsed light (IPL), intense regulated pulsed light (IRP) and LipiFlow suggests potential underlying differences in practice philosophy, access to technology or clinician training.
What Factors Impact Approaches to Dry Eye Treatment?
We examined several potential factors that might account for the discrepancies in treatment approaches:
- Practice Philosophy: Some practices may prioritize a conservative approach, focusing on basic management strategies, while others may embrace a more comprehensive treatment model that includes advanced therapies.
- Access to Technology: The availability of advanced treatment devices can significantly impact whether practices incorporate these modalities. Practices with easy access to IPL or Lipiflow are more likely to offer these services routinely.
- Continuing Education: Clinician training and awareness of emerging therapies play a crucial role. Practices that prioritize ongoing education may be more informed about the benefits and indications for advanced treatments.
- Patient Demand: Practices that actively educate patients about advanced options may see higher demand, which in turn, influences the provision of these treatments.
- Insurance and Reimbursement: Variations in insurance coverage for advanced therapies can also affect treatment decisions. Practices that can navigate reimbursement processes may be more likely to offer these services.
- Collaborative Care Models: Some practices may have established partnerships with specialists or multi-disciplinary teams that facilitate referrals for advanced treatments.
Trends in Dry Eye Management
Our analysis highlights a clear trend in the management of dry eye disease, especially among practices that offer advanced treatments.
The emphasis on meibography and functional tests for meibomian gland health is particularly noteworthy.
By utilizing tools like the Korb meibomian gland evaluator, these practices can gain valuable insights into the functionality of the glands, which is crucial for developing effective treatment plans.
In addition, incorporating patient-reported outcome measures such as the SPEED questionnaire adds an important dimension to the assessment, enabling providers to capture the subjective experience of their patients.
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This holistic approach—combining clinical evaluations with patient feedback—ensures that treatment is tailored to the individual’s specific needs and helps track improvements over time.
By utilizing a variety of tests, healthcare providers can gain a deeper understanding of each patient’s unique situation.
This comprehensive assessment not only helps in accurately diagnosing the severity and type of dry eye, but also allows for tailored treatment plans that address individual needs.
The shift toward patient-centered care reflects a broader trend in healthcare, emphasizing personalized strategies to improve outcomes and enhance overall quality of life for those affected by dry eye disease.
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Analysis highlights a clear divergence in practices between providers who offer advanced dry eye treatments and those who do not.
Key Takeaways from Our Observations
Advanced Treatment Facilities:
- Meibography & Functional: These practices routinely perform meibography and functional tests like the Korb meibomian gland evaluator, allowing for a detailed assessment of meibomian gland health and function.
- Patient Questionnaires: They commonly utilize standardized questionnaires, such as the SPEED score, to gauge symptom severity and guide treatment.
- Comprehensive Testing: In addition to meibography and questionnaires, they conduct a variety of tests to assess dry eye severity and type, ensuring a holistic understanding of each patient’s condition.
Basic Care Facilities:
- Limited Testing: In contrast, offices that do not offer advanced treatments seldom perform meibography or functional assessments of the meibomian glands.
- Minimal Use of Questionnaires: These practices often lack the use of comprehensive dry eye questionnaires, which can limit the understanding of the patient’s experience and severity of symptoms.
- Focus on Basic Assessments: Testing in these offices tends to focus on basic methods like Schirmer’s Tear Testing and Tear Break-Up Time (TBUT), along with slit-lamp exams for conditions like blepharitis and demodex.
This contrast underscores the importance of adopting a more thorough approach in diagnosing and managing dry eye disease, particularly in practices aiming to improve patient outcomes with advanced therapies.
Implementing meibography and functional testing, along with symptom questionnaires, can provide a more nuanced understanding of dry eye conditions and enhance treatment effectiveness.
James E. Grue, OD, is a health-care reform speaker and consultant. To contact him: JimGrue@HealthCareRegistries.com
Ronald P. Snyder, OD, FAAO, is the president and CEO of HealthCare Registries, LLC. To contact him: RonSnyder@HealthCareRegistries.com
Michael J. Lipson, OD, FAAO, is the chairman of the OrthoK Advisory Panel of HealthCare Registries, LLC.
