One of my favorite aspects of being an independent optometrist is how many options we have to practice in a way that works best for us as individuals. In the last week, I have seen patients for preventative eye care, prescribed glasses and contact lenses, performed glaucoma follow ups, fit specialty contact lens patients, treated dry eye, and just received in-depth training on the aesthetic capabilities of our new dry eye treatment device. All in one week!
Even better, the more I branch out into specialty care, such as dry eye, the more my practice grows. In fact, adding specialty care to my practice is the exact thing that has fueled our growth over the past three years and has allowed us to move into a new, much larger clinic space, hire additional staff, and add an associate, all in the last six months. None would have been possible without the increase in revenue we have experienced since adding dry eye specialty care. In an optical environment where we are squeezed from all directions by insurance plans, online opticals, and increasing corporate competition, specialty care such as dry eye is a way to not only stand out from the noise but to increase revenue and patient satisfaction. I’m going to share the steps we used to add dry eye services over the last three years that have helped to grow our business.
Step One: Ask the Right Questions
Step one is so simple it seems obvious. First, you have to start actively diagnosing dry eye. I found that before I was really focused on it, I wasn’t doing the things I needed to do on a regular basis to know who was having dry eye symptoms, or even identify patients who were at a higher risk of developing dry eye symptoms. I had to get serious about asking the right questions and looking at the right things during my exam.
We started asking every patient:
Do your eyes ever feel dry? (I know, novel idea to just ask…but many don’t.)
Do your eyes water or ever look red?
How do your eyes feel when you wake up?
All of these questions can help you find patients who are symptomatic and need your help.
Step Two: Get In-Depth on Every Patient Exam
Step two is to examine the eyelids, eyelashes, and meibomian glands — both ease and quality of expression — on every exam for every patient. Yes, every patient. You will be utterly shocked at the number of patients you’ll see with blepharitis, demodex, and meibomian gland dysfunction, which are the primary predictors of dry eye symptoms and also increase the risk of developing dry eye symptoms.
Step Three: Start Treating Dry Eye
Step three, now that you are diagnosing dry eye, is having options for treatment. I have a four-pronged approach to starting dry eye treatment that anyone can start doing in their office tomorrow, with very little — if any — investment. This approach will yield symptom improvement in many mild dry eye patients. It can be even better if you invest a little in having dry eye products available in your office. Many of my patients buy the products I recommend in my office because I have them on hand and it is convenient for them. They also like knowing they are getting exactly what I have recommended.
My four-pronged approach to early treatment is:
- Lid/lash hygiene with either hypochlorous acid spray, or if demodex is present, a tea tree oil cleanser.
- Warm compresses daily using a warm compress mask.
- A lipid-based preservative-free artificial tear in the morning and at bedtime. (Then, as needed, but a.m. and p.m. are non-negotiable.)
- Breaks from devices every 20-30 minutes and blink exercises.
If patients are very consistent with these four habits, most will begin to feel improvements in their symptoms, and I will see improvement in their slit lamp findings. However, compliance is the biggest issue for most with dry eye treatment. It isn’t that patients don’t want relief, most just find it very difficult to be consistent with these at-home treatments.
Investing in Dry Eye — and Your Practice
If all you do for dry eye is recommend these things, you will still have some happy patients, but if you want to go a step further to treatment options that remove some of the burden of consistency from the patient, you will want to consider adding treatment procedures as well. In my office, we offer eyelid/eyelash in-office cleaning, heated expression, low level light therapy (LLLT), and, just recently we added intense pulsed light (IPL) as treatment options. Remember, we have been focusing on dry eye for over three years now. You do not need to invest in all of these to start seeing success. Pick one that makes sense for your practice and start there. Then add as needed.
Dry eye diagnosis and treatment can be a great way to grow your practice with a very small investment to start. All it takes is looking for the patients who need your help and deciding to jump in!