What to Know About Getting Started with Dry Eye Treatments

For many practitioners considering incorporating dry eye treatments into their practice, there are often questions about timing, logistics, and patient buy-in. Over the years, I’ve been able to hone my approach to ensure that it serves my practice and my patients – without any of the headaches that come with adding a specialty. 

The Right Equipment Goes A Long Way
One of the biggest things to consider is ensuring your patients understand the benefit of these treatments, because that changes everything. It creates buy-in, which results in compliance, and ultimately optimal outcomes. 

For the practitioner just starting out with dry eye, you need some kind of camera. The worst-case scenario would be a holder for your cellphone positioned at the slit lamp. While that’s not something I’d recommend, if it’s just getting you started, it can be helpful and cost effective. The camera is essential because it helps you get the patient buy-in. If the patient can’t see the issue for themselves, that slows down outcomes, because the compliance isn’t always there. As a practitioner, it can make you feel discouraged. I’ve found in these situations many of us try to over-explain things and then we end up doing a sales pitch, which is never helpful. 

Once I had great equipment in my office that aided in my explanations to patients, I never felt like a salesperson. That’s a pivotal, tangible change, and it’s one of our primary goals. Optometrists don’t like to sell things. We don’t want to spend our patients’ money. If we don’t have patient education materials or tools, we end up feeling like we’re pushing treatments on our patients, rather than educating them on the importance of these treatments and why they’re so necessary to their overall health. 

Let Your Patient Know Your Plan
We never want to use trial and error on our patients, and that’s especially important with dry eye treatments. It’s beneficial to take the time to write out exactly what conditions you’re trying to identify, and from there, what your primary treatment options are going to be for those conditions. A common mistake I see many doctors make is playing the guessing game. If their first attempt doesn’t work, they bring the patient back in to try something else, and they keep trying different things until something sticks. 

This isn’t a good approach. Instead, work to identify the underlying diagnosis, and then you have a treatment specific to that diagnosis. You know what you’re dealing with, and there is no trial and error. My best success comes from identifying the individual contributors to what the patient is experiencing, and then addressing those specific issues.

I’ve also structured my exams to reassure my patients that I have a plan for their treatment. I let them know that the initial appointment is all about getting the diagnosis. We test in every category – water, oil, allergies, inflammation, bacteria, lid function, systemic factors, and environmental factors. Whatever comes back positive, we pair it with a treatment that works for that category. I let them know that it might be cumbersome in the beginning, but when they come back, whatever has improved, we can dial back. If it’s not all the way better, we add treatments to that category. 

Include the Patient in Decision-making
Make sure your patients feel included in everything you’re doing so you don’t make them feel like you’re selling them something. Once we determine the primary issue, I outline three different paths for us to take with their treatment, a method I call “good, better, best.” The goal here is to make the patient an active participant in their care and let them know their concerns matter. I ask them what their goals are – do they want the cheapest option, the option that takes the least amount of time, the easiest option, the option that only uses natural products? Whatever their goals are, that’s the option we choose. 

I never want my patients to think I’m selling them something. That’s also where the “good, better, best” options help. The “good” option is the bare bones treatment – it may not have all the bells and whistles, but it will treat the conditions and provide relief for the patient, eventually, but usually with more at home tasks involved. The “better” option builds on that, including more advanced techniques. The “best” option is typically the most advanced of the three, but it targets everything we’re looking at and is going to give the patient the best result, and typically with less work at home. 

Regardless of which option the patient chooses, I want them to know it’s their choice. I lay everything out for them, I highlight my diagnosis, and I provide my explanation for each treatment plan. I also tell them what I would do if I was in their shoes, which helps them feel confident in me and the treatments I’m suggesting. 

Another key here is to send the patients home with everything you’ve explained during the exam. A lot of patients worry about remembering everything you’ve said, and I’ve noticed the relief on so many patients’ faces when I tell them they get a copy of everything we went over to review and read again at home. They get a book with additional resources, as well as their specific exam results, and they can take their time to review everything. Laying the groundwork for them and having this kind of patient education is incredibly beneficial – especially for treatments such as dry eye that are primarily cash pay. 

Office Logistics
A significant factor that trips doctors up when they’re getting deeper into dry eye is the time that they believe it takes and how it can disrupt the schedule. The way to alleviate that concern is to have as many tools upfront as possible. Patient history and a thorough dry eye evaluation are critical, but they take time. Our goal is to have all of that completed before we do the full dry eye exam. We make sure that patients have filled out our extensive questionnaire before their dry eye evaluation, so when they walk in, we have all of that information loaded into their records. 

From there, you need to set up a protocol in your office for the different tests your techs need to administer, what images they’re getting, and everything that needs to be done before you walk in the room. Your time needs to be spent with the patient, educating them on their condition – not collecting data. That’s how you get that patient buy-in and that’s how you don’t get bogged down in your schedule. 

Dry eye treatments can be incredibly beneficial to patients’ long-term health, and it’s our job as their health care providers to ensure we’re providing the highest quality of care. Patient education goes a long way, and small changes over time can help you grow this specialty to benefit your practice and your patients.