Top Tips to Creating a Standalone Dry Eye Practice

Five years into my cold start, I wanted to expand my patient base by offering medically-based dry eye and ocular disease services. As a dry eye sufferer, I wanted to impact the lives of patients dealing with debilitating symptoms associated with dry eye disease. I began screening patients, bringing them back for full evaluations and prescribing topical medications and plugs. 

Starting Small and Growing with Patient Demand

In those early days, I had limited resources both diagnostically and therapeutically. Initially, I couldn’t afford Lipiflow, so I referred patients needing that treatment to a local OD who had purchased the device. I continued to manage the patients’ post-treatment, which fostered a great collaborative relationship. 

However, over time, my dry eye practice started to grow, I started to see more dry eye patients, adding equipment and advanced treatment therapies, and the more I did, the more difficult it became to manage alongside primary care. I tried various scheduling techniques hoping to keep dry eye within my primary care practice. However, dry eye patients require undivided time and attention to achieve desired clinical outcomes and patient goals. 

In 2024, I took a leap of faith and established a standalone dry eye facility. In May 2025, it will be one year since its opening. I see patients at the dry eye office half a day on Mondays (twice a month), all day every Wednesday and half a day on Fridays. We typically see one patient per hour for initial consultations with imaging and reports, 30 minutes for a monitoring visit and 45 minutes for treatment. We are on track to surpass six figures in the first year of business. 

Catering to Patients’ Needs

Dry eye is a multifactorial and multisymptomatic condition, and most patients require multiple steps in a treatment plan to achieve their goals. We offer a range of treatments including topical prescription medications, Lacrifill canalicular gel, collagen extended duration plugs, Rinsada ocular irrigation, Nulids Pro, Zest cleanings, nutraceuticals, doctor-approved OTC products, medical-grade skincare, doctor-approved cosmetics, thermopulsation, amniotic membranes, autologous serum tears, low-level light therapy, intense pulsed light therapy, radiofrequency, dilation and irrigation and gland expression.

I tailor my approach to each patient based on their disease state. Our office will acquire equipment and develop treatment packages to target the specific disease I aim to improve. I rely on peer-reviewed literature, dry eye algorithms and clinical studies to establish my protocols and service offerings. However, researchers do not fully understand or study certain aspects of ocular surface diseases, such as ocular rosacea, across all skin types. Consequently, over the past five years, I have had to modify and offer services off-label to address the ocular signs and symptoms associated with rosacea in patients with darker skin tones.

I firmly believe in the importance of solid diagnostic abilities. If I were to open another dry eye clinic, I would implement a system that conducts multiple diagnostic tests, including non-invasive tear breakup time, tear meniscus height, redness score, meibography and anterior segment imaging with fluorescein. Additionally, the device should generate a comprehensive report. I would also include Inflammadry testing for the MMP9 inflammatory biomarker and tear osmolarity testing.

Creating a Payment Structure

Typically, we offer treatments without a recognized billable procedure code to the patient in bundled packages. The patient must pay for the entire package upfront on the first day of treatment. To ease the burden, we offer installment payment options via third-party platforms. However, most patients pay without using these installment services. 

For services that we can bill to insurance, we verify insurance and obtain a patient out-of-pocket estimate through our clearinghouse. We thoroughly educate the patient that this is an estimate. Patients must make all out-of-pocket copays when they check-in for their appointments. Lastly, to book an appointment, patients are required to put down a nonrefundable $50 deposit. If a patient cancels their appointment for an evaluation, monitoring or treatment without 24 hours’ notice, a $25 fee is added to their account, which must be paid before rebooking.

Additionally, the mindset of patients in a medical facility is different, as we rarely encounter resistance regarding paperwork, fees or treatment plans.

Giving Patients What They Need

Since opening our doors, Visionary Dry Eye Institute has been very well-received by patients. Our practice is growing through patient self-referrals and word of mouth. Currently, 40% of referrals come from my primary care office. We screen all our patients with SPEED and offer a meibography screening for a fee. If a patient scores 6 or higher on SPEED or if the meibography images are abnormal, we refer them. Additionally, we use Google AdWords to generate self-referral leads, resulting in about 40% of our new patients being self-referred. The remaining 20% of referrals come from other ECPs and medical professionals.

Patients drive from nearby and as far as four hours away to come to my clinic. They often say, “No one has ever explained to me or showed me what is going on with my eyes. They just keep prescribing drops or doing IPL, and I was not getting better.” My patients appreciate the tranquility of the institute as a standalone facility where they are not mixed in with glasses, contacts or surgical patients. Managing dry eye requires a listening ear and time to explain.

Collaboration is Key

It’s very common for patients to seek out my services themselves, without the direct referral from another eye care provider, and they’re often upset and curious why their OD never referred them for additional services not provided at their office. Something that’s highly important to me is earning and keeping my patients’ trust. We always want to do what’s best for our patients so they maintain that trust.  If you don’t have a treatment or service that a patient needs for relief, co-manage with a colleague or refer them for treatment. 

Collaboration is key to strengthening our profession. Managing and treating dry eye disease may not fit every practice, so find a colleague with a passion for dry eye and co-manage. Don’t let patients suffer.