October 23, 2015
4 min read
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Developing a dry eye clinic, part 1: If you build it, they will come

A three-part series explores the idea of developing a dry eye service in your practice.

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In just a short couple of weeks, we will convene en masse in Las Vegas for our annual shindig, the American Academy of Ophthalmology annual meeting. As usual, we will be buying stuff and selling ourselves, and the hot topic is going to be dry eye. Seriously, hotter than femtosecond laser-assisted cataract surgery! Even more than that, being a dry eye doc is going be cool; who doesn’t want to be cool?

Admit it: You would like to be cool.

No worries, mate. That’s why I am here. There is plenty of room in the dry eye space for you, and I am happy to show you the ropes. Things are pretty interesting right now with lots of research taking place and a boatload of resources being put in play to help us treat all types of dry eye. Not only that, but it turns out that there are literally millions of patients out there who have symptomatic dry eye and could use your help. This column will begin a three-part series on developing a dry eye service in your practice. I will start out with basic concepts and then move on to the most advanced protocols presently available. You can then choose your most comfortable level of engagement in this clinical space.

Are you ready for a dry eye practice?

Like anything else in medicine, the prospect of new business is the wrong reason to consider adding any kind of clinical service. The first thing to consider is whether or not you find the area of dry eye interesting and if you truly want to treat both dry eye and dry eye patients. This may actually be the most important step in building a dry eye practice. I have noted before in my trip to the Hundred Acre Wood that uncomfortable dry eye patients can be difficult to care for. Dry eye symptoms are frustrating, and many of your patients will insist on sharing them with you in excruciating detail at every visit. Take a deep, honest look in the mirror and ask if you are comfortable with this being a part of your clinic experience. If you build it, they will come.

There is an awful lot of work out there for ophthalmologists right now, and many of us are already really busy. Do you have room in your schedule to see dry eye patients? You do not even have to contemplate an influx of new patients to the practice. There are likely hundreds of symptomatic dry eye patients already present in your established patient population. Do you have room for them in your schedule? If you are booked solid more than 6 weeks out, it may be very difficult to even find an appointment for these patients. A few minutes shoulder to shoulder with your administrator in front of a computer will answer this question pretty quickly. Booked out 6 weeks will quickly become 8 or 10 weeks once word gets out that you are treating dry eye. If you build it, they will come.

Dry eye visits are not short visits, at least in the beginning. Both initial evaluations as well as follow-up visits take more time than you think they will. This is due in part to the nature of the problem, but also because you will be instituting new care protocols that are a bit different from what you and your staff are doing now for cataract surgery, for example. Are your staff and you OK with starting something from scratch? Is the team psychology strong enough to withstand the frustrations of the development process? Trust me; every step in this three-part process will require a “learning environment” and a tolerance for upheaval. Perhaps you have been reading about the coming onslaught of patients and you are already committed to improving your clinical efficiencies in the office. Installing a completely new service can actually be helpful when it comes to breaking the inertia present in any successful process. Launching a dry eye service will invite the onslaught. If you build it, they will come.

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Is dry eye interesting enough that you would like to treat it? Can you see yourself caring for truly needy patients who are uncomfortable and sometimes desperate for your help? Do you have space in your schedule, or can you adjust your practice protocols to accommodate an influx of patient visits that represents truly new business? Will your staff buy in to the changes that will be necessary to make this a success? If so, welcome aboard and let’s get started.

Initial patient encounter

Having a dry eye service means doing everything you can to make it easy to diagnose dry eye. This actually starts with the initial contact with your practice, whether on the phone or online. It seems simple almost to the point of being trivial, but it is important to know just why a patient is making an appointment, and to do that, someone has to ask. If the first question is, “Why do you need an appointment?”, the second should always be, “Are you having any problems with your eyes?” Everyone “upstream” from you, the doctor, should then interpret the answers in such a way that any patient who might turn out to have a diagnosis of dry eye will be evaluated for the possibility. Whether you end up running a basic, standard dry eye clinic (part 2 of the series) or an advanced, high-performance version (part 3), everything starts with someone “turning on” your dry eye protocol before you actually step into the exam room.

No matter how complex your particular version of dry eye care turns out to be, you now need to know more about your patient’s symptoms. Everything starts with symptoms. Your reception staff or technicians should now have every potential dry eye patient fill out a dry eye questionnaire to ascertain both the particular symptoms and the degree to which these symptoms are affecting your patient. There are two very good ones out there, the OSDI and SPEED questionnaires. It really does not matter which one you choose, but as a new dry eye clinic, you will probably find the OSDI easier to work with. Both the absolute score (severity) and the answers to individual questions (specificity) will guide you on the next steps in the evaluation and treatment of your patient. What comes next in your protocol depends on what type of clinic you have chosen, basic or advanced.

The choice to provide a dry eye service is as fundamental to a practice as choosing whether or not to open an optical dispensary or offer LASIK. You need to fully commit personally, and installing the clinic will take every bit of leadership skill you possess. There is no more dabbling in dry eye. There are literally millions of symptomatic patients out there. If you build it, they will come.

Next: The basic dry eye practice.

Disclosure: White reports he is a consultant for Bausch + Lomb, Allergan, Shire and Eyemaginations and on the speakers board for Bausch + Lomb and Allergan.