Margie Recalde, OD, focuses her blog on the nuances of diagnosing and treating dry eye: the need for early intervention, tips for doctors just starting out and paradigm shifts in treatment. She owns Lifetime Optometric, a private practice in the Central Valley of California, and specializes in dry eye.

Disclosure: Recalde is a speaker/consultant for Allergan, Bausch + Lomb and Sun Pharma.

BLOG: Tips for starting a dry eye practice

Reimbursables, private pay

Medicare provides us with a common denominator for estimating reimbursement rates. With our Medicare patients, we receive varying reimbursement levels for the medical visit based on the number of tests performed, external photography and the treatment plan. For patients requiring a more aggressive approach, Medicare also provides approximately $1,500 — an equitable reimbursement amount — for amniotic membrane procedures. These procedures are excellent options and can provide significant relief for many of our patients. There is an upfront cost for the membrane, but the profit margin is generally better than that of cataract surgery.

For our patients who are private pay, we add on the tear staining as an additional test and explain that it is part of the dry eye evaluation. This gives our patients a feeling of added value to what they are spending on the dry eye exam. Since it also can be difficult to get insurance coverage on dry eye prescriptions, we take care to inform our patients about need-based prescription programs offered by the makers of long-term medications such as Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan), Xiidra (lifitegrast ophthalmic solution 5%, Novartis) or Cequa (topical cyclosporine ophthalmic solution 0.09%, Sun Pharmaceutical). Patients do have to submit to a qualification process, but if they meet the criteria, they receive complimentary medication from the pharmaceutical company.

Essential treatment options

Expensive equipment is not necessary to treat most of your dry eye patients. I recommend three essential treatments as a dry eye practice starter pack.

Nutraceuticals. Artificial tears and lid hygiene treat the symptoms of dry eye from the outside in, whereas nutraceuticals treat the underlying cause from the inside out by helping our bodies to naturally produce more and higher quality tears. I personally take and recommend HydroEye (ScienceBased Health) to all my patients because it includes the unique omega GLA (gamma-linolenic acid). GLA has been found to relieve dry eye in several clinical studies, including the HydroEye clinical trial (Sheppard JD Jr., et al). HydroEye’s patented formula combines GLA, along with other omega fatty acids and key nutrient cofactors that work together to provide targeted dry eye relief.

Artificial tears. Patients often tell me they have already tried and failed on this route; however, they are usually using the wrong kind of artificial tears — such as Visine (tetrahydrozoline HCl 0.05%, Johnson & Johnson) or Clear Eyes (naphazoline HCl 0.012%, Prestige Consumer Healthcare) — which are not formulated to lubricate the eye. I always recommend a specific brand to avoid confusing my patients with too many choices, and then start them on it before they return for their dry eye evaluation. Since many insurance providers require documentation that patients tried and failed artificial tears, starting them on over-the-counter treatments makes it possible to move immediately into prescription medications without wasting the first dry eye exam.