Dry eye treatment education
Create a process to ensure patients don’t leave without scheduling or committing to treatment.
BY PATTI BARKEY, COE
A patient calls your office and makes an appointment for a dry eye consult. She heard how your practice can treat patients with this dreadful condition, and, after three visits to other offices, she is still looking to gain some relief from her daily struggle with fluctuating vision and tired, dry eyes.
A thorough examination shows the following:
• SPEED survey score of 16
• Tear Osmolarity Test positive, OU (TearLab)
• InflammaDry positive, OU (RPS)
• LipiView I&II (TearScience) demonstrate decreased lipid layer, increased partial blinks, gland atrophy, and blocked glands
• Scatter testing demonstrates the severity of the patient’s fluctuating vision complaint.
This scenario appears to be a slam-dunk opportunity for you and the patient. Your physician spends time explaining the severity and the multifactorial nature of the patient’s dry eye disease (DED) and returns her to the dry eye counselor. This staff member explains that the physician has prescribed Prokera (Bio-Tissue) followed two weeks later by LipiFlow treatment (TearScience), both prescription Restasis (Allergan) and Xiidra (Shire), a lid scrub, mask, and eye drop to aid in decreasing the patient’s complaints and symptoms. The patient listens but says she must go home and ask her husband before scheduling or committing to the treatment plan. Your physician is shocked the patient did not commit — she seemed engaged during the physician’s explanation. After all, she called and made this appointment.
Help patients avoid the confusion in the local pharmacy’s dry eye aisle by offering products in your office. An example of Bowden Eye’s product selection includes HydroEye nutritional formulation (ScienceBased Health), OCuSOFT lid scrub, OASIS Tears Plus eye drops (Oasis Medical), Avenova with Neutrox (NovaBay), Retaine HPMC and MGD eye drops (OCuSOFT), Cliradex eyelid and lash wipes, Eye Hydrating Mask (Bruder), and Tranquileyes mask (Eye Eco).
COURTESY OF BOWDEN EYE & ASSOCIATES
DED is grossly underdiagnosed, and the treatments are relatively new and, in most cases, presented to the patient for the first time in a consultation. When it is clear that patients need treatment, they should not leave with nothing in hand or scheduled. While the doctor explained DED to the patient, the patient may not have been fully educated on the benefits of the products and therapies offered.
Here, I explain how you can better educate patients on DED treatments so that patients buy in and fully understand the benefits.
The dry eye education experience starts at the initial phone call. Identify patients who come in as new patients for consults revolving around complex services as well as those patients who, due to their insurance coverage, must invest out of pocket for their dry-eye diagnosis and treatment, so that patients have a clear understanding of the costs.
Your staff can do a host of things to “pre-educate” patients both before and during the visit to make the experience a productive one, including:
• Creating an educational website. Make sure your website contains information on all your DED services and products. Partner with vendors that can help with this process. For example, Bio-Tissue and TearScience have staff who will help you add the appropriate information to your website, so you don’t have to reinvent the wheel. To ensure patients use this information, have counselors and front desk staff always invite patients and their family members to visit your website to learn about available products and services prior to their consultation.
• Mailing an educational packet. This should include brochures, etc. about the services and products available.
• Using online tools. One new product, CheckedUp, provides the patient with interactive dry eye education. It includes auditory, visual, animation, and touch elements. Practices can purchase a dry eye-only subscription or a complete subscription that also offers content on cataract surgery, glaucoma, LASIK, and more. This amazing tool is like having a digital counselor!
• Pre-counseling the patient. Have your counselor start a dialogue with the patient prior to the physician interaction so that the patient better understands the physician’s recommendations. This also allows staff to be prepared for patients who might expect to be treated on the same day as their consultation.
• Pre-verify that the patient has coverage for Prokera. Because of bundling concerns, we don’t do these the same day unless it is an emergency need, but we want to be prepared for the patient’s needs and provide them with accurate coverage information.
• Invite family and friends. When patients make or confirm the appointment, ask them to bring a family member or significant other. When a family member or friend accompanies the patient during the education process, it helps the patient tremendously with the decision to “invest” in items that otherwise may make them feel guilt. DED patients need and want relief from their constant discomfort and visual strain.
Patients have enough choices to make, so take the decision on which services to purchase out of their hands when possible. When our providers recommend a treatment plan, they choose what products they feel will work best for each patient rather than forcing the patient to choose between masks, lid products, etc. We develop a product line based on the patient conditions.
Early in the process we created a “bundle” that included a mask, lid cleanser, nutraceutical, and a lubricant drop. It was easy for the provider to put the patient on the “bundle” than list each product during their recommendation. The counselor reviews the products and demonstrates proper usage to the patient and family member where necessary. Then, the counselor bags the products, prepares a step-by-step instruction sheet, and walks the patient to the front desk for check out.
Note that over time, your office may get some duplications of products. For instance, we carry D.E.R.M. (EyeEco), Fire and Ice (Rhein), Bruder and Tranquileyes (Eye Eco) masks because some patients preferred one over the other. If this happens, keep them all in stock. Educate patients that your practice is their dry eye supply center for all their dry eye needs, and they will be forever grateful.
Treatments offered based on the severity of the patient’s dry eye disease
» Prokera (Bio-Tissue) biologic corneal bandage
» Blephex lid and lash cleaning and exfoliating procedure
» Epilation and examination for Demodex
» Blephex with initial application of Cliradex eyelid and lash cleanser
» Blephex with expression
» LipiFlow (TearScience) treatment for meibomian gland dysfunction
» Intense pulsed light therapy (Lumenis M22) with expression
» Maskin Meibomian Gland Probe (Rhein Medical)
» Punctal plugs
Finally, put yourself in the patient’s shoes. Walk through the office as a dry eye patient multiple times and experience where any confusion may start so that you can fix it.
Also, educate your staff so they can recommend products. At Bowden Eye, we try many products “in-house,” so we can offer only the best to patients. In addition, vendors understand the “newness” of their DED products and treatments, so they engage in staff training to help you navigate this process. Bowden Dry Eye University (www.dryeyeuniversity.com) is available as well for staff and provider training.
You need the myriad treatments, products, and therapies to be successful in the treatment of comprehensive DED. When you make the decision to embrace these patients and provide them with education on DED therapies, everyone will win. OP
Patti Barkey, COE, is chief executive officer for Bowden Eye & Associates, Bowden Eye Services Management Organization, Dry Eye University and Eye Surgery Center of North Florida.