New Year’s resolutions: A reset for 2021
Despite the setbacks posed by the COVID-19 pandemic, practices could still make progress on their goals.
Click Here to Manage Email Alerts
Wow! 2020 sure did not turn out quite the way we expected, did it? 2020, the year of the eye doctor. So not.
A year that started out with a rush got clobbered with the lockdowns of March. Our communal financial carnage was amplified by a blanket “stand down” order from both the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery. In a year during which we expected to be deservingly lauded for the incredible successes we have collectively achieved on behalf of our patients in areas as diverse as dry eye and wet macular degeneration, we find ourselves thankful to still be in business. Adding insult to injury, we face the long-term damage sure to come from across-the-board cuts in our reimbursement. In the shorter term, we are learning just how low we are on the totem pole of “essential”: One academic center ranks ophthalmology No. 31 on the priority list to receive a coronavirus vaccine.
The hits just keep on coming.
Be that as it may, at this time last year I put together a list of New Year’s resolutions for my role as a dry eye disease doctor. It was a fun exercise, so I thought I would give it another go for 2021. First, I should probably account for how I did with last year’s resolutions. Pretty much the only place I fell short was in my quest to obtain blood work (Sjö, Bausch + Lomb; Omega-3 Index, OmegaQuant) on my patients. Nope. Still lousy there. There was no opportunity to insert myself into the conversation about LASIK and DED because there was blessedly so little activity in that arena in 2020.
With everywhere else, I think I did pretty OK. I managed to send in a couple of Eye Care Out Loud episodes; Dr. Tal Raviv would probably say I am still slacking. Although we did not do so well on ordering blood work, SkyVision did a very good job at doing basic DED testing such as osmolarity and MMP-9, we dramatically increased our use of symptom surveys, and we are on high alert for patients who need autologous serum tears. Intense pulsed light was successfully launched, and our volume has steadily grown as the number of happy post-IPL patients tell everyone how well it works. Rony Sayegh, MD, returned to Cleveland, and he has assembled a multispecialty team at the Cleveland Clinic to care for our neurogenic pain patients, another check in the success column.
Here, then, are my DED resolutions for 2021:
1. Yes, Tal, I resolve to add more podcast episodes more quickly.
2. Sigh. I resolve to revisit outpatient testing. My team and I will take another crack at ordering blood work. Adding yet another test/medicine/treatment that is not covered by insurance is painful. In this case, the “pain” is worth the effort.
3. I resolve to use topography when my patients complain of blurred vision. It is clear that even the most dedicated DED practices underutilize corneal topography as a diagnostic tool when patients have blurred vision caused by dryness. Some topography systems have a dry eye module (Cassini), and others can map epithelial changes (Atlas). Even your most basic bread-and-butter instrument can be used to document induced or irregular cylinder that improves with treatment.
4. I resolve to make a special effort to have my patients look down while we are at the slit lamp and examine the base of their eyelashes. Cylindrical dandruff around the lash is pathognomonic for Demodex infestation. There are therapies on the way that will be transformative in how we treat evaporative DED associated with meibomian gland dysfunction. Diagnosing and treating Demodex will be the next big thing in DED.
5. In keeping with what we already know about diagnosing Demodex, I resolve to never pluck an eyelash with the intent to look at it under a microscope. Have you seen those things? Yuck. Easiest resolution to keep in, like, ever.
6. I resolve to try every generic medication in the dry eye quiver. I am bone-weary of the battles we fight every day trying to find some way to make it economically feasible for our patients to have affordable treatment options.
7. I resolve to make the iTEAR 100 neurostimulator available to appropriate patients even though I personally cannot keep it on the “sweet spot” for more than 0.7 seconds. Losing TrueTear (Allergan) as an option for treating severe DED is a blow. Note that having access to this device means that the manufacturer, Olympic Ophthalmics, needs to make a resolution to come up with a viable business plan.
8. I resolve not to take another sabbatical from speaking, teaching and consulting. This past year has had a kind of “back to the future” feel to it, like the years I spent just seeing patients and being home for dinner every night. A very simple life but hardly a small one. One that I have enjoyed despite missing my friends and colleagues. Being a front-line DED doctor is still the best part of my life as a physician. Attending events and meetings and interacting with you all has always been a delight and a joy. Having the opportunity to work with our industry partners in the development of medications and devices is a privilege. I have been honored to be in boardrooms representing front-line docs who spend most of their days simply caring for patients. If you will still have me, I will get on a plane again.
9. And finally, I resolve to hang in there as best I can. You should, too. Through what I hope to be the last few months of the pandemic, I will hang in there. Under the pressure of the inexplicable pay cuts headed our way, I will hang in there. Faced with the blockades erected by insurance companies that prevent our patients from receiving the treatment we prescribe, I will hang in there. Under the dark cloud of a regulatory environment that seeks to devalue the efforts and sacrifices we make as physicians, I will hang in there.
And let us all resolve to be there to help any colleague who for whatever reason is having trouble hanging in there.
- For more information:
- Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; email: dwhite@healio.com.
Collapse
Read more about
Click Here to Manage Email Alerts