This article is more than 5 years old. Information may no longer be current.
Ready ... aim ... plug!
Click Here to Manage Email Alerts
It seems as though everywhere I turn, colleagues are talking about reversible punctal occlusion (RPO). Though this technology has been around for some years, it is only recently that RPO has garnered significant attention as a viable therapeutic endeavor. And for good reason. RPO has assisted clinicians as an adjunct in managing dry eye, enhancing the therapeutic efficacy of a topical drug, augmenting wound healing after refractive surgery and supporting contact lens wear. In essence, RPO has helped numerous patients and has earned a rightful place in today's eye care practice.
However, despite the accolades, we must be careful not to portray RPO as something it is not. For instance, occluding the punctum of an acutely inflamed ocular surface may only serve to "pool" inflammatory mediators, thereby exacerbating the condition. Likewise, using RPO for blepharitis-related dry eye isn't going to provide the same therapeutic results as for an aqueous deficiency. Finally, though rare, a "buried" punctal plug can lead to intracanalicular tear stagnation and possible dacryocystitis. Indeed, like other therapeutic endeavors, RPO should be employed prudently and not with reckless abandon.
In an era of outcome analysis, all procedures are subject to scrutiny and RPO is no exception. Therefore, it is incumbent upon us to assure RPO's profile as a safe and effective treatment modality. To this end, I propose a simple "self-assessment" when contemplating RPO.
- Does RPO make sense for this particular patient? It sounds simple, but this isn't always an easy question to answer. Given the patient's ocular condition, response to alternate therapies and the indications for RPO, one needs to decide whether this is a logical therapy. Fortunately, collagen plugs afford us a valuable therapeutic trial.
- Does the patient understand RPO? I marvel at the number of patients who initially perceive RPO as a procedure that blocks tear production rather than impair outflow! It is vital that each patient understands how RPO works, what we hope to achieve by employing it and potential problems. Fortunately, the reversibility of RPO makes it much more palatable.
- Does the insurer understand RPO? We have learned - all too well I might add - that legal justification and clinical proficiency doesn't assure compensation for services rendered. Many insurers still do not understand RPO, its indications, the procedure vs. the plugs and optometry's role. Whereas this scenario can be frustrating, it also provides an excellent opportunity to help define an insurer's policy regarding RPO.
So, the next time you're contemplating RPO, get ready ... take aim ... think! If you answer affirmatively to the aforementioned questions, there is good likelihood all parties will be pleased.