This article is more than 5 years old. Information may no longer be current.
Screen for dry eye in every exam
Click Here to Manage Email Alerts
NEW YORK – Jason Miller, OD, MBA, screens patients for dry eye in all comprehensive exams.
Miller spoke as part of a contact lens panel here at Vision Expo East.
Miller explained that he first administers the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire to all patients.
“Give this to them while they’re waiting to see you; it gives them something to do,” he said. “Symptoms are really important, almost more important than what I’m seeing at the slit lamp.”
During the exam he administers fluorescein and lissamine green.
“The vital dyes, as part of your exam, take an extra minute,” Miller said. “Look at patients’ break-up time, staining. Don’t look past their eyelids. Look for notching. If they have signs and symptoms, when they come back I express.”
Miller said during the comprehensive exam he looks for clues that indicate dry eye. If necessary, he brings the patient back for a full dry eye evaluation.
He talks to patients now more than ever about the meibomian glands.
“I say it’s like having a dirty windshield in your car,” he said. “It will make it hard to see as sharply as you can, so we need to improve the quality of your tears.”
“Why do we treat ocular surface disease?” he asked.
Sixteen percent of contact lens patients drop out of lens wear on a regular basis, he said.
“That’s a huge number,” Miller said. “Talk to them about why they’re dropping out. We know ocular surface disease is a huge problem, especially in presbyopic contact lens wearers. What’s your protocol to address symptoms and treat them?”
Miller advised attendees to avoid the “grab bag” approach to treating dry eye.
“Don’t grab two or three bottles of drops and put them in a bag and tell the patient to pick whatever works best,” he said. “It goes against everything we’re about. The patient will think they could have done that themselves. Have something more for these patients than artificial tears.”
Miller prescribes a Bruder mask and a nutraceutical.
“It’s important to give them a comprehensive view; it’s not just one treatment,” he said.
He tells patients that they need to maintain the treatments until their next visit.
Miller also discussed the importance of providing patients with a good experience.
“We know what it’s like to go to a nice restaurant or go to Disney or stay at a great hotel,” he said.
Take a step back and evaluate what patients see when they walk into your office, when they check in and when they go through pretesting.
“Can you combine seven tests into one?” Miller said. “Can you keep them from jumping from room to room? If you can make that a good experience, they’ll return to your practice.
“It’s more than just a product or service. It’s a way to meet and exceed their expectations,” he continued. “They expect us to say, ‘What’s clearer, 1 or 2?’ but try to cut out unneeded steps.”
Miller said change is now the norm in his practice.
“You must have a staff culture that’s open to that,” he said. “The future of eye care is that we have to be highly integrated. You have to use EHRs, autorefractors ... anything you can do to improve your efficiency.”
Delegation is important, because the more time the doctor has to talk with the patient about their condition or prescribe products the better, Miller said.
“You’ll be more efficient, more modernized and more profitable as a practice,” he said. – by Nancy Hemphill, ELS, FAAO
Reference:
Quinn T, et al. Effective and efficient use of technology in practice: Grand rounds. Presented at: Vision Expo East; New York; March 21-24, 2019.
Disclosure: Miller reported no relevant financial disclosures.