BLOG: You are never too busy to care for the ocular surface
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Some eye care specialists may believe they do not have time have time to deal with ocular surface disease — that tackling dry eye disease is too time-consuming, complicated and confusing, potentially making them inefficient with patients.
However, we know that a healthy ocular surface is paramount, not only for good visual acuity but also for optimal surgical outcomes. This is true with cataract surgery as well as refractive and even glaucoma procedures. Comprehensive eye care requires paying attention to patients’ ocular surface even if they don’t have symptoms.
I practice in a multi-office group where dry eye disease (DED) management is imbedded into every clinic day, incorporated within the flow. Ocular surface disease (OSD) is the most common disease state eye care providers see on a day-to-day basis — whether or not optometrists are looking for it. I estimate I spend about 60% of my time on dry eye.
Globally, epidemiological studies reveal the prevalence of DED ranges from 5% to 50% (Stapleton F, et al). Based on data from the National Health and Wellness Survey, 6.8% of U.S. adults — approximately 16.4 million people — have been diagnosed with DED (Farrand KF, et al). The prevalence increased with age (2.7% in those aged 18 to 34 years vs. 18.6% in those older than 75 years) and was higher in women than men (8.8% vs 4.5%).
Due to the sheer volume of patients who have the condition, DED management can certainly be a profit center. Anyone looking to medically diversify the scope of their practice should consider emphasizing OSD treatment. Remember, these are patients who are already coming in.
A ‘multifactorial approach’
I see dry eye management as a journey — it is a lifelong condition that is also progressive in nature, and no single therapy works for all patients. I typically start patients on the most appropriate medical therapy for their specific form of OSD, one that usually aligns with what is covered by their insurance plan. If they do not achieve the desired results with prescription therapy, I will reach for additional cash-pay procedures.
I believe it is important to first establish a relationship with patients and build trust before recommending noncovered treatments. These include device-based interventions such as LipiFlow (Johnson & Johnson Vision), TearCare (Sight Sciences), iLux (Alcon), MiBo Thermoflo (MiBo Medical Group), eyeXpress (Holbar Medical Products), NuLids (NuSight Medical), BlephEx (BlephEx LLC) and intense pulsed light therapy (various companies).
Dry eye treatment requires a multifactorial approach, often layering on therapies until the patient’s ocular surface is optimized. Eventually, we reach a maintenance phase, which often includes a yearly lid treatment like LipiFlow to keep them from regressing. It is worth noting that the more adherent patients are to their overall regimen, the less often they will require the device-based interventions mentioned.
By the numbers
Treating dry eye is the right thing to do. And although financially beneficial, optometrists should not make the mistake of approaching the condition in a transactional manner with their patients. That said, it can be a profit center for medically minded optometrists who wish to expand their practice. Remember, these are patients you are already seeing.
So, what do the numbers look like for a hypothetical new dry eye patient?
A new comprehensive exam is CPT 99204, which reimburses $185. 26 in my practice. A follow-up exam for an established patient ranges from $46.13 (CPT 99212) for 10 minutes to $148.33 (CPT 99215) for 40 minutes.
My baseline dry eye consult includes meibography with LipiScan, MMP-9 testing (Quidel), tear osmolarity testing (TearLab), fluorescein staining tear break-up time and gland expression.
Patients with DED will come in three or four times a year. Additional charges accrue for treatments, including punctal occlusion, heat mask, artificial tears, nutraceuticals and device-based interventions.
References:
- Farrand KF, et al. Am J Ophthalmol. 2017;doi:10.1016/j.ajo.2017.06.033.
- Stapleton F, et al. Ocul Surf. 2017;doi:10.1016/j.jtos.2017.05.003.
For more information:
Josh Johnston, OD, FAAO, is clinical director and residency director at Georgia Eye Partners, where he also leads the Dry Eye Center of Excellence. He also is founder of Oculus Consulting Partners and serves as an adjunct faculty member at Southern College of Optometry.
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