Optometric Billing Dry Eye-Grow Your Practice

Pulled this from our friends at Noble Vision Group

"Research shows that artificial tears, although beneficial, appear to be palliative and there is no evidence that they can treat the inflammation in dry eye disease. Doctors that want to build this part of their medical practice need to employ the use of medications that target the disease.

Articifial tears such as Systane, Optive, Blink, Theratears, Soothe, Refresh, Genteal etc. are a good starting place in the management of mild dry eye but may not be a sound treatment strategy alone for active disease. For example, in the phase III clinical trials for cyclosporine A 0.05% (Restasis) there were two treatment arms: one that recieved cyclosporine and one that received the vehicle, which turned out to be one of the best artificial tears available known as Endura a few years ago. When biopsy’s were performed on patient’s conjunctival tissue after six months of treatment the group treated with cyclosporine had less T-cells measured showing an improvement in the inflammation associated with the disease. However the group treated with the artificial tears alone (Endura BID + Refresh PRN) showed an increase in inflammatory T-Cells of over 39%!

This is probably why doctors that TREAT the dry eye with targeted treatment options seem to grow their medical practices faster as opposed to simply providing an artificial tear samples alone. Gallup pole data shows that most patients had already tried 3-5 artificial tears before seeing an eye doctor and yet over 70% of doctors put that patient on another artificial tear. No wonder they are seeking new practitioners.

Now, as I stated, I do begin all treatments with an artificial tear alone in mild cases, or in addition to targeted treatments. So when should a doctor consider targeted treatments such as Restasis and steroids such as Lotemax, which effectively target the dry eye disease?

There are three times I would consider the need for targeted treatments such as Lotemax and Restasis. If a patient is on a good artificial tear (as opposed to drops with BAK such as Visine or ClearEyes) and you see ANY of the following:

• The patient has dry eye symptoms including dryness, grittiness, burning, stinging, foreign body sensation, transient blurred vision, redness, irritation, epiphora etc.
• The patient shows signs such as corneal or conjunctival staining or an osmolarity reading above 308mOsmol/L
• The patient when using an artificial tear does not feel that the symptoms resolve for more than 4 hours or requires 4 or more drops per day.

All of these indicate that there is likely some degree of underlying inflammation or unprotected areas of the ocular surface and that warrants a more targeted treatment approach."
-Dr. Paul Karpecki

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