By Shane Kannarr, OD
March 4, 2020
Your dry-eye patients have multifaceted lives with many needs, including, for some, contact lenses. The ability to be free from glasses during the day offers a huge improvement to a patient’s quality of life.
Here is how I help my dry-eye patients stay in their contacts, and the positive impact this has made on both my patients and practice.
My three-OD, two-location practice in Kansas has about 6,500 active contact-lens wearers (counting both full- and part-time wearers). We generated about $500,000 in contact-lens revenue last year. At least 30-40 percent of our contact-lens patients have signs of dry eye.
Over the last couple of years, we improved our contact-lens practice by changing how we listen to contact-lens patients’ complaints and by introducing Restasis eye drops to some treatment plans.
The improvements in how we care for our contact-lens patients have been important both clinically and financially. Glasses-only patients generate significantly less revenue and fewer friends and family referrals than patients who wear both contact lenses and glasses.
Preventing CL Dropouts Due to Dry Eye
Prior to changing our patient-care approach and adding Restasis to some treatment plans, we were losing 10-15 percent of contact-lens patients due to dry eye. We realized there was room for improvement.
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We conduct 10, or more, contact-lens exams a week, so we know we should be adding 520 contact-lens patients a year to our practice. But when we looked back at the numbers, our practice was not growing by that rate. Contact-lens boxes purchased were not going up 10 percent a year. We felt we had to address this issue to see continued growth in our contact-lens practice.
Once we started identifying dry-eye patients, and treating them appropriately, in many cases with Restasis, we began seeing what we thought was a more appropriate growth rate. Now, contact-lens boxes ordered and contact-lens exams are both growing by 15 percent, or more, a year.
Changing How We Listen to Patients
Initially we were like everyone else. When patients were having contact-lens issues, we made all the “normal” changes to contacts, and then said, “I am sorry, there is nothing we can do, here is your glasses prescription.”
Now we listen to the patient’s concerns, listening for these key dry-eye complaints:
1. Fluctuating vision
2. End-of-day discomfort
3. Burning gritty feeling
4. Periodic red eyes
5. Tired, not sleepy, but fatigued eyes
We take a look at the patient’s tear film. At this point we will schedule meibography and a dry-eye evaluation on our Oculos.
Identify Dry-Eye Complaints During CL Exam
In our clinic, we most often identity dry-eye complaints during a contact-lens exam and then schedule the patient back for a dry-eye evaluation. This allows us to practice efficiently, as well as prepare the patient for any out-of-pocket expenses they may have for “medical treatment.” During the contact-lens exam we also make sure patients are in the lenses that provide the best technology for each patient to have the most success at contact-lens wear.
Once it has been determined the patient has dry eye, we look at the underlying cause. If it is episodic, it might be as easy as adding Refresh Tears to the beginning and end of the patient’s day. But most patients have tried this before seeking care, so this is a small number.
If we see significant lid disease, we have moved to treating with either LipiFlow or another TearScience device to first address the underlying cause. But I always like to explain to patients that in many cases this is part of the problem, not the entire issue. I use the onion analogy, I can remove one layer of the problem to get to the next layer. I say this because many of our patients with lid disease will need ongoing treatment with Restasis, supplements and/or a lid hygiene regimen.
Reintroduce CL Wear
Once we are seeing improvement in the quality and quantity of the tears, we reintroduce contact-lens wear, or begin to modify the contact-lens brand they are wearing. For example, many of our patients will see improved benefit from Restasis when we refit them in a contact lens like Oasys One Day. We feel this is due to the almost bandage contact-lens effect during long days of screen time and other stressors.
In summary, implement these steps to keep more of your dry-eye patients in contact lenses:
1) Identify complaints
2) Schedule dry-eye evaluation
3) Determine type of dry eye
4) If significant MGD is present, treat that condition first
5) If any inflammation, or significant staining (corneal or conjunctival), begin treatment with Restasis
6) Once we see improvement in tear film quality and quantity, modify contact lenses to maximize benefit
7) Educate the patient as to the proper expectations and need for ongoing treatment during the entire process
Shane Kannarr, OD, is the owner of Kannarr Eye Care, a Vision Source practice in Pittsburg and Girard, Kans.