#28: Building a Dry Eye Practice - Dr. Art Epstein

[AdminWolf]

Episode 28: Building a Dry Eye Practice - Dr. Art Epstein

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Dry eye is an extremely common condition that's often been under-diagnosed and treated.

But thanks to advances in our understanding of dry eye, the availability of new diagnostic tools, and new forms of treatment, OD's have a real opportunity not only to help patients, but also grow their bottom line.

In this ODwire.org Radio interview, Dr. Art Epstein stops by to:

• Review the pathophysiology of dry eye
• Talk about new diagnostic equipment and techniques ...
• How his practice became known as one of the premiere dry eye centers in Arizona. (And tips on how you can replicate his success in your area.)

Don't miss the great practice-building advice in this show!



Sponsored by Oculus

Now featuring their Keratograph 5M Topographer!

Attending AAO Seattle? Visit them at booth #410 for a demo

 

[Paul Farkas]

Any questions or comments?

This is the place to continue the ODwire.org Radio/Podcast conversation.

Dr Art Epstein is standing by to field your questions and comments.

 

[Frederick Satkowiak]

Tip #1

Open a practice in a very dry State with a very large Geriatric patient population, say Arizona.

 

[Kandi S. Moller]

Not wet WA (or OR)!

 

[Frederick Satkowiak]

Most of OR and WA are deserts.

If one heads east of the Cascades lots of dry, windy weather. Pendleton, OR or Walla Walla, WA may generate lots of clientele

 

[Art Epstein]

Opening a practice in AZ certainly didn't hurt. Having a wife with an already huge geriatric following didn't hurt either. That said, dry eye is everywhere and very much an untapped niche in most practices.

I've seen very successful dry eye centers in super humid Tampa and Houston. Its often the rapid change in humidity and temperature along with seasonal variation that drives borderline dry eye patients nuts and prompts them to seek care. One of the most successful ODs who uses Tear Science's Lipiflow system is Paul Jensen who practices in Seattle.

So, buy an Oculus Keratograph, a Mastrota paddle, absorb yourself in dry eye and you too can create a successful dry eye practice.

 

[Ken Elder]

I have tried in my 13 years of practice to "build a dry eye practice" and unfortunately, have not been particularly successful.

I've done the questionnaires, the vitamins, the nutritional supplements and counselling, the TBUTs, the Schirmers, the Zone Quicks, the lissamine greens, the rose bengals, the punctal plugs, the restasis, the lid scrubs, the steroids, the artificial tears, the ointments, the gels et al.

The biggest problem I run into is that for the majority of patients, "dry eye" does not rise to more than a minor annoyance for them. As such, they are not willing to shell out hundreds of dollars a year on medications, drops, and office visit copayments to monitor and manage a condition that again, is not more than a minor annoyance to them.

No doubt, there is a subset of these patients that do suffer from chronic, aggravating dry eye. And those patients, when successfully treated are appreciative.

But I have not been able to manifest that critical mass of dry eye patients to make it a financially viable part of my practice.

 

[Allan Panzer]

Successful Dry Eye Practice

Reading your post Ken really brings back fond memories. (Ok not so fond)

I will sum this up briefly. And I am never brief.

When patients come to a "successful" dry eye practice, remember....they have pretty much already tried all the typical treatments.

They have already taken supplements...they have already used "restasis". My favorite statement that they all say is..."your not going to give me restasis are you?"

My fav...

Lipiflow? Great idea..I spoke to them two years ago. Those patients like to say..."It costs how much?"
Uhhhh is that like covered by my insurance...cause you know the last guy took my insurance...do you?

Be careful what you wish for, you just might get it.

 

[Allan Panzer]

The biggest problem I run into is that for the majority of patients, "dry eye" does not rise to more than a minor annoyance for them. As such, they are not willing to shell out hundreds of dollars a year on medications, drops, and office visit copayments to monitor and manage a condition that again, is not more than a minor annoyance to them.

This is because you are telling them that they have dry eye..

When you get the really really bad ones, they will pay pretty much anything to fix it.
Problem is as I said, they have already paid and paid..why some have even had lipiflow and meibomian gland treatments by the time they hit your door.

You feel like its an annoyance, they feel like its ruined their life.
Reminds me of Low Vision..no one much comes to me for Low vision...why..cause they are all somewhere else.

You might be happy the really bad ones are somewhere else.

 

[Charles A McBride]

I have tried in my 13 years of practice to "build a dry eye practice" and unfortunately, have not been particularly successful.

I've done the questionnaires, the vitamins, the nutritional supplements and counselling, the TBUTs, the Schirmers, the Zone Quicks, the lissamine greens, the rose bengals, the punctal plugs, the restasis, the lid scrubs, the steroids, the artificial tears, the ointments, the gels et al.

The biggest problem I run into is that for the majority of patients, "dry eye" does not rise to more than a minor annoyance for them. As such, they are not willing to shell out hundreds of dollars a year on medications, drops, and office visit copayments to monitor and manage a condition that again, is not more than a minor annoyance to them.

No doubt, there is a subset of these patients that do suffer from chronic, aggravating dry eye. And those patients, when successfully treated are appreciative.

But I have not been able to manifest that critical mass of dry eye patients to make it a financially viable part of my practice.

+1. It's somewhere between the lines of the treatments don't work well to the treatment is worse than the disease.

Lord knows how the demodex theory will turn out but it at least it's something new and that gives me hope. -Charlie

 

[Art Epstein]

Ken... You raise good points. Some patients are just annoyed by dry eyes, but some are debilitated by the condition. When I started out in practice in NY I had no idea that I would eventually average 15 or more keratoconus patients a day. I started by fitting a small handful, immersing myself and getting good at it. That segment of my practice - an area of interest for me, grew by leaps and bounds.

Those that say that these dry eye patients go to a ton of doctors and don't get relief are 100% correct. They don't. The lesson in this is: don't do the same things that the other doctors did or you will end up with the same result - an unhappy patient looking for someone who can help them that isn't you. To answer Charlie. its not Demodex. Since I wrote a piece on it, I received a ton of emails from notable ODs and MDs who shared my angst at the commercialization of a usually benign critter that has been around long before we have. There is not one iota of evidence that Demodex causes MGD although it does appear to be associated with inflammation and rosacea - but even that isn't certain.

Regarding the Lipiflow, there are practices that do 10 or more procedures a week. I agree with Alan that for many patients the cost will seem excessive, but for many of those same patients plunking down $1000 for glasses doesn't phase them or your staff. If you don't see the value or the benefit, don't bother incorporating it in your practice. It won't work. If you do, it can be life altering.

I think the bottom line is that no one will become a dry eye guru doing the same thing and using the same techniques that they did yesterday. We already know that that is a strategy for failure. I am working on a course called Building a Dry Eye Center - From Start to Success. The first 2 hours are clinical and designed to make the attendee think about tear dysfunction and ocular surface disease in a totally different way. I believe that most of us can do that and be successful at it...