Dry eye journey - the launch
It’s common to find that even after affirming and confirming the decision with yourself and your staff, there are still nagging questions about what you'll need to build a successful dry eye practice. Take a breath and relax because you're already equipped and well-prepared!
There's no need to invest in expensive capital equipment yet. Hold off on signing that banknote or taking out a HELOC loan. Most everything you need to start a dry eye practice is already at your office. Your exam lane undoubtedly has a slit lamp, printer paper, and fluorescein strips. If you’re reading this, you already have the single most vital component needed to build a dry eye practice - your clinical knowledge and acumen, and a desire to help your patients lead better lives.
The most important skill for any dry eye practitioner lies in the ability to distinguish between patients with dry eye and those without. Rest assured that you will run into those complex patients with multiple underlying clinical issues, but let’s set that conversation aside for now and focus on a more straightforward dry eye approach.
A good doctor knows which problems a patient may have and how to treat them, but a great doctor knows what a patient does not have and perhaps more importantly, what a patient doesn’t need to be concerned about for the time being. The ability to recognize what disease or diseases are unlikely to be present helps to prevent unnecessary tests and mitigate creating unnecessary worry for your patient or their loved ones.
Interest hones our senses. Without much additional effort, your clinically attuned eyes will naturally scope out for signs of dry eye when looking through the slit lamp, along the same cognitive lines as one becoming more attuned to bird calls when with an increased interest in bird watching.
A successful dry eye evaluation begins even before staff greets your patient when they arrive to your practice. Your online presence should indicate your expertise on the subject of dry eye and how that expertise manifests in the improved outcomes of patients who choose your practice. Once a patient does arrive, they should be greeted, welcomed, and then given a dry eye questionnaire like SPEED, DEQ5, or OSDI.
Having patients answer carefully designed questionnaires like the above helps address a fundamental clinical problem that's not often discussed - the pre-test probability of a pathology or prevalence rate. Not even the most refined diagnostic test for dry eye or anything else works well when the prevalence rate is low. A positive test does not mean a patient has Dysfunction X, and a negative test does not necessarily mean the absence of Dysfunction X. Nearly all clinical tests will have some number of false-negative and false-positive results.
The Dry eye questionnaires we're discussing provide a framework for your patients to really think about their eyes and how driness impacts their lives. They allow the patients to both qualify and quantify their experiences with dry eye and it serves as a baseline for future visits so any changes the patient experiences are relative to information we already have.
We have lift-off!
This simple addition to your patient intake process sets the foundation on which your practice can build the more involved elements of treatment. You, your staff, and your patients now all speak the same dry eye language. Think about how much easier it will be to invest in diagnostic equipment when you know you have hundreds of patients already visiting you who need dry eye help.
Our next article will delve a bit deeper into the workflow and mechanics of slit lamp examination for your burgeoning dry eye practice. See you soon!