DED Detection: The Physician Perspective

By James R. Hale, OD

Valley Eye Care is a very busy optometric practice that uses state-of-the-art diagnostic technologies and eye care products to ensure that our patients receive the best care possible. Our clinic is constantly busy, seeing an average of 50 patients per day. Add to that the number of patients we see daily at our separate dry eye clinic, approximately five to eight, and you can easily understand how important maximizing workflow can be.

In order for our dry eye clinic to run smoothly and efficiently, we decided to devise a technician-based patient evaluation and management protocol. The physicians are still an important part of the care that patients receive; however, our technicians are the driving force behind the preoperative workup.

DETAILING A TYPICAL DRY EYE PATIENT APPOINTMENT

During a typical appointment, after the patient arrives and is greeted by our staff, he or she is immediately met by a technician and asked to fill out a detailed dry eye disease (DED) questionnaire. The patient then goes to the back of our clinic, where our dry eye diagnostic instruments are housed. The first test that our technician performs is the Keratograph 5M (Oculus; Figure 1). After this test is administered, the patient is taken to an exam room where the technician takes a thorough history and performs a Zone Quick test. The technician updates the patient’s chart and then evaluates, grades, and scores the Keratograph 5M results.

At that point, I enter the exam room, review the key Keratograph 5M and other test results directly with the patient, and discuss all of the problems that are contributing to his or her DED (Figure 2). Armed with specific data on why the patient has dry eyes, I then prescribe treatment targeting the multiple problems identified in that patient. Once the patient has had a chance to ask questions about his or her DED, the technician takes over so that I am free to move on to another patient.

The technician then reviews the entire treatment regimen with the patient; demonstrates warm compresses, eyelid massages, and installation of eye drops; and provides any other necessary education. With a good understanding of the problem and a detailed treatment regimen in hand, the patient can start on the path to successfully treating the DED and relieving his or her symptoms.

ADVANTAGES OF TECHNICIAN-DRIVEN MANAGEMENT

Training our technicians so that they can be trusted to drive the patient evaluation and DED treatment protocol relieves physicians of the time it takes to perform these tasks. It also provides other practical benefits in the patient care process. For instance, using technicians to incorporate the Keratograph 5M has allowed me to quickly assess the details of the disease and focus on targeting each individual patient’s specific dry eye–related problems. Clinically, having immediate access to so much information from the Keratograph 5M, I am able to spend my time evaluating disease rather than performing tests. As a result, my DED management has transitioned from a trial-and-error approach to a problem-oriented approach.

Most of all, having a concrete way to show the patient what is going on with his or her own eyes has increased patient compliance drastically for the treatments that I prescribe. Showing the patient the Keratograph 5M analysis of tears flowing across the front of the eye, the punctate keratitis of the cornea, the plugged and atrophied meibomian glands, and so much more, has proven to be an excellent motivator for the patient to work hard to resolve his or her condition.

TAKE-HOME POINTS

Like so many of my colleagues, I am very comfortable with dry eye care. I studied dry eye, I have attended hours of continuing education classes, and I have managed hundreds and hundreds of patients at a high level. However, I just didn't know what I was missing by using a slit lamp as my primary tool to evaluate dry eyes until we began using the Keratograph 5M in our clinic. This technology has completely changed my approach to DED management by providing me access to such extensive new data and imaging. The Keratograph 5M allows me to evaluate patients in much greater detail and provide greater patient education than ever before.

DED Detection: The Technician’s Perspective

By Brandy Cherry, CPO

Anyone who knows me, knows that I am motivated by the prospect of providing exceptional patient care. I love helping people and seeing their positive end results. Nothing gives me more pride in what I do than the smiles on our patients’ faces. I am lucky enough to manage Valley Eye Care’s dry eye clinic for Dr. Hale.

The doctor’s time is valuable and should be spent with patients, not on charting. This is a large part of the reason that Valley Eye Care utilizes a technician-based management process, which helps us to effectively and efficiently provide excellent patient care. In this process, myself and other technicians are in charge of the preoperative dry eye workup and evaluation, including testing with the Keratograph 5M.

During a typical appointment, a technician will conduct all of the imaging, assess the results, and scribe the results before Dr. Hale or another physician ever enters the exam room. The doctor will go over the results and fine-tune them, if needed, before seeing the patient. During the doctor’s time with the patient, the focus of the conversation is on the results of the diagnostic tests and the next steps in treatment and care. Once the physician is finished with the consultation, the technician reviews the steps needed in the patient’s treatment plan. The technician also helps the patient to schedule a follow-up appointment as defined by the doctor.

EASY CLINIC WORKFLOW

Having a device like the Keratograph 5M in our clinic has greatly helped in our day-to-day clinic practice. It has set up the doctors for a successful, easy clinic workflow day to day, and it has increased patient compliance. Compliance has skyrocketed since we added testing with the Keratograph 5M to our diagnostic workups, and, in fact, our dry eye routine was a mess before we began using the Keratograph 5M. Dr. Hale was spending 30 to 40 minutes—if not more—with every dry eye patient, which was just not efficient for the clinic or for patient compliance. Now that we use the Keratograph 5M, the time that Dr. Hale spends with patients has been cut in half. It has given the technicians the ability to lead our dry eye clinic and to be able to do imaging on demand, which is a game-changer for our clinic. We have amazing technicians here, so it only takes about 10 tests to feel comfortable assessing the Keratograph’s results.

FINDING FULFILLMENT

I was not always fulfilled in my role as a technician, and that was because the workflow for patients with dry eyes drove me crazy. Dr. Hale was spending too much time with patients, they were not being compliant, and we had many patients coming back for follow-up appointments unhappy with their lack of progress.

But after the Keratograph 5M was introduced, we then had the ability to fine-tune our dry eye clinic. It has boosted patient compliance, which makes me very happy because we're actually helping them, and they come to their follow-up appointments happier than ever before.

In our experience, patients want to see what their specific problem is, and they desperately want to feel themselves get better. With the Keratograph 5M, patients can now actually see what was wrong with their eyes (Figure 2). And when they come back, they can see how they improved. Such a process has helped me to feel fulfilled, knowing that I am finally able to help patients and to get them to become compliant. For us, the Keratograph 5M has helped our doctors be more successful and our patients be more successful, compliant, and happy.