Life in the Dry Eye Lane

My dry eye practice, Noh Eyes, stands out as a dry eye-exclusive practice (Figure). I provide no routine eye care or other medical eye care services. I don’t own a phoropter, I don’t have an optical, and I don’t stock contact lenses. I place all my energy into the proper diagnosis and treatment of dry eye disease (DED), and it makes a world of a difference for my patients.

THE PRACTICE, IN BRIEF

Noh Eyes’ doors opened in October 2022. At the time, I did it all: answered phones, scheduled appointments, checked each patient in and out, performed pretesting, testing, and doctoring. I was open 3 days a week, saw about six patients each day, and was growing by about two new patients each week. As time passed, the office got busier, and I was exhausted by the end of each day. After a year of working alone at the office, I hired my first employee. She started at 18 hours a week and has since worked up to 30 hours a week. I’m now in the process of adding a virtual assistant to help with daily tasks. This process of slowly adding employees over time has worked well for me.

Because Noh Eyes is a dry eye-only practice, I comanage every patient with another eye care provider. This is an aspect I enjoy. Working closely with other optometrists and ophthalmologists in the area has created a sense of community. About half of my new patients come from eye care provider referrals, and the other half come from an internet search or word of mouth. Practicing in rural Arkansas, I have patients who travel from all over the state. About half drive more than an hour one way just to get to my office. I also see patients who travel from out of state to see me.

THE PATIENT VISIT, DIAGNOSTICS, AND TREATMENT OPTIONS

A patient’s dry eye journey begins with a 1.5-hour appointment, which includes a dry eye evaluation. I start with an extensive patient history, and I’m still surprised at how much I can learn from a patient’s history alone. It provides so many clues as to the cause of the disease and what to look for during diagnostic testing. Additionally, it makes patients feel supported and understood, which creates a better relationship built on trust.

When it comes to diagnostic testing, my favorite tests include meibography, noninvasive tear breakup time, corneal nerve sensitivity, and vital staining. Diagnostic testing typically takes no longer than 10 minutes, with the rest of the time spent educating patients.

In-office treatment modalities include intense pulsed light therapy, radio frequency, intraductal probing, autologous serum tears, lid margin cleansing, palpebral conjunctiva and fornix irrigation, amniotic membranes, and topical medications. Treatment suggestions are based on diagnostic testing findings. There isn’t a magic formula to treat DED; each patient’s disease state is unique, requiring a personalized treatment plan. Due to the chronic nature of DED, I tend to see my patients every few months.

FUTURE PLANS

I am the only provider in my practice, but I hope to bring on other practitioners in the future. I have other things planned for the future of my practice as well. A wish list item of mine is a plasma-based modality to use for conjunctivochlasis and nonsurgical upper lid chalasis. I hope to bring this on in the next 6 months. Additionally, we have laser and injectable privileges in Arkansas, so I plan to incorporate cosmetic injectables at some point. Further down the line, I want to take a more holistic approach to treating DED that incorporates diet, lifestyle, mental health, and body wellness.

It’s been so fulfilling, rewarding, and enjoyable for me to be able to practice this way, and I love sharing how optometry can be practiced in your own way, on your own terms, with your own spin.