Contact Lens Practice Pearls

The #1 Thing You Need for a Dry Eye Center of Excellence

BY DAVID L. KADING, OD, FAAO

For the first time since punctal plugs, dry eye is sexy. Remember when we used to think that we understood dry eye and that we had the ultimate solution? All we had to do was put a plug in our patients’ punctum; they would instantly have tears filling up their eyes, and their dry eye would go away. If you did a lot of plugs, you had a dry eye center of excellence. But over time, new technologies offered additional solutions, and our centers of excellence lost their focus.

Establishing Your Center

Now, more than ever, we have an increased interest in dry eye—a greater number of companies producing dry eye products, new techniques to diagnose dry eye, new definitions of dry eye, and more dry eye treatments than we could possibly perform on one patient in a given year.

If you want, you can invest hundreds of thousands of dollars on tools for your office. You can now earn incremental revenue in your office by selling heat masks, nutraceuticals, and lid wipes. You also can perform in-office procedures that generate additional revenue, such as thermal pulsation techniques, rotating lid cleaners, and hot metal plates applied to the eyelid. But does this make your office a center of excellence?

Alternately, you could invest countless hours reading journal articles and attending educational events of other well-respected dry eye “specialists.” But does this make your office a center of excellence?

Sorry, folks, but simply investing time and money won’t create a dry eye center of excellence. What you need most is a little thing called excellence. Superiority, distinction, quality, and brilliance are all characteristics that separate a center of excellence from a regular dry eye center.

The Path to Excellence

In discussions with two of my dry eye heros (Drs. Donald Korb and Michael Stern), I have come to realize that what separates good from great is how we see early stage disease. Anyone can diagnose end-stage disease. Most lectures end up placing their emphasis on deciding when to start treatment. Your ability to differentiate dry eye as a disease rather than an occasional bothersome dryness will be what differentiates you from other practitioners.

The best practitioners may elect to start patients on treatment even before symptoms develop, because they are treating the disease, not the symptoms. These are the same practitioners who know how to best treat an end-stage patient, because their craft has taught them that the signs they see on the eye should dictate treatment rather than what patients are telling them.

If you want a dry eye center of excellence, invest in the knowledge and technology, but, most importantly, invest in a new mindset—one focused on treating and stopping a disease from progressing regardless of the stage, complexity, or your patients’ pocketbook or insurance coverage. In the end, you need to be able to think beyond the status quo. CLS

Dr. Kading owns the Specialty Dry Eye and Contact Lens Center in Seattle. He is the co-owner of Optometric Insights with Dr. Mile Brujic. He has received honoraria for consulting, performing research, speaking, and/or writing from Alcon Laboratories, Allergan, Bausch + Lomb, CooperVision, Johnson & Johnson Vision Care, Oculus, OptoVue, RPS Detectors, Paragon Vision Sciences, TearScience, Valeant Pharmaceuticals, Valley Contax, VSP, ZeaVision, and Zeiss. Follow him on Twitter @davekading.