Our philosophy at Beach Eye Care is to take the best care of our patients, and everything else will follow. Dry eye disease (DED) management is a lifelong requirement; whether the goal is to improve symptoms, visual quality, or to ensure great results from a cataract or refractive procedures. It is through this “blueprint” approach that we ensure all in the practice understand our commitment to excellence and how we ensure optimal outcomes for our patients.
To arrive at a systemic approach to DED management, our team reviews our testing procedures on an ongoing basis. When we agree a change is needed, we have a process in place to communicate that information and train our team members. We are constantly assessing our processes and systems, which allows us to stay in step with the latest technology and science. Clear and constant education, communication, and training helps us stay together as a team so we can always reflect a consistent message to our patients.
team in our clinic. We, with the help of all of our Providers, identify what the staff is doing well and also identify areas for needing improvement. Hands-on training sessions occur quarterly, and informational pieces of training for clinic education are held at each office monthly. These focused meetings allow staff to ask questions and practice necessary skills for improvement. We use quality assurance forms as a tool to identify underperforming techs and recognize those doing a great job—we have high expectations for each person on the team. The structure we have in place for training is an essential part of the blueprint for success.
When symptoms of dry eye prevail, our technicians will collect a through history and perform Tearlab osmolarity testing. Our contact lens technicians are also trained on point-of-care testing further emphasizing the importance of this objective metric and establishing consistency across all parts of our practice.
After the doctor’s assessment and initial treatment plan, DED patients have a repeat visit for a more detailed dry eye work-up. We will monitor the initial treatment and perform additional tests such as meibography, InflammaDry (Quidel), and repeat TearLab as needed. We may also measure tear meniscus volume, tear break-up time (TBUT) and check the cornea and conjunctiva for fluorescein staining. By documenting objective measures of DED, we can monitor the effects of treatment and adjust accordingly. Sharing this information with patients can helps clarify their condition and show changes.
We are committed to performing tear osmolarity testing because it is simple and provides instant, objective data. TearLab helps us learn if our treatments are effective, and it also validates what is going on for the patient. Sometimes, patients will complain about their allergies or being on the computer all day because of for how their eyes feel, not convinced yet that they have a dry eye disease. Osmolarity provides a science-based measure that patients can follow, playing a critical role in our blueprint for excellence.
We use the osmolarity results—whether normal or not—to initiate our conversations. If normal, I explain that there can be different reasons for their symptoms or visual complaints, such as MGD, and explain we will be going through a thorough work-up to identify and treat. If I use fluorescein dye, I show them slit lamp images of their staining. Patients always are more compliant when they have something they can see. Consistency and compliance with treatment, I tell them, is key. This is about lifelong management because there is no cure for DED.
Our education is also multifaceted. The IT team and marketing director keep our website up to date with detailed information about DED, including discussions on everything from TearLab to iLux (Alcon) and videos for patients to reference even before they come in. We send patients home with written documentation that, we review with them periodically, along with instructions and reminders. All of these avenues combine to empower patients to be active participants in their care.
We commonly start patients on artificial tears if they are not already using them. We describe home therapy with hot compresses, digital massage, and lid wipes, and we discuss the potential need for LipiFlow (Johnson & Johnson Vision) or iLux therapy. We explain the benefits of nutraceuticals and talk to patients about daily habits and the importance of blinking. I also make use of moisture goggles and eye seals for my CPAP users. Some patients may also benefit from room humidifiers, the environment can be a factor for many patients.
If osmolarity remains high or was high initially, we talk about adding options, i.e., Restasis (Allergan), Xiidra (Novartis), or Cequa (Sun)—I use all three for different reasons—and re-educate that improvement does not happen overnight. In severe inflammatory cases, we may pulse dose steroid drops to improve the ocular surface and comfort of the patient, this can really help jump-start treatment. In more mild cases where OTC Retaine, Refresh or Systane has not worked, I may recommend a trial of autologous serum eye drops. Our providers will recommend punctual occlusion or cautery when the tear-film inflammation is under control, this helps increase tear volume for the patient. There is no one-size-fits-all treatment for an ocular surface disease, therefore, our practice makes use of a wide array of treatment options, so we specifically tailor our recommendations to address the underlying causes of signs and symptoms.
Our Metrics of Succes
A robust metric of success is when patients refer friends or family. We use patient surveys to solicit feedback, finding they feel well-cared for and appreciative of the cutting-edge technology we use to aid in our diagnosis and treatment decisions. We also measure success by patients’ postoperative cataract or refractive surgery results, which we track with outcome data and surveys.
Another important indicator of successful DED management is comfortable contact lens wear for patients who dropped out or were not prior candidates. Getting patients into contact lenses for the first time has been crucial during the pandemic as glasses fog with mask wearing. Patients are now opting for contact lenses at a wider age range.
At Beach Eye Care we have exceedingly high expectations for everyone in the entire practice. By sticking to our blueprint and consistently following established processes across clinical departments—always with an eye toward ways to improve what we do and how we do it,—we maintain a rigorous quality of care for each and every patient we see.
About Deanna Ritenour, OD
Deanna M. Ritenour, OD, is in practice at Beach Eye Care, Virginia Beach, Va. She received her Bachelor of Science degree at Washington and Jefferson College and Optometric degree at The Pennsylvania College of Optometry, where she completed a 2-year internship at The Eye Institute and earned her Doctor of Optometry degree. Through her experience at four different externships, including The Allentown VA Outpatient Clinic and Advanced Eyecare PC in Pennsylvania, she gained a thorough knowledge of providing full-scope optometric care.