Set the stage for a proper treatment plan

Ophthalmic techs can use the patient workup to perform dry eye tests and provide education on prescription medications.

By Zack Tertel, managing editor

Weeks before entering your office, a patient dealing with ocular dryness purchases a bottle of over-the-counter (OTC) artificial tears at her local pharmacy. Because the drop leads to less discomfort, she does not come to her appointment with the intention of mentioning these complaints.

“The unfortunate part of that, if the patients have a defective ocular surface and if it’s been ongoing for a while, there could be a lot of different things causing the symptoms, whether it’s allergies, exposure, or inflammation,” says Patti Barkey, COE, administrator, Bowden Eye & Associates, Eye Surgery Center of North Florida and director/partner, Dry Eye University and Dry Eye Access.

While these patients may get some immediate relief from the artificial tear, it only provides temporary comfort and doesn’t get to the root of the problem, explains Ms. Barkey.

This is where the ophthalmic technician becomes so important. Here, Ms. Barkey explains the key role they play in proper diagnosis of dry eye disease (DED) and education about prescription medications that can slow or stop the progression of DED.

Start with a proper system for testing

“Years ago, it used to be that any time the patient used the words “dry eye” someone handed them a sample of artificial tears,” says Ms. Barkey. Rather than this approach, she says the goal should be to make a proper diagnosis so that the physician can offer a clinical treatment plan to get their ocular surface under control, which can include prescription medications.

For symptomatic patients, Ms. Barkey says it’s crucial that practices have a standard of care that can drive the technician to move forward with a diagnostic test right away. Much like how a tech knows to test for best corrected visual acuity based on complaints of poor vision or how mentions of flashes and floaters would trigger a dilation so the doctor can view the back of the eye, standing orders for diagnostic tests should be in place if a patient presents with ocular surface issues, she says.

Results of questionnaires such as the Standard Patient Evaluation of Eye Dryness Questionnaire (SPEED), for example, can trigger the testing. “If your office has a system where the SPEED score and the patients’ symptoms can drive a diagnostic, whether it’s InflammaDry (Quidel) or osmolarity, then when the doctors is in front of the patient they are armed with evidence of what’s going on with the patient to properly prescribe an appropriate medication,” says Ms. Barkey.

Educate on prescription medications

All technicians should know about the available prescription products to properly set the stage for the patient, says Ms. Barkey. The technician should explain that, while the OTC drop may provide some relief, it does not address the root cause of DED. Medications such as Restasis (Allergan), Xiidra (Novartis), and Cequa (Sun Ophthalmics) come into play. If the patient is not producing enough tears, Tyrvaya (Oyster Point) could be an option.

“Say for instance, Ms. Smith has a lot of symptoms, or the SPEED score pulls out a lot of those symptoms, what I can say to her is, ‘Technology and advancements are great right now, and there are a lot of medications on the market that can help with DED. Let me do some tests that can help the doctor determine if a medication is going to work for you and, if so, clearly define which one would be best,’” Ms. Barkey says.

Streamline the path to treatment

Without a system like this in place, the doctor is not able to make a proper diagnosis. They may determine the need for these tests while seeing the patient but run out of time to order them, says Ms. Barkey. The patient then must return for another visit to gather this info, which delays care and reduces efficiency. “If the tech had already gathered the info and educated the patient up front, it is easy for the provider to say, ‘I know Suzy mentioned this to you already, but you are a great candidate for this medication. Let me write a prescription for you and we will see you back soon to see how it is working.’”

The team should make sure that the patient then has enough time to obtain the medication (prior authorizations can slow things down), use the medication, and return to access effectiveness, Ms. Barkey adds. The return appointment would include another SPEED assessment as well as a repeat of the diagnostics so the clinician can share the effectiveness that the medication has provided. OP