Make Eye Drops a Practice Builder

Natural homeopathic eye drops can be part of your treatment plan for a variety of ocular conditions. A key to success: Offer drops for sale, and make it easy for patients to comply.

Conditions such as dry eye, irritation from contact lens wear, cataracts and the occurrence of floaters afflicts a large and diverse cross section of optometric patients. Among the treatment plans you can offer for these conditions are homeopathic eye drops from Natural Ophthalmics. If you start selling the eye drops, you will find that they are a patient loyalty builder, with patients happy to find relief for ongoing conditions, and a revenue-generator, to boot.

Introduce the Eye Drops As a Standard Treatment Option

Natural Ophthalmics offers a wide range of products that are effective with floaters, cataracts, dry eye and contact lens wear. You can have your patients use the oral eye spray (Total Ocular Spray) and the company’s cataract eye drops for eight months and then have them back for a follow-up visit. At this point the least improvement in acuity is half a line better with the best improvement three full lines. You can recommend this protocol to patients who do not want to have surgery or have eye conditions that would cause a higher risk of vision loss post-surgery.

Natural Ophthalmic products come as drops, pellets and an oral spray. For people with dry eye syndrome you can prescribe tear stimulant drops, for cataracts you can prescribe Total Ocular Spray and cataract drops or cataract pellets. For corneal staining, you can prescribe Ortho-K Thick for night time and Ortho K Thin for daytime with or without contact lens wear.

The biggest advantage of these products is that there are virtually no side effects and all of the eye drops can be used with or without contact lenses on. There are no steroids in them, and they are only sold through professionals.

Start with a Conservative Investment

You can start with a $350 dollar inventory, but you could start with just one Natural Ophthalmics product at a time and gradually add eye drops and eye pellets for other conditions as your patients became more confident with the products. Doing it this way, your original investment could be as low as $60 with a net of $60.

Natural Ophthalmics has a recommended price for their products. None of their products retail for more than $24.75. With the correct presentation of the products, you should break even with the $350 investment in three weeks.  

Tie Eye Drops to Practice Branding

The holistic branding may be great for your practice. You may let your patients know that you provide holistic care, not just eyecare, with point-of-sale products and show a DVD provided by Natural Ophthalmics in your reception room.

Educate Patients

First, you should ask the patient if their symptoms are worth using the products. If they say no, then you can suggest procedures they can do at home and over-the-counter products. If they say yes, then you can explain how the products work.   

When patients purchase products for eye or general health conditions, you should tell them to call if they feel the product didn’t help with their symptoms and you should consider giving them full credit towards future services.


New Revenue Stream: Lubricating Eye Drops

Offer lubricating eye drops as part of a treatment plan for dry eye and LASIK co-management patients. Patients enjoy convenience and avoid brand confusion at retail outlets, while your practice adds a new revenue stream.

Instead of giving patients a prescription to hunt on their own for the eye drops, you could offer exactly what they needed right in our office. In the process, you also could build revenues. 

Sell Branded Eye Drops for Slightly More than Pharmacy

On average, the lubricating drops you can sell cost $10 to $15 in a pharmacy. In exchange for the patient’s convenience and the added sense of security that comes from getting the drops directly from you, you can sell the product for slightly more than that.

Keep Inventory Simple

You should only invest in selling one brand of eye drops in three different versions–preserve, non-preserve and gel.

Doctor Prescribed and Sold

Like eyeglasses, contact lenses or any other product you would prescribe for a patient, it is best when selling eye drops to write down your prescription, and hand it to the patient or to the person who will conduct the transaction. Since most of our patients opt for LASIK procedures, you can make the eye drops a standard part of the preoperative and postoperative regimen for every patient. This is an approach that any OD who has a LASIK co-management specialty can emulate. It also works if you are able to make the eye drops you sell a standard part of a treatment plan for patients with dry eye.

Enable Patients to Use Flex-Spending Dollars on Drops

Be sure to write out a prescription for the eye drops so patients can use their flex-spending account dollars to pay for them. When you hand the patient off to the front desk for check out and purchase of the drops, remind them that they can use their FSA dollars.

Display at Front Desk

Make sure all of your patients know they can purchase eye drops from you-and can use their FSA dollars to do so–with a product display at your front desk and a sign that explains the product and the ability to use FSA.

Practice-Building Opportunity: Add a Dry Eye Clinic

Dry eye is an under-diagnosed and under-treated eye condition. Creating a dry eye clinic serves your patients’ needs—and provides you with a revenue stream.

Over 40% of patients mention dry eye as a primary or secondary complaint. You may not have looked into it yet, but there is a good chance, with the aging population of Baby Boomers and the growing number of people on prescription medications that create dry eye, that this percentage is similar among practices. What’s more, most patients with dry eye complaints are unsatisfied with the treatment they have so far received.

According to Gallup, over 70% of people with dry eye complaints have seen at least three doctors and are still searching for a remedy. In addition, the majority of that 70% still searching for a successful treatment have tried at least three different artificial tear products that have not provided relief. With numbers like these, you should consider to launch a dry eye clinic, devoting one to two days per week to seeing nothing, but patients with dry eye complaints.

High Per-Patient Revenue

Patients who have already tried multiple treatments unsuccessfully are willing to do what it takes to find relief. That attitude is borne out by the per-patient-revenue of dry eye patients.  

Click HERE to download a dry eye calculator that lists the expenses and profits of dry eye treatment so you can determine your potential return on investment.

Delegate Dry Eye Pre-Testing

The key to making dry eye clinics profitable is to streamline the process so you can see as many patients as possible on the days you devote solely to dry eye. For example, your staff can conduct osmolarity (Tear Lab) testing, a five-second test that measures the salt to solution level in the eyes (any reading over 308 is considered an indicator of dry eye). Your staff may also perform testing with an  iCaretonometer which does not require a puff of air or administering drops that could affect the surface of the eye and interfere with the rest of the dry eye examination. Patients are then placed in the exam lane and given a more specific dry eye questionnaire to fill out to assess how the condition is affecting their eye comfort and vision.

After the patient has filled out the questionnaire in the exam lane, they can watch Eyemaginations educational videos with animated graphics that illustrate the condition and pose trivia questions. These videos may also be playing in the reception area. Between the questionnaire and the educational videos in the reception area and exam lane, patients are primed to speak to you when you arrive. They have the state of their condition in mind from the questionnaire and have the beginnings of an education on the topic from the animated videos.

Streamlined Doctor-Patient Time

By the time you get to the exam room, your tasks are limited. After reading the osmolarity measurement, you then can do an assessment of the eyes, expressing the meibomian glands in the lower central and nasal eye lid and then using the slit lamp for an assessment based on your observation. The technician instills a drop of fluoresceine and then lissamine green dye and using a Raton filter you can assess the degree of staining, the tear meniscus height and tear film break-up time. You then should do a fundus examination to rule out eye diseases that can lead to dry eye such as diabetic retinopathy because diabetics have a high prevalence of dry eye disease. You can project the images of the patient’s eyelid glands from the slit lamp onto a flat screen monitor via the TelScreen EyeRes system to show patients a picture of their condition and bring to life what you are explaining to them. You may also run through the Eyemaginations animations related to their specific condition while in the lane.

Code and Bill for Dry Eye

When patients visit your office with medical conditions that they already know cause dry eye-often on referral from their primary care doctor-you are able to bill medical insurance for the visit and services, but when patients present with symptoms such as dry eye-related blurry vision, you would bill vision insurance. The extensive testing using instrumentation also offers an opportunity for billing. For example, in addition to offering patients a literal picture of their condition, the pictures you project onto the slit screen enable you to bill for anterior segment photography when appropriate. With dry eye a condition frequently related to medical conditions a patient may not yet know they have, such as diabetes, it is not uncommon for a vision insurance patient to eventually become a patient whose treatment is billable to medical insurance. You may also able to bill for the TearLab osmolarity test which reimburses approximately $46 for two eyes of testing (The AMA CPT recommends reporting 83861 twice, using the “-59” modifier for the second eye tested to indicate that it is a “Distinct Procedural Service”). Click HERE for a detailed article on coding and billing for dry eye.

A Long-Term Treatment

There is no cure for dry eye and it frequently worsens with age, additional medical conditions and the addition of new prescription medications. Your patients will be served by your long-term care, thereby creating a loyal patient base likely to refer you to friends and family as the doctor who finally provided them with relief.

Caffeine May Be Key to Relief for Millions of Dry Eye Sufferers

Caffeine can increase tear production and may someday be a treatment for dry eye syndrome, a new study shows. All of the participants in this small study produced more tears after taking caffeine than after taking a placebo. The researchers knew that caffeine can affect people differently, so they tested participants for two genetic variants that are related to response. They found that those who had the two variants also produced the most tears. It’s estimated that caffeine affects about half of all people, though this varies by ethnic group. An earlier study showed that only about 13% of caffeine users had dry eye, compared to 17% of non-users.

About 5% of the U.S. population has dry eye syndrome. It’s more common in women and after age 50. Dry eye sufferers are not able to maintain the healthy layer of tears needed to keep the eye moist and make good vision possible. Their eyes can sting and burn. In some people, dry eye escalates into a vision-damaging disease.

It’s important to see an ophthalmologist if symptoms continue. Treatment options range from simple warm compresses, eye washes and artificial tears to medications and tear drainage devices. Much more research on the caffeine-tear production connection is needed before doctors will know how to best use it to treat dry eye.

Know Your Billing and Coding: Dry Eye

Learn easy billing and coding tips to make dry eye treatment a profitable part of your practice. How often do you hear patients complain about the following: “My eyes are dry,” “My eyes water all the time,” “My eyes feel like there is something gritty in them” or  “My eyes are blurry when I read or work on the computer.” Patients with dry eye symptoms are prevalent in every optometric practice.  In fact, according to the Dry Eye Workshop in 2007, prevalence of dry eye ranges from 5%-30% in people aged 50 years and older.

Long-Term Patients

In many cases, dry eye syndrome (DES) is a chronic eye condition requiring more than the simple recommendation to use OTC artificial tears to relieve symptoms. Often first diagnosed during routine eye exams, DES may often be a chronic eye condition requiring ongoing treatment and frequent follow-up.  Typical DES treatment may include office visits, punctal plug insertion and tear osmolarity testing. Additional tests may include schirmer’s, corneal staining and tear break-up time, however, these are not separately billable procedures but instead included in the office visit.

Typical Treatment Plan–and How to Code for It

A typical patient scenario may look like this:

-Initial office visit 99204/92004 for diagnosis and initiation of therapy and osmolarity test 83861
-One-month follow-up office visit 99213 along with insertion of punctal plugs 68761
-Two-week or one-month follow-up office visit 99213/99212 for punctal occlusion. IMPORTANT: 68761 has a 10-day global period so any visit or procedure associated with DES performed in the 10 days following initial punctal occlusion is included and not allowed to be billed separately.
-Three- to six-month follow-up office visits 99213/99212 to monitor symptoms.

A reminder that the following diagnosis codes support medical necessity for closure of the lacrimal punctum by plug 68761, 370.00-370.07  Corneal ulcer
-370.20-370.21  Superficial keratitis without conjunctivitis
-370.23  Filamentary keratitis
-370.33-370.35  Certain types of keratoconjunctivitis
-371.42   Recurrent corneal erosion
-375.15  Tear film insufficiency
-710.2  Sicca syndrome

Establish Medical Necessity for Punctal Plugs

Also note that most insurance beneficiaries will reimburse for two separate punctum closures 68761 on any given day. As long as medical necessity is documented then closure of two additional punctum may be performed if necessary to alleviate symptoms. In addition to the original short-term collagen plugs, 90-day extend collagen plugs are also available. For patients with year round dry eye symptoms the permanent silicone plugs are most beneficial and may stay in place for long periods of time.

ODs Best Equipped to Treat Dry Eye

Treatment of dry eye patients may vary depending on the severity of symptoms, but remember that DES is a condition affecting millions of people every day and optometrists are in the best position as primary care eye doctors to manage these patients.