Jenny Lee, OD-4, University of Waterloo, contributes her perspectives on the Canadian Dry Eye Summit.

This weekend, members of NextGen OD/Eye Care Business Canada and the CRO (Clinical & Refractive Optometry team) had the opportunity to attend the annual Canadian Dry Eye Summit, held in Toronto, Ontario from November 12th to 13th.

This conference is truly one of its’ kind in Canada, featuring innovative, thought-provoking talks from several heavy hitters in the dry eye management scene from across the country including Drs. Richard Maharaj, Trevor Miranda, Wes McCann and countless other faculty.

The conference also featured live demos and exhibits of various equipment and products hot on the market from industry representatives.

Nyah Miranda OD-1 NECO
Nyah Miranda, NextGenOD Digital Communications Associate at the CRO and booth in the exhibit hall. Nyah is an OD-1 student at NECO.

As a current fourth year optometry student at the University of Waterloo as well as the Vision Science Editorial Assistant for the Clinical and Refractive Optometry Journal, having the opportunity to dip my toes in the dry eye scene this weekend was truly a worthwhile and incredibly informative experience. Here I’ve highlighted three key pearls from my time with some of Canada’s best dry eye gurus.

#1: Now, more than ever, evidence-based medicine is crucial to the progression of optometry.

The extent and scope of optometry is vastly different than where it was even ten years ago.

Likewise, in order to keep up with a rapidly evolving field, it is vital to remain up-to-date with the current studies and to read beyond the conclusion of an article, as aptly stated by Dr. Maharaj.

In a talk about the impacts of nutrition on ocular surface disease, Dr. Kim Friedman broke down each key component (such as dosage and form), presenting the evidence for and against the inclusion of different supplements for dry eye.

Her talk emphasized not only the benefit of paying attention to the literature to support a medical recommendation, but also reading between the lines of a study conclusion and being able to draw your own insights.

Chances are, if we can access this information easily from the internet, so can our patients, and it gives you that extra edge to be able to keep up with them.

#2: Expert opinion is what bridges the gap between a research study and direct patient benefit.
Following up from the previous pearl, as practitioners are the direct points of contact for a patient seeking to manage their dry eye, it is important that we not only synthesize and make our own interpretations but also use this knowledge to develop our own expert opinion that is backed by the knowledge we obtain from reputable, reliable sources.

The true benefit of a conference such as this is that we are able to gather some of the brightest and most well-versed minds in a very specialized aspect of optometric care, and disseminate knowledge through expert opinion.

However, expert opinion is ultimately at the bottom of the evidence-based medicine pyramid – and it is up to the individual eye care professional to look beyond the neatly-packaged one hour COPE lecture to educate themselves.

As Dr. Maharaj stated in his talk on demystifying dry eye, “expert opinion is where it begins, and then we need to climb up the ladder”. The role of industry in educating optometrists on up-and-coming technology and the impacts of staying up to date in the literature are heavily understated.

#3: Ultimately, your patient care comes down to your ability to communicate and use the appropriate terminology.
Dr. Jeff Goodhew and Dr. Tina Goodhew provided an excellent outline of how to present the idea of dry eye management to the patient in a way that not only empowers the patient to seek their own care, but also does not place the onus on the doctor to feel obligated to provide a whole dry eye assessment during a routine eye exam.

Drs. Goodhew and Goodhew, as well as several of the speakers at the conference, highlighted the importance of how to approach the topic of dry eye with the patient, and some salient points and phrases that could be easily incorporated into any eye exam.

Building on this idea, Dr. Maharaj discussed how patients are already doing their own research and developing their own ideas about dry eye before they even come into your office – and as such, it is crucial to be able to use the right language and arm the patient with the correct information so that when it is disseminated to friends and family, there is no room for miscommunication.

At the end of the day, it is your words the patient will remember, and not the result of a randomized controlled trial.

Ultimately, I walked away from this conference with a newfound sense of respect for all the ongoing research and efforts being put into advancing the scope of optometry and the knowledge surrounding what we know about dry eye.

With the resources available to us, it is easier now than ever to stay up-to-date in the field, whether by reading case reports from fellow optometrists or attending trade shows and actively engaging with industry representatives.

I look forward to seeing where my own journey in optometry takes me!

If you are an optometrist looking to contribute back to the community with case reports of your own, the CRO (Clinical and Refractive Journal) is an excellent place to start.

We help you with the process of publishing your own article and becoming a COPE approved instructor! This is an excellent opportunity particularly for those looking to submit case reports as part of the Academy’s Fellowship program. CRO is on the Academy’s list of authorized journals for Fellowship points.

Jenny Lee, OD


Vision Science Assistant Editor, CRO Journal

Jenny Lee is an onboarding resident with the University of Waterloo School of Optometry and Vision Science.

She is a recent 2023 graduate and is passionate about pediatrics and vision therapy.


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Dr. Trevor Miranda describes his multi-practice location on Vancouver Island with UW ’95 classmate, Eyes Wide Open host, Dr. Glen Chiasson. In particular, Dr. Miranda stresses the importance of having great products that are “Channel-protected” for optometry in building a Dry Eye Sub-specialty

About the Guest

Dr. Trevor Miranda graduated from the University of Waterloo in 1995. He is a private practice optometrist and partner at Cowichan Eyecare, five full-scope optometric practices on Vancouver Island which offer Dry Eye, Low Vision, Myopia Management and Vision Therapy specialties. Trevor is a past CEO of Eye Recommend and founder of Sunglass Cove. He is a co-founder of MyDryEye and the Dry Eye Summit; he is dedicated to dry eye treatment and has co-launched My Dry Eye, a Canada-wide network of optometrists who have a special interest in treating dry eye. In his spare time, Trevor enjoys playing hockey, soccer and golf, and being a Rotarian.

Episode Notes

Dr. Trevor Miranda describes his five-location practice (Cowhican Eyecare) with nine eye docs on Vancouver Island.  He discusses how sub-specialities including vision therapy, myopia management and dry eye have been incorporated into the DNA of their independent practice. Two locations have dedicated dry eye clinics.

Dr. Miranda reveals the clinical approaches and practice protocol the group has deployed in order to generate a significant revenue stream from dry eye. He also delves into importance of team culture and staff training in delivering clinical excellence and practice efficiency.

Dr. Miranda stresses the importance of the dry eye technicians in their practice. This allows him to run a full state of primary eye exams while the practice delivers clinical excellence in dry eye.

Omni-channel e-commerce and custom communications plays a very important role in the practice.  Dr. Miranda advocates Optometry channel-protected products like the new preservative-free eye drop entrant into the Canadian market, Dry Eye Relief products (Aequus Eye Care). Aequus is supporting optometry with excellent and well trained representatives, a fact that Dr. Miranda appreciates.



Dr. Glen Chiasson

Dr. Glen Chiasson

Dr. Glen Chiasson is a 1995 graduate of the University of Waterloo School of Optometry. He owns and manages two practices in Toronto. In 2009, he co-hosted a podcast produced for colleagues in eye care, the “International Optometry Podcast”. He is a moderator of the Canadian Optometry Group, an email forum for Canadian optometrists. As  a host of  “Eyes Wide Open”, Glenn  looks forward to exploring new new technologies and services for eye care professionals.

Dr. Chiasson enjoys tennis, hockey, and reading. He lives in Toronto with his wife and two sons.

Dr. Chiasson splits EWO podcast hosting duties with Roxanne Arnal.


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Artificial intelligence is a branch of computer science that uses various techniques that aim to mirror human intelligence. One AI technique is machine learning, which relies on vast data sets to learn and predict results without human intervention.

Artificial intelligence has slowly made its way to optometry as well. It is unlikely that AI will ever replace an optometrist but it does have the potential to ease many aspects of their jobs.

This doesn’t mean that robots will be running around in our healthcare facilities; rather, AI focuses on a large amount of patient data to give insight into diagnosis and treatment methods.

Let’s look at how it has the potential to change an optometrist’s practice.

Streamline Management
Software is coming to the market that provides autonomous management of tasks related to patients. Repetitive tasks like scheduling, billing, and follow-ups can be done on the fly and updated in patient records as new information is received.

This improves organizational productivity for many optometry practices, making them more efficient leaving more time to focus on patient care.

Early Detection
One of AI’s advantages is that it can process vast amounts of data more quickly as a computer is doing most of the legwork.

This especially comes in handy when processing optical coherence tomography (OCT) images, retinal images and dry eye. It can look for patterns within these images that optometrists might miss because of the subjective nature by which these images are analyzed.

Diabetic Retinopathy
Machine learning can monitor these images over time and see if any changes are occurring that lead to eye diseases that manifest progressively.

FDA-approved AI systems are already appearing on the market that analyze fundus photography to detect elements of diabetic retinopathy such as hemorrhages, aneurysms, and other lesions.

It can detect these changes early on, leading optometrists to formulate a health plan with the patient. Additionally, this system requires minimal training and can outperform humans.

Technology to detect other ocular diseases such as glaucoma by fundus photographs, optical coherence tomography (OCT), and visual fields is currently in its early stages.

AI is beneficial for open-angle glaucoma cases where symptoms don’t typically exhibit themselves. Since glaucoma can’t be cured, early detection may help manage the disease to prevent it from getting worse to the point of severe vision loss or blindness.

Dry Eye
There is also new AI technology emerging  in the dry eye arena.

When it comes to talking to patients about their dry eye disease, a picture is worth a thousand words. Conversations become easier when you can show a patient an image of their ocular surface. Suddenly it all clicks (pun intended).

AOS is one company that takes it a step further with innovative technology. The platform automatically grades an image for Bulbar Redness, Injection and Lid Redness. In Staining mode the software counts punctate of a fluorescein image. It can also convert a fluorescein image into 2D and 3D which brings a real wow factor.

The images show patients proof of their condition and the analysis provides context. It’s much like the difference between stating a fact and telling a story.

We can now give meaning to symptoms felt and seen in the eye. And it’s especially useful for assessing progress during follow up appointments. Lower redness numbers or lower punctate counts tell me and the patient we are on the right track.

AOS analysis improves patient education which helps boost compliance. Better compliance leads to better outcomes and that leads to happy, loyal patients.

Reduce False Positives
False positives occur when a test result shows that a disease is present when it is not in reality. Here AI can help as well.

By looking at vast amounts of medical data regarding symptoms that a patient presents, AI can predict the likelihood of a disease or condition being present.

As a result, patients can save time by avoiding unnecessary consultations with their optometrist or an ophthalmologist and save money on unnecessary medications.

In Optometry and Beyond
Artificial intelligence is showing its potential in many medical fields other than optometry, including oncology, dermatology, pharmacology, and genetics.

Though still in its infancy, improvements in this technology will help doctors verify their diagnoses and interpret data faster independently.

This does not mean that a doctor’s work will become redundant, as AI algorithms are not yet 100% accurate. There will cases when a doctor’s insight will be invaluable in diagnosing diseases.

Consider AI a tool to benefit the health care provider and the patient.


is the founder of Corporate Optometry, a peer-to-peer web resource for ODs interested to learn more about opportunities in corporate optometry. Canadian ODs and optometry students can visit to learn more.


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Dr. Steven D’Orio, practicing in partnership his father Dr. Greg D’Orio, shares his approach on incorporating a dry eye specialty within the practice.

About the Guest

Dr. Steven D’Orio first became interested in the field of Optometry during high school. This led him to take greater interest and involvement into his father’s practice. D’Orio graduated from Salus University School of Optometry in Pennsylvania, and experienced first-hand working in primary care and triaging ocular emergencies in Albert Einstein Hospital, low vision at The Eye Institute, and trained further in contact lenses and ocular disease at Will’s Eye Hospital. Dr. D’Orio has taken special interest in Dry Eye, incorporating the latest equipment and treatment options to meet his patients’ needs.


Episode Notes

Dr. Steven D’Orio explains his motivation to incorporate a dry eye specialty in his Toronto practice. He indicates his preferred approaches to diagnosis tools and which therapeutic options and treatments he deploys. The impact of COVID on dry eye is also discussed.

He and Glen share their points of view on how industry representatives can and have truly added value to their practices, and how staff can be optimally deployed to benefit the patient experience.

Finally, Dr. D’Orio shares what he sees as exciting new dry eye therapeutic options on the near-term horizon, but not before he and Glen debate the intricacies of Philly Cheese Steaks, an indulgence they both enjoyed while interning in the City of Brotherly Love.



Dr. Glen Chiasson

Dr. Glen Chiasson

Dr. Glen Chiasson is a 1995 graduate of the University of Waterloo School of Optometry. He owns and manages two practices in Toronto. In 2009, he co-hosted a podcast produced for colleagues in eye care, the “International Optometry Podcast”. He is a moderator of the Canadian Optometry Group, an email forum for Canadian optometrists. As  a host of  “Eyes Wide Open”, Glenn  looks forward to exploring new new technologies and services for eye care professionals.

Dr. Chiasson enjoys tennis, hockey, and reading. He lives in Toronto with his wife and two sons.

Dr. Chiasson splits EWO podcast hosting duties with Roxanne Arnal.


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The first annual Canadian Dry Eye Summit (CDES) was held on May 25 -26th, 2018 at the Hotel Novotel in Mississauga Ontario. The sold out event brought together over 160 attendees, faculty and industry for two days to learn, share and experience all that is new in the dry eye space. The CDES was born with a singular mission: To ensure patients across Canada receive outstanding, compassionate care for their ocular surface based on the evidence of the day. This two day session certainly went a long way towards that mission.

Dr. Laura Periman demonstrating IPL

Chief Learning officer, Dr. Richard Maharaj brought together over 14 experts from across North America to share their knowledge and experience in the dry eye space. Over 10 hours of COPE approved CE was provided covering topics such as:

  • The role of inflammation in DED
  • Highlights of TFOS DEWS II
  • Dry Eye as a vision disease
  • Scleral Lenses in the treatment of DED
  • Introducing a dry eye practice into a busy clinic
  • Marketing your medical niche

Dr. Trevor Miranda receiving a Lipiflow Treatment

The CDES also brought together the industries best technology and products under one roof. This offered attendees the opportunity to see the latest technology in diagnosis and treatment and get a glimpse of what is coming down the road. A unique feature of this years summit were the hands on workshops where folks could try out technologies such as Lipiflow, IPL, Blephex, Tear Osmolarity and many more.




Dr. Art Epstein

A quote from one of the speakers, Dr. Art Epstein, OD, FAAO sums up the event quite nicely:

“What I especially liked about the Summit was that it offered a well thought-out and balanced mix of clinically focused lectures combined with hands on wet labs and dry eye demonstrations. The presenters included a notable cast of US and Canadian dry eye experts, and the audience was warm, friendly and receptive.”




Planning is already in the works for 2019, visit and get on the mailing list for next years event.






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One of the key metrics we track in SIMI Analytics is Revenue Breakdown. What products and services are bringing in the most revenue? We compare this to how much time is spent to offer these products and services on the exams side to evaluate the effectiveness of the time invested.

According to SIMI Analytics, a healthy primary care practice brings in 26% of their revenue from exams, diagnostics contribute 10%, spectacles 50%, contact lenses 12% and miscellaneous (OTC products and optical accessories) 2%.

Detailed Breakdown

We often break this down further to look at how much chair time is being dedicated to services as compared to products. For instance, we always evaluate the revenue generated from contact lens assessments in comparison to how much revenue is being generated from contact lenses (both gross and net dollars). As contact lenses have become a commodity, it has become even more important to the financial health of the practice to ensure that the chair time associated with the care of contact lenses is covered.

A number of practices we work with have successfully introduced Specialty Contact Lenses, Vision Therapy, and Dry Eye Clinics as a means to both meet patient needs and increase revenue. In these practices, the Revenue Breakdown in SIMI Analytics looks a little different.

Here’s how you can expect to generate your revenue:

Impact on Staffing Decisions

Note in particular how primary care practices are much more dependent on optical sales for financial health. A practice offering Vision Therapy generates a much greater percentage of their revenue from the services of Vision Therapy versus selling frames and lenses. From this information, the practice can make more sound business decisions. For instance, if your practice is predominantly offering Vision Therapy as the main means of revenue, our recommendation would be to hire a frame stylist for the optical instead of an optician and concentrate your staff cost resources on hiring skilled and passionate therapists for Vision Therapy.

For practices offering medical contact lenses, such as Ortho-K and Scleral lenses, the differences to note are the increased revenue sources from both Exams and Contact Lenses. In this case, the products are much more profitable and it makes sense to expect more revenue from this source as compared to Eyeglass Revenue. Another metric we like to follow in our Contact Lens clinics is sunglass sales. Our expectation is that the revenue from plano sunglasses should be significantly higher. Again, staff decisions will be impacted by this information. Not only do you want to hire someone who is knowledgeable in contact lens care to assist your patients but you will want that person to also be passionate about sun protection. There is also an implication to your inventory decisions. This practice will carry a large selection of plano sunglasses.

The most interesting change in revenue generation for a Dry Eye clinic, besides the increased Exam revenue, is the increase in sales of OTC products. Drops, vitamins, wipes and make-up all contribute to increased revenue in this type of clinic. Given this, it is our recommendation to hire a dedicated staff member to be your Dry Eye Clinic coordinator. This is the person who will confidently explain all the products and solutions to each patient and follow through with after-care instructions.

Whether you choose to differentiate or remain focused on Primary Care, the key to success is to decide on one and stay focused. Keep track of the time it takes you to generate your income and use that information when making decisions about changing or adding extra staff, services, and products.



is the co-founder and managing partner of Simple Innovative Management Ideas (SIMI) Inc. and expert Practice Management contributor for Optik magazine. She can be reached at


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Our aging population, along with the heavy use of digital devices and dry environments of work and living, mean more cases of dry eye. Creating a practice specialty–a dry eye center–as our practice has done, enables you to capture the opportunity to treat these patients, and keep them in your practice with services that address their needs.

I practice in a shared OD-MD practice with two ODs, including myself, and three MDs, and we seethousands of patients a year who experience dry eye.

The MDs and ODs typically share the same patients. Some cases are easily managed with lid hygiene and palliative care. More difficult dry eye cases are managed by the ODs through our dry eye center, which we call the Advanced Tear Analysis (ATA) clinic.

Our clinic is about 10,000 square feet. The exam room for ATA is about 100 square feet, so it does not require much space. The only thing that separates it from the other rooms is the addition of a LipiFlow machine.

The ATA exam can be used for any dry eye patients. However, the process is very thorough. Some cases of dry eye may not require the extensive testing. Patients who do not improve with treatment after one office visit will be referred to the ATA clinic, which is the minority of the patient population.
Each half-day may average from 9-13 post-operative and acute care patients. The ATA clinic will schedule only up to two additional patients for a half-day. Due to scheduling and post-operative care demands for time slots, the ATA schedules patients on two half-days a week. The exams can range from 45 minutes to an hour. We may see four ATA exams a week per OD. These exams take longer, but are 50 percent more profitable than a traditional office visit.


As the volume of dry eye patients grows, the OD can serve an unmet need. The OD can treat most cases of dry eye. For severe cases, the MD can do surgical procedures such as tarsorrhaphy, gold or platinum weighted eyelid implants, intraductal probing and punctal cautery.


The ATA exam represents the new exam that is dedicated to the diagnosis, management and treatment for the more difficult cases of dry eye. The patient must have had an initial comprehensive examination beforehand either at the practice, or at another practice. ATA exams share clinic space with post-operative exams and walk-in patients.

Comprehensive exams have their own set of rooms as these exams typically take the longest amount of time. The initial dry eye, or ATA, exams are held on two half-days a week for the initial testing and evaluation. Re-checks typically take less time, and can be scheduled throughout the week if necessary. LipiView II (TearScience) imaging is done on all patients, and the machine is centrally located near other pre-testing equipment. The exam room with the LipiFlow is reserved for the ATA clinic during scheduled treatments or possible treatments.

The Advanced Tear Analysis center at Durrie Vision. Having a specialized place, protocol and instrumentation for dry eye analysis and treatment.enables the practice tocare for a growing population of dry-eye patients.

There are many opportunities for managing dry eye in a refractive surgery practice, even if it is only during post-operative healing. Some post-operative patients need extra help with dryness. The majority of my exams are geared toward treating the ocular surface. Treating the ocular surface in general creates better surgical candidates, leads to improved visual outcomes and increases patient satisfaction.


The prevalence of dry eye is estimated to be as high as 30 percent in some larger population studies for adults over age 50, with women suffering in greater numbers than men. Medications contribute to dryness. Environment and climate can also exacerbate dryness.

An unfortunate, newer trend of dry eye is that we now see younger patients in our practices. A less nutritious diet as compared to previous generations, increased electronic device screen time and contact lens overwear contribute to a poor tear film.

Dry eye is complex and multi-factorial. It is only getting worse, and the patients are increasing. Effectively managing dry eye is one of the greatest challenges in eyecare. Many patients who suffer from dryness struggle with vision, comfort, as well as quality of life. To ease the suffering of one of these patients is a rewarding experience. —Suzanne LaKamp, OD, FAAO


All dry eye patients need comprehensive exams. The following dry eye exam services incorporate additional testing for the ocular surface, that could not have otherwise been performed at the comprehensive exam.

The ATA patients get entrance testing with repeat retractions. The technician will then take the patient through HD analyzer imaging. The imaging is helpful in looking at image scatter from either problems with tear film or changes to the natural lens. It is a non-invasive test. Patients may get LipiView imaging if not already done at a previous exam. The patients all take the SPEED questionnaire.

At initial or subsequent visits, there may be various types of staining, tear break-up time, inspection for lid abnormalities, and Schirmer’s testing with anesthetic. A slit-lamp exam with meibomian gland functional testing is performed using either the Korb evaluator or with a cotton-tip applicator. There is no additional cost to providing questionnaires or a slit-lamp exam, other than chair time. LipiView and other equipment can be costly to a practice, and need to fit the practice budget. Dry eye exams services can help recover this cost, as well as performing LipiFlow.

Palliative treatments include a wide array of artificial tears (not sold in office) and punctal plugs. Specific artificial tears are recommended (Systane Balance and Retiane MGD are common), and samples are given. Our practice does temporary and permanent plugs. Plugs are a billable service for patients with insurance. Reimbursement for permanent plugs is typically good.

There are pharmaceutical options for treating dry eye. Patients are sometimes prescribed Restasis for tear film insufficiency. We have a new product, Xiidra, which is a promising treatment. More treatment options can lead to increased success. Corticosteroids and Doxycycline are prescribed for dry eye patients who experience a lot of inflammation, but carry a degree of risk with side effects. Many patients are now being treated with Omega 3 supplements or fish oil. We typically recommend higher quality brands such as PRN Omega Dry Eye formula or Nordic Naturals. Supplements can be sold in office, but we do not currently carry them.

Any patients with severe dry eye, such an non-healing epithelium or exposure, would be referred out of our practice. These cases could include surgical intervention, scleral lens fits, serum tears or amniotic membranes.


For managing meibomian gland dysfunction-related dry eye, therapeutic treatments include LipiFlow and BlephEx. We recommend all patients with meibomian gland dysfunction perform lid hygiene and warm, moist compresses for at-home maintenance. We sell the Bruder eye mask. While there are many warming moist eye masks on the market, patients like the convenience of having the mask available in office. Depending on quantity purchased, the Bruder mask can cost the practice $8-$12.50 each. Recommended mark-up would be at least 50 percent or greater.

We also sell Avenova lid cleanser. Most pharmacies charge the patient an average of 3x more for Avenova than for what we sell. It is much more affordable to get the product at our practice. The products are available at the check-out, where the patient will also schedule any following appointments. The warming eye masks and Avenova have been instrumental in helping our dry eye patients, as the majority have meibomian gland disease.


While all of the doctors at my current practice manage dry eye disease, the OD plays a larger role. The MDs spend more clinic time performing comprehensive examinations on surgical candidates, which is the largest revenue generator in the clinic. The OD sees a variety of patients including pre- and post-operative surgical care, acute care and patients for dry eye management.

Some of the dry eye patients include acute, resolving post-surgical dryness. There are also patients with chronic dryness for years without a history of surgery. The ATA clinic exams are performed exclusively by the ODs.


Most dry eye is evaporative, and some of the newer technologies work to improve meibomian gland dysfunction. The most valuable imaging equipment in diagnosing meibomian gland disease is the LipiView II. It is also one of best resources for educating our patients. For patients who suffer from meibomian gland disease, the LipiFlow is a great tool to have in clinic. LipiView and LipiFlow are essential to any dry eye clinic. While cost was previously a big hurdle for patient and practice alike, a recent decrease in activator pricing for the LipiFlow improves accessibility. More clinics will likely purchase the equipment, and hopefully the number of patients who get treatment will increase.

For patients with plaques along the lid margins, lid debridement is an effective procedure in restoring meibomian gland function. A golf club spud can be used in office, as well as the BlephEx.

Practices typically purchase the LipiView/LipiFlow and the BlephEx equipment. Length of time to profit varies per practice, and depends on what each practice charges for treatment. A typical yearly budget may require four LipiFlow treatments a month and 24 BlephEx treatments a month to be profitable.

As a cash-pay practice, we are fortunate to perform whatever testing we feel is best for the patient without concern for the varying insurer reimbursement policies. The testing aids in diagnosis and patient education. The patients are very receptive to testing. We charge for treatments such as BlephEx, LipiFlow, and punctal plugs. We also charge for products sold in-office such as the Bruder compress and Avenova. Each exam, including follow-ups, has a fee. We are reimbursed 100 percent for what we charge. For managed care patients, there is no current insurance coverage for meibomian gland dysfunction.


Dry eye services are marketed within the practice by word of mouth. The doctors will refer current and new patients to the ATA clinic if the dry eye patients need further testing and follow-up. Current plans involve integrating the ATA online link into the main web site. We have one that we can give out to patients, but is not yet accessible to the general public.

We developed a dry eye handout that is available in all exam rooms. The handout includes various treatments for dry eye. LipiFlow and BlephEx are some of the listed treatments. It is helpful to have a handout that advertises provided services, which the patient may elect to later choose if palliative therapy is not enough.

The dry eye clinic is not currently advertised on the web site, but will be in the near future. The services are relatively new, and were mainly developed as a way to better serve our current patients. The practice model is direct business-to-consumer. Within a few months of beginning the dry eye clinic, patients new to the practice are scheduling. This was surprising considering we have not actively advertised outside of the practice. There have also been a few referrals from outside practitioners. The addition of LipiFlow has been driving some of this outside business for the dry eye clinic. Word-of-mouth is also contributing to the increase in new patients.


Suzanne LaKamp, OD, FAAO, is an associate at Durrie Vision in Overland Park, Kan. To contact:


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