SCOT MORRIS, OD, FAAO
[email protected]
Scot Morris, O.D., F.A.A.O.
[email protected]
Business
Industry Consultant
Advisory Board Speaker Bureaus
Research
• Morris Education & Consulting Associates, LLC Senior Consultant/Owner • Ocular Technology Solutions, Inc. Lead Consultant/Founder • Allergan • Office Mate
• • • • • • • • • •
www.mecace.com
www.ots‐consultants.com
The Game Plan
Purpose Diagnostic Dilemmas Treatment Tips
Advanced Medical Optics Bausch & Lomb Com2 Industries Inspire Pharmaceuticals Odyssey Medical OPTOS Vision Service Plan Vistakon Vmax Vision Industries Zeiss
Practice Profits
• Inspire Pharmaceutical • AMO/VISX
The Game Plan
www.eyeconsultantsofco.com
Objective Explain a simple diagnostic protocol Teach a universal treatment protocol How to Proceed, Practice and profit with Dry Eye
The Game Plan
Issues The Learning formula ○ What do we not know? ○ What do we assume to know? ○ What do we not want to know? Th The realities liti off optometric t t i practice ti ○ Misinformation ○ Keeping Up ○ Too many options ○ Managed care
Did I miss anything?
1 1
The Game Plan
The Game Plan
Benefits
Actions Teach Diagnosis and treatment
○ ○ ○ ○ ○
ACT Be better Dr. Be more efficient ↑ revenue ↑ patient satisfaction
DON’T ACT Problems will get worse Patient issue will get worse Patients go elsewhere You lose money
Let’s Take A Poll
Always think about practice management
Dry Eye Syndrome One
of the Most Common Conditions One of the Most Mistreated/Undertreated How many patients per day do you see with dry eye symptoms? Who is the most likely to have dry eyes? What is the most effective treatment for dry eyes?
Diagnosis 1. 2. 3.
Tear Deficient Dry Eyes Evaporative Dry Eyes Surface Disorders
20 - 40% Of Patients Will Be Affected 59 Million Americans at Risk 89% Americans Have NOT Heard Of Dry Eye
Tear deficient 3. Neural Loop:
1. Lacrimal Glands: • Neurogenic/androgenic inflammation • T-cell activation • Cytokine secretion into tears
• Decreased neurosecretory Afferent signaling
Tears Inflame Ocular Surface 2. Ocular Surface Can there be only one
• Cytokines Disrupt • Cell function • Mucin production • Cellular apoptosis Stern et al. Cornea. 1998:17:584
2 2
What is Dry Eye: Really!! Continuum of severity ranges from mild to severe1 Chronic dry eye is the result of disease progression
1Pflugfelder.
Diagnosis Evaporative
2.
Lids Meibomian Gland Dysfunction
Am J Ophthalmol. 2004.
Diagnosis Surface disease
3.
Lid Margin
○ ○
Palpebral conjunctiva Ocular Surface
○ ○ ○
Diagnosis Symptoms 2. Signs 3. Protocol 1.
Inflammation Infection
Innervation Microvilli Mucin
Symptoms of Dry Eye Dry Eye Severity Level
1
2
3
4
General Symptoms
Mild Symptoms
Moderate Symptoms
Severe Symptoms
Severe Symptoms
Symptoms: Itchy, Sandy, Gritty, Gritty Dry
Never to Seldom
Sometimes
q Frequent
y Always
Discomfort: Stinging, Burning, Pain
No
Yes
Yes
Yes
Vision: Blurring, Interrupted
No
No
Sometimes
Usually
Less than 2X per day
Several times per day
Several times per day
Several times per day
Use of Artificial Tears
McDonnell et al. ARVO. 2004.
3 3
Signs of Dry Eye Dry Eye Severity Level
Diagnosis
1
2
3
4
General Symptoms
Mild Symptoms
Moderate Symptoms
Severe Symptoms
Severe Symptoms
Diagnosis Conjunctival Staining
Mild
Moderate
Marked
Scarring
Mild punctate
Marked punctate central t l
Severe punctate erosions i
Corneal Staining Tear Film
Symptoms Signs 3. Protocol 1.
1.
2.
2. 4. 5 5.
Visual signs
6. 7.
Filamentary keratitis
Other
3.
8. 9.
Example Staining Tear Film Breakup Time
< 12
>2
