By: Paul M. Karpecki, OD, FAAO Clinical Director – PECAA

Adding an area of focus to your practice allows you to stand out for patients in need. The latest and fastest growing area is that of a Dry Eye specialty clinic, but doctors have been doing this for years with practices that provide specialty contact lenses, vision therapy, low vision etc.  But I also believe there are more great opportunities now and in the future.

What it Brings to Your Practice

First and foremost it brings enjoyment to practice. I mean you wouldn’t ‘specialize’ in an area such as vision therapy, low vision, dry eye or others if you didn’t have a passion for the patients and the subject matter. We spend more time at work than almost any other role, so why wouldn’t we want to maximize our enjoyment of it? There is an old saying of finding work you enjoy and you never work a day in your life. It also brings in notoriety and recognition from patients. In this day of information on demand and social media, patients are taking more responsibility for their health. They are looking on the internet for doctors that can help their condition and who ‘specialize’ in the field. Finally you’re likely to see practice growth and success as your practice expands in all areas beyond the specialty as dry eye patients for example may have glaucoma, cataracts, contact lens wearing issues etc.

Newest Options

It seem like dry eye centers are popping up everywhere and 90%+ are run by an optometrist. In the US, there are 30-50 million people estimated to have DED but only about 1.5M are currently being treated with therapeutics. (Ref D. Steinberg et al. Equity Research Americas, May 18, 2017: 1-38).  Plus we are at a stage where we can help these patients dramatically. This wasn’t the case 15 years ago. Today we have drugs available to treat dry eye (lifitegrast and cyclosporine), ester-based corticosteroids for SPK and dry eye flare ups, treatments for obstructed meibomian glands including two mechanical procedures (LipiFlow, iLux and TearCare likely soon) as well as lid debridement, IPL and hydrating compresses that maintain optimal heat for up to 10 minutes after just 20 seconds in the microwave. For the biofilm that forms in almost all forms of dry eye disease we have blepharoexfoliaton or Blephex and newer lid scrubs. Finally we have more new an advanced artificial tears than any time in the past that can alleviate symptoms between therapeutic dosing. Other advances include 180 day dissolving punctal plugs and effective omega fatty acids with GLA/EPA/DHA. What a great time to focus a practice on ocular surface disease — if you can sort out the options and we’ll feature a segment on that next month.

Where the Opportunities Are:

Age related macular degeneration (AMD) is very similar to dry eye, likely to double in the next decade or two and worth consideration. Like dry eye there are tools for early diagnosis (osmolarity for dry eye and dark adaptometry for AMD),  better imagining (meibography for dry eye and OCT for AMD), better monitoring technology (ForeSeeHome) and even multiple treatment options such as nutritional supplements with effective carotenoids including, lutein, zeaxanthine and meso-zeaxanthine and AREDS formulations for intermediate AMD, spectacle lenses that block high energy visible light, and even intraocular implants for advanced AMD like the implantable miniature telescope. Then don’t forget the low vision specialists for these advanced patients and anti-VEGF for wet AMD.  Or consider getting involved in the newest technology, augmented reality, for AMD patients. Adaptec, a small company, created a pair of glasses that allows patient with a central scotoma, as in most cases of AMD, to have the central image placed outside the fovea. Patients in trials had very significant vision gains.

Diabetic retinopathy could benefit from specialty doctors who can better communicate among the professions (endocrinologists, PCPs and retina specialists to name a few), monitor the patient appropriately and with proper timely referrals should proliferative diabetic retinopathy signs or DME be noted. Then there is glaucoma, more advances for VT such as Neurolens technology (eyeBrain Inc.) that is helping patients with TBI and further lending support to the importance of eye misalignment leading to trigeminal dysphoria. There are other areas including functional medicine in great need of experts and many other fields related to what we do as optometrists.

If you select an area to focus on, you have to become the expert in that field. You should take the time to be educated extensively in that area, visit doctors who have achieved this, work with a retina group if you want to focus on patients with diabetic retinopathy for example, join societies specific to that area of focus and gain extensive experience.  Pretty much any area of eye care with a substantial need, can be chosen to focus on and differentiate your practice, enhance your joy in coming to work each day and help numerous patients in need of someone dedicating their time, education and knowledge to their condition.

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