Nearly all business models, including optometry practices, utilize KPIs (key performance indicators) as the standard for gauging success. In the realm of practice management, this involves analyzing conversion rates, the number of exams per day, revenue per hour, and profit/loss margins. However, patient KPIs can also be applied to dry eye assessment and management.
As the clinical director of the Dry Eye Relief Center at Lusk Eye Specialist, Pamela E. Theriot, OD, FAAO, sees patients who have often suffered for years with discomfort and disappointment after seeing numerous doctors. She uses KPIs at each stage to educate patients, build compliance, and appraise treatment effectiveness.
Set the standard using straightforward scores
Both Dr. Dierker and Dr. Theirot begin their dry eye assessments by having patients fill out the Standard Patient Evaluation for Eye Dryness (SPEED) questionnaire.
In regard to symptom surveys, Dr. Theriot stated, “I prefer the SPEED. I always want to have one of those on board, so I have something to measure in the future. It is super easy for a patient to be able to answer the questions, and then a couple weeks or months later, reanswer those questions and know if there has been an improvement.”
By using the SPEED questionnaire as a key metric, during both the initial visit and follow-ups, patients can be reminded how intensely they were affected by dry eye symptoms prior to treatment and quantify improvement based on their own responses.
Additional dry eye diagnostic tools to use as KPIs
In addition to the SPEED questionnaire, one of Dr. Theriot’s diagnostic KPIs is the Schirmer test to measure tear production, as it can give patients a definitive score that can be re-measured to show an increased score subsequent to proper treatment.
According to Dr. Theriot, “With the Schirmer, we have numbers from the get-go. And patients really like to know their numbers. They like to know their blood pressure. They like to know their A1C. They like to know these numbers, as well, and they like to see their improvements.”
Both doctors also employ meibography, slit lamp examination, vital dye staining, and videography to visually demonstrate to patients the effect of the different dry eye factors on ocular surface damage. Dr. Dierker also utilizes tear osmolarity and matrix metalloproteinase-9 (MMP-9) testing.
Get goal-oriented
While freedom from discomfort is a universal aim, patients also have individual goals they hope to achieve through addressing their dry eye disease (DED). It is imperative to identify these goals and put forth a targeted treatment plan while also promoting realistic expectations.
Goal setting involves:
- Discovering the patient’s goals
- Determining if patient and provider goals align
- Explaining how the treatment plan is tailored to meet those goals
- Setting appropriate expectations
In the discovery phase, the patient conversation should involve an in-depth discussion of symptoms. Often, individuals don’t realize that some issues, such as fluctuating vision, could be tied to DED. Once the OD has a solid grasp of exactly what is going on, they can work toward solving these problems and elevating quality of life.
Addressing common goals for dry eye patients
Two of the goals Dr. Theriot’s patients often express are having the ability to spend more significant time in contact lenses and being able to wear eye makeup without negative ocular consequences. According to Dr. Theriot, “That's such a problem for some of my dry eye patients. Their eyes are so irritated they can no longer wear makeup.”
Though patients may not want to hear it, she also points out when makeup may be the culprit, such as in the case of wearing false lashes, glittery eyeshadow, or liner on top of the waterline. Even with her staff, she is a stickler for cosmetic hygiene.
She advises patients to “keep the tightlining for date night or a big event because it really is blocking your oil glands.” For lashes, if an individual simply refuses to have them removed, she offers pearls on how to keep them really clean to avoid repercussions.
In relation to goals, Dr Dierker also pointed out that the optometrist’s goals may differ from those of the patients and should be discussed upfront as well. In a surgical setting, these often involve repairing the ocular surface so that a procedure, such as cataract surgery or laser assisted in-situ keratomileusis (LASIK), can occur. He stressed the importance of instilling in patients the knowledge that the surface of their eyes must be as healthy as possible to achieve optimal surgical results.
Educate through email
To avoid information overload and overwhelming the patient on their initial visit, Dr. Theriot makes sure everything the patient needs to know is written down and made accessible on the day of the exam. She also distributes handouts outlining standard dry eye protocols. However, she feels that implementing an email sequence has been integral to her clinic’s success.
After the initial visit, she sends patients a series of emails; the first reiterates exactly what DED is, the next lists available medications, the third explains in-office treatments, and so on. This not only serves to educate but is often a springboard for questions during future visits.
These communications also provide a way to build rapport and inspire trust. At the end of each email, Dr. Theriot makes certain to include a personal tidbit, like the fact that she has a dog named Rosie. On their next visit, the patient will inquire about her dog and share stories about their own.
She stated, “Because patients are getting a touchpoint for me every week after they've seen me, it has built a lot of patient-doctor relations that I didn't have to spend time in the exam lane to develop. They feel like we have a much stronger personal connection. So, usually, by our second visit, I'm already getting hugs.”
In closing
By utilizing patient KPIs to assess DED severity and treatment success, optometrists can elevate care and engagement, which ultimately leads to better outcomes and greater patient satisfaction.
Having the doctor and the patient aligned with the goals makes achieving them easier.
