Published in Non-Clinical
OSD Mentorship Heaps Rewards on Both Sides
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Mentorship can speed new ophthalmologists through the complex world of ocular surface disease, advancing the field and boosting patient access to care.
When it comes to treating ocular surface disease (OSD), most doctors don’t leave residency ready to identify problems, follow a treatment paradigm, and build a practice model that supports top-level treatment for patients who suffer from this ubiquitous problem.
You can learn a lot from the literature and get inspired at a professional meeting. But who answers your questions when they arise? Who builds your confidence? Who helps you choose when to buy new technology and when to hold off?
A mentor can do all of those things, and it’s easy to get started. We hope our mentorship experience encourages you to give it a try and elevate OSD treatment for your patients.
I love being a mentor. I have fun sharing my nontraditional career, my passion for clinical research and clinical management of OSD, and my collective success with patients, but most important is the ripple effect. The more doctors we have who deeply understand OSD and take an evidence-based approach, the more patients will benefit. And the number of OSD patients outnumbers cataract surgery 10:1.
I got hooked on helping patients unravel their OSD when I first started practicing in 2008, and 10 years later, I started a practice focused solely on OSD management. I’m still learning, doing clinical research, and applying new tools, and I’m beyond thrilled to share knowledge, exchange ideas, and mentor others.
Here’s why I hope more new doctors will think about getting a mentor in OSD:
There’s so much work and opportunity in OSD, with many patients asking for our guidance—there is more than enough to share within the community. We need all hands on deck! I think that’s why the OSD community is extraordinarily cooperative, open-minded, and idea-sharing. We all share our knowledge, tricks, tips, and pitfalls very generously.
There’s a culture of collegiality that fills me with belonging, meaning, and joy. For younger colleagues who see us having friends and a positive, supportive community to lean on, I think the OSD world is very inviting, and no one feels uneasy about approaching a potential mentor.
There’s a thread that joins the doctors who are interested in OSD. Perhaps it is a lifelong-learning, growth-mindset, intellectual curiosity, or a keen interest in problem-solving, but it really begins with paying attention to what we see in our patients and having a strong desire to meet their needs.
I have always had a hunger to learn and understand better, and I see those traits in the doctors I mentor. It’s incredibly satisfying for me to solve a mystery, as well as to do clinical research to stay on the cutting edge, offering patients early access to the next therapeutic.
Mentorship is all about the new doctor, so while we talk about the past when someone wants background context, we’re excited to share all the new ways we can diagnose and treat patients today. Now we have in-office therapies that serve as a cornerstone for jumpstarting improvement, as well as targeting contributors to OSD.
For example, OptiLight (Lumenis) light-based therapy is highly effective at getting control of inflammation, the underlying cause of dry eye disease due to meibomian gland dysfunction (MGD), reducing the Demodex burden on the face and eyelids, as well as addressing the rosacea component.1-3
The procedure-based approach is beautifully complementary to the pharmaceutical approach, which we’re excited to know may soon expand to include a game-changing eye drop to tackle Demodex in the eyelids and meibomian glands (TP-03, Tarsus).4 We continue to use all our tools, but a growing list of game-changing therapies like these will keep making it easier to identify the main culprits of OSD and address them in targeted, effective ways.
Hooray, we’ve gained a legion of incredibly novel pharmaceuticals, devices, therapeutics, and interventions! But how do you get started? It can be pretty overwhelming for new doctors, and capital purchasing decisions are tough.
We talk about which diagnostics and in-office therapies they need to get started, as well as how to do things like combine therapies, follow up on medical appointments long-term, and navigate insurance. Once doctors embrace the ongoing learning process, knowing the field is rich with innovation so they can expect good things to come, then OSD treatment becomes purposeful and directed rather than onerous, and they can implement it in their clinics.
As a mentor, it’s an incredible honor and privilege to meet young, energetic, amazing, smart doctors while becoming a touchstone and resource for them. That’s how I met Dr. Greider-Sideris, who has a strong dedication to OSD. I tell her and other young doctors that we’re all making this field better together. It’s wildly exciting to me to think of what the next generation of doctors will discover and implement and how they will enhance this field.
Figure 1 is a photograph of Dr. Periman and Dr. Greider-Sideris together.
Figure 1: Courtesy of authors.
As Dr. Periman says, OSD has come a long way. The dry eye clinics I experienced in residency focused on managing OSD due to tear deficiency with Schirmer’s tests, testing corneal and conjunctival staining, placing punctal plugs, prescribing cyclosporine (Cequa, Sun Pharma; Restasis, Allergan) and lifitegrast (Xiidra, Novartis); and hot compresses, lid hygiene, and occasional antibiotic therapy for evaporative dry eye secondary to MGD.
I left residency with a good, basic understanding of OSD but did not anticipate it being as large a part of my practice as it is now.
When I joined my first private practice out of training 3 years ago, I saw a lot of patients with primary complaints of redness, burning, discomfort, and crusting in the morning, despite many of them having taken immunomodulators and using frequent artificial tears for years. These patients were often extremely frustrated by years of symptoms without relief and were desperate for alternative and more successful treatment.
I found that these patients’ symptoms were often more attributable to MGD and Demodex-associated blepharitis than tear deficiency, so my primary treatment for OSD shifted away from tear supplementation and immunomodulators and towards blepharitis management.
In my professional opinion, conventional blepharitis treatment is not very effective, relies too heavily on patient compliance, and there has not been enough focus on how to provide newer and more effective treatment modalities. Dr. Periman is the pioneer that has brought attention to the importance of treating MGD and Demodex blepharitis and has brought incredibly impactful scientific and technological advances to our field.
When I realized that this could best be done by learning how to manage OSD effectively, I, of course, reached out to Dr. Periman and am so happy I did. Under her mentorship, I’ve been able to help so many patients that I would not have been able to if it were not for the advances she has made in the field. Her mentorship has also helped me grow my business more rapidly than I expected in my early career. As Dr. Periman says, “good medicine is good business.”
Here’s what you need to know about OSD mentorship:
I’m in a private ophthalmology Facebook group with Dr. Periman, and I follow her on Instagram (@DryEyeMaster), so I started talking to her through social media. I told her I had a large number of patients with blepharitis and MGD, and I was very interested in the treatment paradigm she had written about.
She was very willing to talk to me, answer my questions, and offer support. Her goal is to improve OSD treatment for her patients and for everyone’s patients, which makes her a wonderful mentor. I think if we reach out to people who share our passion, we’re likely to get an answer. It’s a small community, with many folks who are accessible through social media and email.
Dr. Periman followed her passion for building a specialized practice, making primary and comprehensive care of OSD her main focus rather than addressing it as a secondary consideration, as in many practices. She’s shown that if you want to focus on OSD, it’s possible, and she achieved a great deal and became a global name in the process.
Her career matches some of my goals, and she’s incredibly inspiring to me. I was really interested not only in Dr. Periman’s treatment paradigms but also in the nuts and bolts of how she started small with low overhead, grew her patient base, and handled revenues in a sphere where many procedures aren’t covered. She generously shared her knowledge and experience.
Dr. Periman has answered questions, offered suggestions, and helped build up my confidence to move ahead in OSD treatment. I had read a lot of encouraging studies about Lumenis’ intense pulsed light technology, but it was a big capital investment at a time when I wasn’t sure about the future of my practice. I was blown away at how Dr. Periman had transformed dry eye management outcomes around using OptiLight.
When I made the leap to purchase the technology, Dr. Periman talked me through the straightforward implementation process. Treatment has been very successful, even with my patients who have failed other therapies, and it’s given me a practice differentiator. A year later, I’m so busy treating dry eye that my schedule is full. I also have had the joy of being able to provide relief to many patients who have suffered from dry eye disease from MGD for years, if not decades.
With Dr. Periman’s help, patients and referring doctors now seek me out for the treatment of blepharitis and OSD. I might have reached this goal without a mentor, but it would not have happened so quickly.
If like me, you didn’t learn everything you need to know about OSD treatment models in school or residency, and you want to elevate your level of care, a mentor can help. Once you start making connections and asking questions, you’ll be part of a very supportive community that’s dedicated to making a positive change for our patients.
- Toyos R, Desai NR, Toyos M, et al. Intense pulsed light improves signs and symptoms of dry eye disease due to meibomian gland dysfunction: A randomized controlled study. PLoS One. 2022;17(6):e0270268. doi:10.1371/journal.pone.0270268.
- Liu R, Rong B, Tu P, et al. Analysis of Cytokine Levels in Tears and Clinical Correlations After Intense Pulsed Light Treating Meibomian Gland Dysfunction. Am J Ophthalmol. 2017;183:81-90. doi.org/10.1016/j.ajo.2017.08.021.
- Sagaser S, Butterfield R, Kosiorek H, et al. Effects of Intense Pulsed Light on Tear Film TGF-β and Microbiome in Ocular Rosacea with Dry Eye. Clin Ophthalmol. 2021;15:323-330. doi.org/10.2147/OPTH.S280707.
- Tarsus Pharmaceuticals. Tarsus Submits New Drug Application to the FDA for TP-03 for the Treatment of Demodex Blepharitis. 2022. https://www.globenewswire.com/news-release/2022/09/07/2511308/0/en/Tarsus-Submits-New-Drug-Application-to-the-FDA-for-TP-03-for-the-Treatment-of-Demodex-Blepharitis.html.