Alana Keller, OD works at Clarkson Eyecare in Wildwood, Missouri as a primary care provider.
“I don't work in a strictly surgical practice and I don't work in just a dry eye clinic,” Dr. Keller said. “I'm simply an optometrist who saw a growing problem with dry eye and found a way to treat my patients more effectively — and that has included providing over 600 treatments using the TearCare® system.”
Referring to dry eye disease (DED) as “the most underdiagnosed and undertreated disease in optometry today,” Dr. Keller said she believes that trend can be reversed if eyecare providers are equipped with the right tools and take the initiative to identify patients with DED and treat them appropriately.
“Studies indicate that about one third of our patients have dry eye disease or symptoms related to it,” she added. “I would say that number is quite low.”
Dr. Keller also noted that since 86% of dry eye cases also have obstructive meibomian gland dysfunction (MGD), the treatment should include “unclogging those glands.”
To help achieve that, she said she chose the TearCare system because it’s affordable and uses manual customized expression.
What is the TearCare System?
The TearCare System is intended for the application of localized heat therapy in adult patients with evaporative DED due to meibomian gland dysfunction (MGD), when used in conjunction with manual expression of the meibomian glands.
The TearCare System includes SmartLids™ that provide a universal fit; precise, consistent and intelligent heat; and a natural blink design—as well as a portable SmartHub™ that enables sensor-driven feedback designed to deliver safe and consistent heat.
SmartLids
- Optimal targeted heat 41-45°C for 15 minutes
- Open-eye design for natural blinking
- Universal fit
SmartHub
- Highly portable
- Brainpower behind consistent heat
- Monitors temperature 240x per second
Referencing the targeted heat and amount of time it’s applied, Dr. Keller said, “That's the ideal time and temperature you want to melt that meibum.”
She said she also likes the fact that the TearCare system is highly portable—and that a clearance assistant device is provided that enables precise gland targeting expression where some other devices don’t allow for patient customization.
“Manual expression is key, because as you know, there's not a one-size-fits-all with the eyes,” Dr. Keller explained. “There will be some stubborn areas that will require more attention to completely drain them.”
She also likes how the SmartLids conform to the eyelid anatomy and allow a patient to blink normally. Since they conform to the outside of the lids only, there isn’t a patient type or anatomy they won’t fit.
“This is beneficial because it takes advantage of the body's natural mechanism of expressing that meibum through blinking, and it doesn't interrupt their day,” Dr. Keller said. “So, a patient can still be on their computer or work if they need to.”
Saying that the TearCare System is “one of the most studied MGD devices,” Dr. Keller noted that there are currently six peer-reviewed published papers out “and counting.”
Why choose TearCare?
Dr. Keller said several factors influenced her decision to choose the TearCare system for her practice, including the fact that it is:
- Cost efficient
- Space efficient
- Supported by extensive research
- Clinically effective
“I knew it worked due to the studies that have been published,” she said. “But I also saw impressive results in my own clinic.”
Dr. Keller said her first patient who received treatment using the TearCare system reported such improvement in her vision that she didn’t think she needed to wear contact lenses anymore — and the second patient who was treated with it reported similar results.
“I continued to see patients like that, which was really a big eye-opener for me,” she explained. “We often hear about fluctuating vision with dry eye, but it's not really discussed when patients have that constant blur. They may come in asking for a new prescription for their glasses, but the cause is really just dry eye.”
Dr. Keller also emphasized that the TearCare system is user-friendly.
“It's very easy for our staff to use,” she said. “Honestly, it doesn’t require a lot of training, and it doesn’t require but 5 minutes of your clinic time.”
The fundamentals of addressing DED
When it comes to addressing DED, Dr. Keller underscored the importance of having the fundamentals in place: Identify and diagnose, educate and treat.
Identify and diagnose
Dr. Keller said patients who are potential candidates for DED include those who are:
- Symptomatic
- Device users with heavy screen time
- Contact lens users
- Perioperative
To screen for DED in such patients, she recommended starting with the SPEED questionnaire or another dry eye questionnaire.
“I personally like the SPEED questionnaire because it incorporates a few extra symptoms that the others don't include that I usually see with dry eye patients,” Dr. Keller explained, also noting how important it is to have the results as a baseline measurement.
“I use it for re-treatments or follow-ups,” she said. “I especially like to show a patient their score to demonstrate how much it's improved. Plus, if a patient skips a treatment, we can give them the SPEED questionnaire to see how they’re doing. If the numbers are creeping back up, they’re usually on board with receiving another treatment.”
The patient’s exam is also key to identifying DED, during which time it’s important to pay attention to tear breakup time and/or the gland structure and function.
“For function, you're just going to use the cheap, easy tool of your finger,” Dr. Keller said. “If you press on the lower nasal glands, you can assess the quality of the meibum and see what the function is. Although having a meibographer is helpful, it's not essential to provide these treatments.”
She also emphasized the importance of using a patient education script.
“That way, you and your staff can feel confident about any of these fundamentals,” she explained. “The more you present it, the more confident and comfortable you are. It just gets easier with time.”
How to educate and treat patients with the TearCare system
When it comes to educating and treating, Dr. Keller said using a patient education script is key here, too. Along with the script, she said she likes to use the visuals and handouts provided with the TearCare system and has them in all of her exam lanes to educate patients. Since she uses the TearCare system, this is the treatment she recommends to clear any obstructions.
She noted that while some patients will be agreeable to starting treatment, others may not. In such instances, she said it’s important to not be discouraged by the “no’s.”
“You’re planting the seed,” Dr. Keller said. “Patients are going to go home and start thinking about it and how their symptoms are affecting them. It’s not uncommon for them to come back the next year and ask for treatment. Since MGD is a chronic progressive condition, I never feel like I’m wasting my time educating a patient.”
The top 10 tips for using the TearCare system
Dr. Keller also provided a list of ten essentials needed to be successful with TearCare, noting that they also apply to the use of any thermal expression device:
- Understand it’s a mindset: DED is massively prevalent. Disqualify the patient as not having dry eye vs. looking for it.
- Create a process that flows well and starts with the collection of a DED questionnaire and one DED sign (TBUT, MGSS, etc.).
- Set the scorecard: Not every treatment results in a WOW moment. Track and measure improvements (this is why #2 is so important).
- Use an education script for the patient: Get confident in your words. Keep it short and sweet and DON’T over-educate.
- Educate the staff. Explain why the TearCare system was purchased and let them experience it.
- Have your not-covered-by-insurance script and examples ready, if needed (hearing aids, LASIK, orthodontist, etc.).
- Lead with scheduling same-day procedures. Period.
- Understand that a provider’s manual expression technique is tied to efficacy. Elevate your skillset (TEaM, DocMatter, resource videos, etc. which are all services provided by TearCare).
- Emphasize the importance of any post-procedure recommendations.
- Test and learn! Try. Fail. Try again. Fail again. Fail better.
Dr. Keller also noted that focusing too much on the cost to the patient is a common obstacle she sees among providers.
“We're not like that with glasses or contacts,” she said. “You just want to go in and identify a disease and then present the best treatment options regardless of cost.”
Dr. Keller added that viewing the concerning meibography results for some young children has fueled her passion.
“You can't help but do everything you can to preserve those glands and ultimately their vision,” she explained. “So don't judge a patient by what you think they can afford. I've done this for a number of Medicaid patients. What's the one thing they say they can't live without? Their vision.”
Noting that she’s still “tweaking things” she’s learned from her own experience, Dr. Keller said she really likes a quote she recently heard from Dr. Steve Vargo: "Comfort is the enemy to change."
“It's easy to just do things we're used to. But when I really identify, diagnose, educate, and treat with a system like TearCare, I feel like I've elevated my level of care and have found my job to be a lot more rewarding,” she explained. “So remember, don't let getting a no from one patient stop you from offering it to other patients who need it. And then celebrate the short-term achievements and set yourself up for some long-term goals that are achievable.”
