Neena James, OD, is a planner. “I like lists and goals,” she says. So the COVID-19 pandemic has “thrown off my one-year and three-year goals” for 20/20 Eye Care, the Huntsville, Alabama, practice she purchased four years ago. She had some advance warning from a friend of hers, an ER doctor, who told her this pandemic could be worse than originally suspected. So she began planning for how to react.
She initially worked alone after stay-at-home orders were issued, coming in about eight hours a week. Her two associates weren’t working for a while, as Dr. James realized that if she became exposed or infected, she’d need at least one of them to cover. Then she staggered staff shifts, allowing only three employees in at a time. She had face shields, masks and gloves at the ready, and printed signs with protocols for sanitization.
“If patients had urgent needs, I saw them. The urgent care centers were turning these people away, so sometimes I’d drive over here three times a day,” she says. “One day, I saw a patient with baby poop in his eyes, another with a thorn and a third with a curling iron burn.” Her willingness to show up and be there for the patients will likely earn her some loyalty when these patients need routine eye care or specialty services, like dry eye.
DRY EYE BUILDS PRACTICE
Dr. James is not at all surprised how devoted dry eye patients are to an optometrist who understands their suffering. “My dry eye was so debilitating that I’d have to stop what I was doing, remove my daily disposable contact lenses and put on my eyeglasses. When I was a student, we might go out to celebrate finishing finals, but I’d have to leave because my dry eye was agonizing.”
She says that addressing even minor ocular surface signs of dry eye can increase patients’ satisfaction with their contact lenses and even eyeglasses. She also understands how quickly some providers can dismiss the symptoms and impact on a patient’s quality of life. “Patients don’t know what’s wrong with them,” she says. “And some providers think of dry eye patients as high-maintenance patients. They don’t have time to deal with them.”
That’s where she steps in. She has trained her technicians to note symptoms of dry eye and begin the conversation with patients. “It takes a little more time to educate patients that watering and burning and fluctuating vision can all be symptoms of dry eye.”
DRY EYE HOMEWORK
Dr. James likes to take a holistic approach with patients, encouraging them to form habits that can help prevent dry eye from becoming bothersome. She starts patients with a “homework routine. Even those who don’t have bothersome symptoms can keep mild signs from getting more advanced. I say it’s a little like brushing your teeth. You don’t wait until you have cavities to start.” She encourages patients to use artificial tears—she particularly likes REFRESH OPTIVE MEGA-3® drops. “They’re not habit-forming, and you can use them once in the morning and once in the evening,” she says.
She also dives deeply into patients’ daily routines: what they’re eating and drinking, the shampoos they use, how often they change their pillow cases and whether they use hair spray or other products that can get into their eyes. She will recommend lid wipes and a daily routine of cleaning eyelids and lashes.
After a week of homework, she’ll encourage the patient to follow up. “If it’s not working,call me and we’ll do Plan B,” she tells them. During the COVID-19 closure, follow up visits could be done via telemedicine. In fact, that has worked so well that she may continue to use telemedicine platforms for follow-up visits with dry eye patients after starting a new medication or punctal plugs, for example.
“My dry eye patients are so appreciative when they start feeling better,” she says. Even those who are on medications or have minor symptoms appreciate knowing that there are actions they can take. They also often talk about it with their friends and family, spurring referrals to the practice.
Dr. James says REFRESH OPTIVE MEGA-3 is a favorite tear formulation. “It’s preservative-free, and it’s great for patients with evaporative dry eye issues. For patients who are inside all day, where the indoor air quality affects them or they’re sitting at their computers with a reduced blink rate, it’s a great option.” The low-blur formula fortifies and restores the lipid layer.
Restasis® is a tried-and-true therapy and is also preservative-free. For patients who need a little more help than the homework routine, Restasis is often the next step.
By improving these patients’ quality of life so dramatically, Dr. James has gained tremendous loyalty.