Crystal Brimer, OD, FAAO, was feeling burned out when she sold her independent practice about 14 years ago. After her planned move fell through, she stayed in Wilmington, North Carolina, where a very restrictive noncompete limited her options. Needing to pivot, Dr. Brimer began her lecturing career speaking about contact lenses and practice management and then branched into clinical trials on dry eye, which sparked her true passion.
“When my noncompete was over, I knew I wanted to dive into dry eye,” she says. She had been recruited to create the Dry Eye Protocol for Vision Source and wanted to do it well. During this time, she approached Oculus to ask if she could help develop a more user-friendly software for the 5M Keratograph that could tell the patient’s story and be an aide to doctors trying to treat more dry eye.
She delivered an eight-minute presentation on the updated software to the 4.000 Vision Source attendees at its national meeting, and Oculus representatives told her they sold more than in the history of the company since 1895, she says. Obviously, she had struck a chord.
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However, when returning to the show a year later, she heard that some doctors struggled with implementing the change into their practices. This was heartbreaking because she knew the potential the 5M and dry eye treatments could have. This struggle became her inspiration to create the Dry Eye Institute, where she leads several retreats for eye care professionals each year, teaching them how to truly implement change and grow their dry eye practices.
SPREADING HERSELF THIN
Now juggling full-time practice with 29 referring doctors, lecturing and the Dry Eye Institute, Dr. Brimer was driving towards burnout yet again. So instead, she isolated her attention to her true passion of dry eye. She considered whether her practice, Focus Eye Care, could survive without providing routine primary eye care, asking herself, “What’s the worst that could happen?” Within a short time after removing the optical and routine care in 2019, she realized this was the best professional decision she had ever made.
She has since rebranded the practice to Dry Eye Equation, a unique environment that is part spa and part “third place,” where people can come and gather. It features a large open atrium, where the Oculus Keratograph sits with a 65” TV to show its images, a hospitality area with flavored waters and snacks and a relaxation room. People can come into this quiet space, any time, free of charge, and relax with a vibrating warm compress mask. “We saw patients’ ocular status improve or degrade, according to their stress level,” she says. “So why not create a place that could help people decompress, while making them feel good about their eyes?”
They can spend a few minutes with Daisy, her 60-pound golden retriever/Great Pyrenees and chow chow mix. “With what I do and the patient base I have, Daisy is needed here. I hear patients talking to her all the time,” she says. “When I’m in an extra-long visit, like a dry eye evaluation, she will intuitively come and snuggle in between my knees and the patient’s knees to console them.”
EMOTIONAL FACTORS IN DRY EYE
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There’s an emotional aspect to dry eye management. “Twenty-nine percent of dry eye patients are depressed. I ask them how many doctors they’ve told about their symptoms and how many years they’ve been experiencing them. That provides me an idea of how much emotional baggage they may be carrying from this,” she says.
“Eyes are an end organ. If your body is inflamed, your eyes will be inflamed. We give each new patient a 140-page book that reviews how to mitigate inflammatory triggers such as diet, hydration, stress, anxiety and sleeplessness. I tell them that we can treat just the eyes, but if they want the best outcome, we need to work together to improve the whole system.”
Dr. Brimer says that sometimes providers treat the symptoms of dry eye disease instead of the cause. The challenge is that the condition often has multiple contributing etiologies. “If you have a boat with four holes, and you plug two of them, you’re still going down,” she says. “It is therefore critical that we identify each underlying contributor and pair it with a solution.”
DESIGN SUPPORTS HEALING
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And that’s why the aesthetics of the space and the environment make a difference. Dr. Brimer wants this to be a place where patients automatically have a feeling of Zen. For example, she has inspirational quotes, unique lighting and a sliding glass door hanging in every room, as well as windows in the exam for the first time in her working career. “I have five lanes equipped, and four of them have windows,” she says. Each room is a procedure room with a spa chair. She has Optometric Aesthetics’ intense pulse light (IPL) system, radio frequency (RF) technology and low level light therapy, TearCare, Lipiflow and is adding aesthetic treatments.
The patients who come to her have usually tried just about everything that their eye care provider or the internet has suggested. “I want to differentiate by making a plan together with the patient, one that is methodical and gives them a “because” as to why we are doing each treatment, big or small. That could mean inserting punctum plugs, using Prokera or other in-office treatments.
Her goal is to get patients stabilized to the point where they need to see her just two times a year, often for a routine IPL and RF treatment every six months.
SCALING THE DRY EYE INSTITUTE
The Dry Eye Institute’s live retreats run two full days, on holiday weekends several times per year. The 10 doctors in the group fly into Wilmington in time for the Thursday training that runs from 1 p.m. to 9:30 p.m., followed by all-day Friday training from 8:30 a.m. to 6 p.m. Participants earn 18 hours of live COPE continuing education.
This schedule allows her to see patients Monday-Wednesday in her practice, providing both patients and her staff with a predictable schedule.
She has watched Dry Eye Institute participants develop close relationships during these two intense days. They go out to dinner together, and they support each other. In fact, that follow-up is almost as important as the training itself. “The first thing I hand them is a practice plan. I say, ‘I want this on your person for the next two weeks. Write everything down. And then it’s so fun to watch the group texts fly as they are working through their thoughts and ideas.”
ONGOING SUPPORT
Dr. Brimer also provides support, including helping doctors negotiate pricing on equipment, for example. They leave the event with a backpack filled with about $5,000 worth of products to get them started, as well as ongoing negotiated discounts on both large and small purchases.
But she felt like she couldn’t provide the training to everyone who wanted it. “Not everyone can drop everything and come to North Carolina,” she says. So she added five live virtual meetings to the agenda in 2023. However, participants still needed to be online on a scheduled weekday in order to access the program, so it still wasn’t as accessible as she hoped.
For years Dr. Brimer has dreamed of making Dry Eye Institute truly accessible all over the world and this year it will become a reality as she launches DEI on Demand. She spent weeks filming the 20 hours of content and then had it professionally edited and housed on a learning platform. Now individuals and entire offices can select to participate in the program and proceed in their own space and at their own pace. DEI Office also includes an individual consultation session with Dr. Brimer once participants complete the program. Soon, the participants of each class will have their own online forum where they can continue to encourage each other.
HELP FOR THOSE WHO NEED IT
In yet another dry eye initiative, Dr. Brimer created Hope In Sight, a charity that helps fund advanced dry eye procedures not covered by insurance. “About three years ago, I was having dinner with a glaucoma specialist who told me she was seeing great results in her referred patients ‘as long as they could afford to get better.’ With as much as I poured into my care, this hit me hard. But it also inspired me to create a 501(c)(3) organization to help offset the costs of treatments.” Both patients and the community came together to contribute nearly $32,000 during a charity gala held in January. “To date, we have been able to provide almost 100 patients with an IPL or LLLT series or a thermal evacuation,” she says.
