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but refer patients for thermal pulsation treatment. Or the practice may utilize one or more diagnostic testing systems with which to monitor patients before and after treatment is received elsewhere. It may also provide sup- portive care, such as punctal plugs and/or recommend- ing the appropriate artificial tears. It's important for a shared-care practice to coordinate with the referral spe- cialty practice where it sends patients to ensure continu- ity of care and that patient discussions are consistent. We know firsthand at our practice that shared care works because many practices refer their patients to us. at said, relationship-building is necessary. We let our refer- ral sources know that we don't take their patients to our optical. We take care of the aspects of dry eye that we're asked to address, and then we send them back to their home practice. Basically, it's not much different from comanaging cataract surgery. e third option is becoming a specialized dry eye practice, offering full-scope diagnostics, treatments, and products, as we do at Bowden Eye. Resources are avail- able for practices that would like to begin moving in this direction. For instance, our team has developed Dry Eye University (dryeyeuniversity.com) for the purpose of sharing our expweriences and keys to success. Another resource, dryeyecoach.com, was recently developed by Whitney Hauser, OD. Industry vendors are helpful as well. ey're educated and motivated to help doctors incorporate their tools and technologies into practice. Getting on board with the dry eye revolution is abso- lutely doable. (See "e Five Ps of Ramping Up a Dry Eye Practice" on Page 10.) When practices really look for dry eye patients, they're usually amazed at the num- ber of them and how many they had been missing. e technology and techniques are obtainable, and they can create a great return on investment. ey also enable practice growth and better patient care. WE OWE IT TO OUR PATIENTS We encourage all practices to commit to being a referral practice, a shared-care practice, or a full-scope specialty practice for dry eye to ensure patients have access to quality dry eye care. Today, we know too much about dry eye to ignore the importance of treating it. It's a chronic disease, and patients won't get better, they'll get worse, if we're content with simply masking the symptoms. Who better to address this ubiquitous condition than optometrists? We're first-line for ocular health care, and we have the best opportunity to educate our patients and initiate treatment. e sooner we address it, the better their future prognosis will be. y JANUARY 2017 11 1. HISTORY AND SYMPTOMS • medical history form • SPEED questionnaire 2. PRE-TESTING BY TECHNICIAN • imaging/meibography (lipid layer thickness, partial blink, dynamic meibomian imaging) • tear osmolarity • MMP-9 3. PATIENT SEES DRY EYE COUNSELOR FOR EDUCATION • counselors educate on the basics of dry eye and the treatments we recommend for most/ all patients • counselors are able to apply the above information and predict what the physician will discuss with patient 4. PHYSICIAN SLIT LAMP EVALUATION, INCLUDING MEIBOMIAN GLANDS • hyperemia/conjunctiva staining • corneal staining/tear break-up time • tear meniscus height • lagophthalmos • eyelid architecture • Marx's Line • lid margin • lid wiper epitheliopathy • anterior segment photos • light microscopy to evaluate cilia for Demodex when indicated 5. TREATMENT PLAN ESTABLISHED WITH PATIENT • core therapy • supportive therapy 6. SECONDARY TESTING PERFORMED BY TECHNICIAN AT PHYSICIAN REQUEST • Sjögrens • antigen reaction • corneal topography • repeat previously performed tests at appropriate times 7. APPROPRIATE FOLLOW-UP ESTABLISHED • Any needed or repeat testing is scheduled prior to or at the time of next follow-up TABLE 1. BOWDEN EYE & ASSOCIATES' COMPREHENSIVE DRY EYE EVALUATION Dr. Robben is chief optometrist with Bowden Eye & Associates in Jacksonville, Fla., and an instructor in the practice's Dry Eye University program.