Dry eye, Feature, Report, Therapies

Clinical model puts dry eye first

In the final instalment of Insight’s five-part dry eye series, optometrist Ms Marilyn Stern reveals how low overheads and no refraction equipment set Perth’s first dedicated dry eye clinic apart. So too does its patient demographic, with several teens counted among them.

When optometrist Ms Marilyn Stern opened Dry Eye WA just a few years ago, new research and technology was providing renewed hope for patients who had long-suffered from dry eye disease.

Stern, who has been practising as an optometrist since 1983 after graduating from UNSW, has previously owned her own full-scope practice in Perth and worked around the state as a locum optometrist in both independent and corporate settings. She was also the first regular fly-in fly-out optometrist for five years to service Newman, a town in the Pilbara region of Western Australia.

For 30-odd years prior to opening Perth’s first dedicated dry eye treatment clinic, she’s seen countless patients with the disease. However, for a long period the only treatment available was warm compresses and eye drops.

That changed when she attended an optometry conference and one of the trade stands had an intense pulsed light (IPL) machine, now considered one of the best forms of treatment.

Stern says she was impressed by the IPL manufacturer’s claims, and thought it represented a sound clinical and business investment. But her views were not supported by her then-employer, so she decided to set up a stand-alone dry eye clinic, with IPL being the primary piece of equipment.

“IPL treats the glands thought to be causing dry eye, but it wasn’t known [when I purchased the machine] that not all dry eye is the same. So I found that IPL doesn’t work for everyone,” she says.

“Managing patients’ expectations is also challenging, as I am at pains to tell people this is not a cure. I also offer other therapies including BlephEx, Low Level LED light Therapy, Blephasteam, lid scrubs, and take-home therapies of heat packs and eyelid cleansers, and I educate patients on using heat packs and massage.”

To keep abreast with innovations and advances in the field, Stern reads industry magazines and journals, and attends relevant lectures and webinars.

“A recent webinar I watched presented by Queensland optometrist Mr Jason Holland provided clinical advice on performing gland expression three times, not just once, and I’ve adopted that advice in my clinic,” she says.

“I also read material that comes across my newsfeed on dry eye and I follow TFOS – I’m looking at what they’re doing.”

In terms of establishing a dedicated dry eye clinic, Stern says there are some key differences compared with a traditional full-scope practice.

“Set up costs are far lower than starting a regular practice as you don’t have the high costs of display and stock, and basic equipment is not vast,” she says.

“Initially, I sent letters to the GPs, optometrists, and ophthalmologists in the area for a radius of 30km, dropped off business cards and referral pads to anyone who responded, but I discovered having a good website is most beneficial.”

She’s also had to overcome the anxieties associated with taking an unconventional step in her career; opening a practice that deals with only one eye condition.

“My husband feels my biggest challenge to start was self-doubt. But following on from that, the biggest challenge I face is convincing other optometrists, ophthalmologists and GPs that what I do is valid and provides great relief to many sufferers.”

An independent optometrist, Stern says her dry eye clinic is sustainable partly because she has low outgoings.

She’s located in a small office in an office block, with low rent and no street traffic. Her patients find her clinic through Google, or from a referral from another optometrist. Ophthalmologists are also referring patients.

Stern’s dry eye patients are not from the typical over 50s patient demographic. She says their age is more spread, with several patients in their teens.

“Some patients have dry eye secondary to other systemic problems, such as thyroid disease – 50% of people I see have thyroid disease – others have rheumatoid arthritis or dermatitis,” she said.

The clinic is also listed in the global Dry Eye Directory, a free service created by Victorian optometrist Leigh Plowman.

Atypically, Stern doesn’t stock frames or contact lenses in her clinic.

“The only glasses I have here are moisture chamber spectacles, which are specifically designed to provide relief from the discomfort of dry eye symptoms. I only have six frames. I don’t provide refraction and have no refraction equipment here whatsoever.”

Marilyn Stern is an optometrist who opened Perth’s first dedicated dry eye treatment clinic in 2017.

This has been reassuring for optometrists who refer patients knowing that they aren’t at risk of losing clientele.

“This is a new concept and it has been challenging to get it up and going. It’s still a work-in-progress but I was encouraged by cities like New York, London and Los Angeles which have several dedicated dry eye clinics. Now we know we can do something for dry eye patients, anything is possible.”

NEXT: Dry eye treatment in Australia