Making dry eye work for your independent optometry practice

Sydney independent optometrist HARRY NOTARAS has continually sought new technology to expand the scope of his practice. Dry eye is an area that’s delivered particular success for his patients, largely due to a willingness to invest in the latest instrumentation.

Mr Harry Notaras and Dianne Pyliots – principal optometrists of Eyewear Youwear, a practice located in the upmarket Sydney suburb of Surry Hills – embodies the philosophy that differentiation and an ability to commercialise special interests will ultimately lead to the prosperity of independent optometry.

A keen investor in new technology, Notaras established the practice in 1995 and has continually sought ways to make his service stand-out to a wdemographic largely comprised of office-based professionals in industries such as architecture, law, art and design.

Dry eye disease was an unknown phenomenon when Eyewear Youwear commenced operations 27 years ago, but as research in the field evolved, so did the practice’s interest in expanding its scope to accommodate its patient base.

“As dry eye became more researched, and studies such as DEWS (Tear Film & Ocular Surface Society’s Dry Eye Workshop) came out, that piqued our interest, because we had patients always complaining about vision problems saying they could see clearly one moment and blurry the next, and they have to keep blinking to correct it,” Notaras explains.

“As the research developed and told us more about how important treating dry eye is for visual function, it got us more interested. And as the early instruments emerged, we embraced them and now there’s a huge amount of opportunity for manufacturers to diagnose and treat dry eye.”

Indeed, Eyewear Youwear began evolving its dry eye suite. Over the years it added an intense pulsed light (IPL) machine from Lumenis, an eyelid warming goggle device incorporating heating capability for meibomian gland dysfunction (MGD) called Blephasteam, and meimbography imaging on its slit lamp. Pyliotis, the practice’s therapeutically-endorsed optometrist, can also prescribe prescription eye drops like ciclosporin and lifitegrast, often working in tandem with Notaras during the dry eye patient journey.

More recently, through BOC Ophthalmic Instruments, Eyewear Youwear sought to elevate its dry eye diagnostic and treatment offering, acquiring instruments produced by SBM Sistemi, a firm in northwest Italy punching above its weight in terms of ophthalmic innovation.

This has come in the form of IDRA, a diagnostic device launched in 2019 that is SBM’s most advanced ocular surface analyser. And earlier this year, the practice introduced Activa, SBM’s first treatment instrument for MGD, featuring an eye mask with heating and massaging technology.

The devices have been welcome additions for Notaras’ practice whose dry eye patients usually fall into two groups. Those with easier-to-manage dry eye caused by environmental factors, and those with anatomical problems such as rosacea, blepharitis and MGD, among other conditions.

“When it comes to dry eye, we see a big mixture of people. We tend to assess everybody that comes through the door, because even though most people will not tell you they have dry eye, particularly contact lens wearers, it’s one of those things that creeps up and they just think it’s normal until you show them otherwise,” he says.

Since acquiring the SBM instruments, Notaras has been impressed with the broad functionality of the IDRA device that has a small footprint and mounts to his existing slit lamp.

“It’s ideal for a practice of my size based in Surry Hills. It provides information for many aspects like tear meniscus height, non-invasive tear breakup time, auto 3D meibography,” he explains, noting additional functions such as auto interferometry test, blepharitis examination, break-up time staining test, white-to-white measurement and pupillometry.

“It also has blink rate detection, which can be recorded to assess whether patients are blinking correctly. IDRA has allowed us to go much more in- depth with one instrument, instead of switching from one to another.”

In Notaras’ practice, Activa acts more as a second-line therapy, with IPL the last line. While it might not be as comfortable for patients as expected, Notaras has been impressed with the results in his practice.