New presbyopia treatments offer promise, challenges, and rewards for practice managers

Expert advice offers key practice management tips for making presbyopia drops an integrated part of a clinical armamentarium.


The recent arrival of presbyopia therapeutics has created an entirely new category that holds both immense promise for patients and significant potential for practices. Many patients love the idea of using drops to treat their condition instead of relying on glasses or surgical intervention. Since these products entered the marketplace, leading practices have fielded appreciable interest—largely driven by word of mouth.

However, with great potential comes real challenges. Confusion around workflow and billing has led many eye care providers to relegate or eschew these consultations in favor of established practices and protocols. They’re missing an important opportunity, as effective integration benefits every stakeholder.

Practices gain access to a new revenue stream, patients gain access to an in-demand treatment option, and the treatment category gains proof of concept, fueling momentum and innovation.

Related: Presbyopia: Revolutionary research lines

Here, we will explore the key practice management imperatives required to make presbyopia drops an integrated part of a clinical armamentarium, including how to structure the model and important patient evaluation considerations.

Adapting an established model

To start, there are important questions that practice managers must answer to facilitate a successful integration. How will I create a revenue stream around this product, and what price point do I land on? How do I educate the patient on the value and importance of the treatment, as well as communicate the value of the consultation itself? What is the role of insurance, and what will (or won’t) they cover?

In the case of presbyopia drops, we can answer some of these questions right away, starting with revenue and insurance.

Given the category’s nascency, insurance won’t cover consultation fees. That means we are looking at a fee-for-service model that is entirely cash pay. The form used to sign for fee for service is an Advance Beneficiary Notice (ABN). Now that we’ve defined our boundaries, we can make some useful comparisons to establish a clear direction.

In the world of contact and intraocular lenses (IOLs), we are experienced at consulting on a range of treatment options, from “basic” (usually paid by insurance) to “premium” (usually paid in cash). This can serve as a useful starting point for creating a premium presbyopia consultation that a patient finds valuable and worth exploring.

When a patient comes in for a vision or medical exam, vision or medical insurance will cover their basic costs, respectively. With those basic costs addressed, providers have an opportunity to inform patients about this new treatment category and present the respective consultation as a separate, premium offering.

Related: Personalized solutions enhance presbyopia management

Beyond covering our practice’s billing and revenue needs, carving out space for a premium consultation allows us to take the time we need to fully educate patients on a new treatment category: one that, as of today, is relatively lacking in ready-made patient education assets.

Educating and evaluating patients

Effectively educating patients starts with communicating the need for a dedicated evaluation. It’s important to explain succinctly and directly that because this consultation is not covered by insurance, it will require an out-of-pocket payment.

From there, a patient should sign a form agreeing to a specialty pharmaceutical consultation. This is the time to explain the basic benefits and limitations of this treatment category, in line with the product literature.

Next, it is crucial to perform comprehensive diagnostic evaluation of the patient. Patients receiving these types of eye drops must have their entire retina assessed, including (and especially) the peripheral retina. Retinal holes, tears, or any degree of degeneration necessitates more active monitoring after treatment is implemented, so these factors must be identified.

Further, effective assessment of the peripheral retina requires dilation; imaging modalities that do not rely on dilation are not sufficient for this purpose. No screening technology available on the market today can visualize all 4 quadrants in equal detail.

Fortunately, since dilation is covered by vision and medical insurance, cost shouldn’t be a barrier. After dilation, a series of different imaging technologies should be used. A fundamental approach would include direct ophthalmoscopy or fundus photography. More advanced modalities, including OCT or widefield retinal imaging, can also play an important role where and when available.

Once the education and evaluation steps are complete, care providers can answer some of the patient’s most important questions, including their daily dosing schedule (usually once or twice), eyes to be dosed, signs and symptoms associated with complications or risk factors, and limitations around nighttime use or use while driving. Go deep here and establish a robust dialogue.

These questions can be answered by a trained technician; however, since the category is new, appropriate time and resources need to be invested up front to adequately train the technicians.

Taking the Initiative

Between the initial discussion, patient evaluation, and deep dive education around treatment, risks, and use parameters, it’s not very hard to justify the premium consultation fee.

Prescribing these medications correctly requires a high degree of due diligence, and patients that are willing to pay for treatment directly generally want their care provider to take every step required to ensure their safety and wellbeing long-term.

Related: Is presbyopia the newest subspecialty?

Implementing these protocols takes time and effort, but the initiative is worth the reward. Too many patients today remain unaware of new or alternative treatment options because implementing something new creates distinct practice management challenges.

However, to provide the most comprehensive care possible and expand our practice potential, we must not only meet these challenges, but exceed them. Fortunately, as this specific category continues to mature, we can expect industry partners to provide additional patient education resources that greatly improve efficiency on the practice end.

For now, though, it is on us as care providers to understand the product literature, carve out a practice protocol that includes (and charges for) the due diligence required, and afford our patients the opportunity to pursue the presbyopia treatment path that works best for them.

Providing exceptional service takes time and effort but offers salient rewards for patients and practices alike.

About the author
Jack L. Schaeffer, OD, FAAO,
is a native of Charleston, South Carolina. He has practiced in Birmingham, Alabama, where he was the former president of an 18-location group practice and a refractive laser center. He lectures internationally, serves on many industry boards and advisory panels, and is involved with clinical studies on contact lenses, pharmaceuticals, and equipment. Financial disclosures: Alcon, Allergan, AMO/Abbott, Avellina, Bausch + Lomb, Brien Holden Institute, Bruder Healthcare Company, CooperVision, Essilor, Hoya, Johnson and Johnson, MiboFlow, Nicox, Orasis Pharmaceuticals, Optovue, Inc., Optos, Sydnexis Inc, Taurus Pharmaceuticals, Bausch Health Companies.