With nearly 16 million Americans diagnosed with dry eye disease and study results indicating nearly half of the U.S. adult population experience the signs and symptoms of dry eye,1 ODs are rightly focused on adding dry eye clinical care to their offices to serve these patients.
A vital component of dry eye treatment is patient education and patient buy-in to use the specific drops recommended by their doctors, despite the confusion of drugstore aisles marketing generic and store brand drops for everything from redness to itching (both hallmark symptoms of dry eye disease).
On this podcast, we sit down with Claudine Courey, OD, MSc, FAAO, an OD who is embracing dry eye treatment on a new stage-the world of online retail.
Previously by Dr. Lyerly: Dr. New Mom: Planning for baby and returning to work
Gravitating to dry eye
Dr. Courey graduated from the University of Montreal School of Optometry and completed a residency in cornea and contact lenses, followed by a master’s degree focused on scleral contact lenses. She was awarded fellowships by the American Academy of Optometry and the Scleral Lens Society and is board certified to practice in both Canada and the U.S. She sees patients at Bellevue Clinque, anOD/MD practice where she runs a dry eye specialty clinic in Montreal.
Dry eye wasn’t Dr. Courey’s first calling as a practitioner, but as she was fitting specialty contact lenses for patients with keratoconus and corneal abnormalities, she started getting referrals for patients needing scleral lenses for severe dry eye.
“When I began treating them and saw how dry eye impacted their daily lives, and as optometrists we have the ability to make their quality of life so much better, it really hooked me,” she says.
She has seen firsthand how helping people with dry eye can give her career meaning and purpose, whether it’s allowing someone with corneal abnormalities to wear their contact lenses all day long or helping someone comfortably read a book again.
Dr. Courey practices in Quebec, and the scope of practice in this province of Canada recently expanded to include the ability to prescribe for glaucoma. In her dry eye practice, she has access to the same treatment and diagnostic technology that practitioners in the United States have-from meibomian gland imaging to prescribing anti-inflammatories.
Her approach to dry eye treatment focuses around the Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II definition of the disease in which restoring tear film homeostasis is the goal of her dry eye treatment regimen.2 Her practice is focused on ensuring every patient receives a comprehensive assessment of his underlying dry eye risk factors and developing an individualized treatment plan addressing at each component of dry eye the patient is experiencing.
Related: New research on improving contact lens comfort for patients with dry eye
As many ODs who practice dry eye care can relate, Dr. Courey found consistent challenges with patients using treatments as she prescribed and achieving meaningful symptom relief. Instead of throwing in the towel, she chose to actively do something different.
Almost a year ago she started an e-commerce business called The Eye Drop Shop.
The idea was born from witnessing patients struggle to find the treatments that she had prescribed for their dry eye. She would send patients out with specific recommendations, and they would return with a red eye drop that was worsening their conditions.
Her solution? Build a website where her patients could purchase the specific products that she recommends and remove the retail confusion. Because the community Dr. Courey serves is rural, the e-commerce website helps patients who struggle getting to the store be able to get the products she specifically recommends.
Building an e-commerce website may seem like a big investment for optometrists, but the tools to do so are readily available for those with the entrepreneurial spirit. Platforms like Shopify exist to streamline the process, and the rest is personal education via webinars and online videos.
“It really is a lot of hard work behind the scenes,” Dr. Courey says. “Search engine optimization (SEO), e-commerce, marketing, shipping and receiving inventory… You have to really embrace the hustle of it.”
Related: 5 marketing tips to grow a practice without breaking the bank
The products that Dr. Courey retails on her website reflect the treatments that she uses in her own practice for managing dry eye patients. Each drop has specific benefits above and beyond what is typically available in drug stores:
• One of her favorite drops is Thealoz Duo. This preservative-free drop contains trehalose that helps retain moisture and protect the corneal epithelial cells.3
• If a patient can’t put drops in her eyes? Dr. Courey carries Calmo Eye Spray, a preservative-free artificial tear containing liposomes and a Vitamin B5 derivative that can be spritzed onto closed eyes, then when the patient blinks droplets of the tear formulation spread onto the ocular surface.
• Another novel treatment is Hylo Duo, which treats dry eye and ocular allergies at the same time.
Why are these products unfamiliar to U.S. doctors? The U.S. Food & Drug Administration (FDA) regulates ingredients that can be used in artificial tears but allows manufacturers to bring new artificial tear products to market without additional (and expensive) clinical testing if they use currently approved active ingredients.
This list of approved ingredients has been relatively untouched since the 1980s.4 To bring a new artificial tear product to the U.S. market with new active ingredients, companies must invest in clinical testing which may not make financial sense for companies planning to retail over-the-counter products.
While ODs and patients won’t find many of these products on U.S. shelves for this reason, the internet has been a level playing field in providing patient access to drops used in Canada and Europe. Thealoz Duo, for example, can be easily found on Amazon.
Related: ODs reach for artificial tears first to treat dry eye
In addition to retailing artificial tear products, Dr. Courey also prescribes and retails cosmetic products. After research, she recommends Zorah Biocosmetic beauty products. Dr. Courey likes that the line is focused on clean and ocular surface-safe ingredients. The Eye Drop Shop retails mascara, eyeliner, and undereye serums and creams from this company.
“It’s not only what goes in the eyes, but also what goes on and around the eyes that can contribute to ocular surface disease,” Dr. Courey says.
Dr. Courey educates her patients about the ingredients in common cosmetics that are ocular surface offenders. There is little federal oversight over ingredients used in cosmetics, and Canada has more restrictions on preservatives and cosmetic ingredients than the United States. Having a product line that she feels comfortable to recommend is important to make sure her patients aren’t undermining her dry eye treatments with the cosmetic products they put on their faces every day.
Related: Cosmetic dangers: Part 1-Popular cosmetics patients use
Successful office retailing
Dr. Courey shares her two biggest tips to successfully retailing products as an optometrist:
• Know your products inside out and know why you are prescribing them. When you educate your patient fully about the why behind your product recommendations and empower the patient to be in control of her own health, she is much more likely to follow the prescribed treatment plan.
• Don’t sample drops in office. “I don’t want you to try it; it’s a treatment,” Dr. Courey says. By prescribing, not sampling, the tone of the recommendation becomes more serious in the patient’s eyes. She writes what she wants her patients to purchase on a prescription pad to underline the importance of using the specific products she is recommending.
Want to learn more about building your own dry eye retail business, whether it’s on your practice website or in office? Contact Dr. Courey via Instagram at @eyedropshop or via email at firstname.lastname@example.org.
Read and listen to more Defocus Media content here
1. Dalton M. Understanding prevalence, demographics of dry eye disease. Ophthalmology Times. Available at: https://www.ophthalmologytimes.com/dry-eye-awareness/understanding-prevalence-demographics-dry-eye-disease. Accessed 9/26/19.
2. Willcox MDP, ArgÃ¼eso P, Georgiev GA, Holopainen JM, Laurie GW, Millar TJ, Papas EB, Rolland JP, Schmidt TA, Stahl U, Suarez T, Subbaraman LN, UÃ§akhan OÃ, Jones L. TFOS DEWS II Tear Film Report. Ocul Surf. 2017 Jul;15(3):366-403.
3. Pinto-Bonilla JC, Del Olmo-Jimeno A, Llovet-Osuna F, HernÃ¡ndez-Galilea E. A randomized crossover study comparing trehalose/hyaluronate eyedrops and standard treatment: patient satisfaction in the treatment of dry eye syndrome. Ther Clin Risk Manag. 2015 Apr 13;11:595-603.
4. U.S. Food & Drug Administration. CFR - Code of Federal Regulations Title 21. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=349&showFR=1. Accessed 9/27/19.