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Offer advanced patient care by bundling services

Optometry Times JournalNovember digital edition 2022
Volume 14
Issue 11

Combining products and resources in creative ways can help grow your business.

Janelle Davison, OD, offers a boutique-style patient experience.

Janelle Davison, OD, offers a boutique-style patient experience.

Combining the latest treatment and diagnostic technology with a focus on providing thorough education has allowed me to create a thriving boutique-style experience for my patients. I believe in being an early adopter of medical technology, and I consider incorporating anything that helps me become more efficient and effective in diagnosing, managing, and educating my patients.

As one of the few Black female optometrist founder and owner in private practice in Cobb County, Georgia, I see patients from near and far. In doing so, I want to provide the best and most advanced care that addresses their concerns.

Bundling tests and treatments

We have created a variety of screening bundles at my practice, combining products and exams that are targeted toward different concerns—sometimes with both cosmetic and medical benefits. In the preappointment paperwork, they see information about available bundles: antiaging, dry eye, and retina. Patients can select whether they are interested in learning more. In addition to making things clearer for patients in terms of cost and benefits, the out-of-pocket and fee-based screening bundles help me identify those who are very invested in their treatment.

Technician instruction the  patient to evaluate their lid appearance. The patient’s response is recorded in the EMR.

Figure 1. Technician instruction the patient to evaluate their lid appearance. The patient’s response is recorded in the EMR.

The antiaging bundle includes an evaluation for drooping eyelids and age-related blurry near vision or presbyopia. The technician will direct the pretesting according to the patient’s preselected bundle.

Patients can evaluate the severity of their eyelid droop at a mirror set up in the pretest room, and we take a picture with an iPad before instilling any drops, such as oxymetazoline hydrochloride 0.1% (Upneeq; RVL Pharmaceuticals, Inc). The patient receives additional information and consultation on acquired blepharoptosis and education on pilocarpine hydrochloride ophthalmic solution 1.25% (Vuity, Allergan), and the package includes an iWellness retinal scan to confirm the macula is healthy.

New drops manage eyelid droop, presbyopia

Upneeq is the only FDA-approved pharmaceutical indicated for acquired blepharoptosis or a low-lying upper eyelid margin when the eye is in primary gaze.1 The condition is common in older adults, affecting at least 12% of adults 50 years or older.2,3

The drop was approved based on data from two 6-week, randomized, double-masked, placebo-controlled phase 3 efficacy studies of 304 patients. The study results found oxymetazoline was associated with significant improvements compared with those of placebo in primary superior visual field and eyelid lift.1

Vuity’s approval was based on data from 2 pivotal phase 3 clinical studies, GEMINI 1 (NCT03804268) and GEMINI 2 (NCT03857542), which included 750 participants with presbyopia aged 40 to 55 years. The study participants self-administered 1 drop of the product or placebo once daily in each eye. Both studies met their primary end points.4

Over 70% of participants treated with Vuity gained 2 lines or better in mesopic, high-contrast, binocular distance-corrected near visual acuity without losing more than 1 line of corrected distance visual acuity at day 30, hour 3 vs participants who administered placebo.4

My patient conversation and follow-up procedure

When I enter the exam room, I review the patient’s exam results and discuss their available options. I take the time to educate the patient on eye health, annual exams, nutraceuticals, and supplements, and I emphasize the importance of knowing their family health history.

Pull quote: We have created a variety of screening bundles at my practice, combining products and exams that are targeted toward different concerns—sometimes with both cosmetic and medical benefits.

For the antiaging package, we instill both sets of drops, telling patients we want to review the results with them and walk them through any adverse effects. After 20 minutes, we reassess patients’ near vision and take a picture of the eyelids.

I offer 1 follow-up teleconsultation as part of the antiaging bundle. This last touch point with the patient comes after they have gained more experience with Upneeq and Vuity outside the clinic. This puts the bow on what patients consider fabulous care. I ask how they are doing with their treatment, review their financial investment, and let them know I’m sending a prescription to the pharmacy. I remind them to contact me if they experience any discomfort or have other issues or concerns.


The pace at which new devices and drugs are introduced in eye care can be hard to keep up with. Some optometrists may complain that they are not interested in selling new treatments to patients. To me, this is the wrong mindset.

Instead, it is our duty as health care providers to stay abreast of all advances and educate our patients about their available options. Patients may not be interested in pursuing a specific option that day, but they will know about it in the future. I do not want to withhold knowledge from patients or have them hear about something new from another source.

1. Sridharan GV, Tallis RC, Leatherbarrow B, Forman WM. A community survey of ptosis of the eyelid and pupil size of elderly people. Age Ageing. 1995;24(1):21-24. doi:10.1093/ageing/24.1.21
2. Kim MH, Cho J, Zhao D, et al. Prevalence and associated factors of blepharoptosis in Korean adult population: the Korea National Health and Nutrition Examination Survey 2008-2011. Eye (Lond). 2017;31(6):940-946. doi:10.1038/eye.2017.43
3. Bacharach J, Wirta DL, Smyth-Medina R, et al. Rapid and sustained eyelid elevation in acquired blepharoptosis with oxymetazoline 0.1%: randomized phase 3 trial results. Clin Ophthalmol. 2021;15:2743-2751. doi:10.2147/OPTH.S306155
4. Vuity (pilocarpine HCl ophthalmic solution) 1.25%, the first and only FDA-approved eye drop to treat age-related blurry near vision (presbyopia), is now available. News release. AbbVie. December 9, 2021. Accessed September 20, 2022. https://news.abbvie.com/news/press-releases/vuity-pilocarpine-hci-ophthalmic-solution-125-first-and-only-fda-approved-eye-drop-to-treat-age-related-blurry-near-vision-presbyopia-is-now-available.htm
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