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Issue: February 2009 Boosting the Bottom Line Through The Treatment of Ocular Allergy

Boosting the Bottom Line Through The Treatment of Ocular Allergy

Learn about opportunities to treat allergy patients and help grow your practice.

By John Rumpakis, OD, MBA

When I present lectures on allergy, I find that practitioners all over the country readily embrace this area of treatment. Some geographic locations and population demographics naturally raise the risk for allergy. But allergies are common everywhere, giving optometrists a great opportunity to treat this condition and augment their practices.

When we look at the current statistics, we discover there's a very high incidence of allergy. However, patients typically seek treatment from general practitioners and may not get the relief they need for ocular symptoms. When optometrists treat patients with ocular allergies, they can deliver the desired outcomes — and increase their income.

In this article, I'll discuss the prevalence of allergy and the opportunities you have to treat this condition and grow your practice.

High Prevalence

Estimates from a nationwide skin test survey1,2 suggest that allergies affect more than 50 million people in the United States, and that more than half (54.6%) of Americans test positive for one or more allergens. In fact, allergy is the fifth leading chronic disease in the United States among all ages and the third most common chronic disease in children under age 18.3 In addition, the costs associated with allergies are extraordinarily high. One analysis estimated that allergies cost Americans $7.9 billion per year — $4.5 billion in direct care and $3.4 billion in indirect costs (primarily in decreased work productivity).4

Based on current data,5 I've calculated that ocular allergy affects about 42% of the U.S. population, and that about 12% of allergy sufferers complain of watery, itchy eyes — the third most common symptom.

The high prevalence of allergy directly impacts our practices. It affects many of our patients who help spend that annual $4.5 billion in direct-care costs.5 But when it comes to ocular allergies, patients may not be spending their dollars wisely.

When we asked what medications patients were taking for their allergies in a Harris Interactive Poll6 conducted on behalf of the Asthma and Allergy Foundation of America, we found that 67% used oral medications and 27% used nasal sprays. A mere 2% of allergy sufferers used eye drops — a far cry from the 12% who complained of watery, itchy eyes.5 What's more, oral antihistamines most likely exacerbated ocular symptoms for many patients due to their drying effects and because they concentrate allergens. This disparity undoubtedly affects patient satisfaction with allergy therapy. So what's the problem?

Right Doctor, Right Treatment

When patients suffer with allergies, the optometrist often isn't their first choice. The Harris Poll6 showed that 69% of patients see their general practitioner first, followed by the allergist and the otolaryngologist. Only 4% of patients see what the study6 described as "other health professionals," which may include eyecare practitioners and others.

This may help explain why patients mostly use oral systemic medications and why eye drops often aren't prescribed, despite the high rate of patients with ocular symptoms. This is an enormous opportunity for optometrists.

Given the prevalence of allergy, you see many patients with this problem. What's most important to them? Fast relief. About 83% of patients say they want something that relieves symptoms within 30 minutes.6 Topical eye medications fall well within that margin, offering extremely rapid relief.6 From the patients' perspective, a doctor who prescribes a medication that works this quickly is addressing their issues and improving their lifestyle (Figure 1).

Figure 1. About 83% of patients say they prefer medications that relieve allergy symptoms within 30 minutes. Topical eye medications fall well within that margin.

In addition, because you have a range of choices in topical allergy medications, you can choose those that are most likely to increase compliance and improve outcomes. About 59% of patients say they don't comply with dosing instructions for allergy medications.5 Specifically, 30% say they take medications less frequently than prescribed, and 6% use them more frequently.5 Inconvenience is the issue for 13% of patients, while adhering to the dosing schedule is a problem for 5% of patients.5

If patients can use medication that requires less frequent dosing, they'll be more likely to follow the regimen. And if we have the choice to prescribe a medication that provides a full 24 hours of relief, why wouldn't we do so? The goal is to relieve symptoms in a way that facilitates patient compliance.

Allergy and the Optometric Model

Optometrists are fortunate to be in a position to treat a wide range of ocular conditions. In fact, we're licensed to treat the vast majority of ocular health problems — all but internal surgical procedures. When it comes to treating ocular allergy specifically, we must learn how to provide quality care within the context of our practice model. These guidelines can help:

Take an evidence-based approach. Evidence-based medicine and medical necessity must drive all of our diagnostic and treatment decisions. Treatment options must be supported by the current clinical guidelines and literature, and then appropriately reflected in the medical record.

Document effectively. Because proper billing is nothing more than accurately translating the medical encounter with the patient, it hinges on our ability to establish a medical reason for therapy in the medical record. Optometrists must always document the need for treatment and the standard of care. Think about what's in the patient's best interest and tell the story in the medical record. Why did the patient come in to see you? What did you do? When do you want the patient to return? Did you prescribe something? Why? How do you want the patient to use the medication? The answers to these questions are the central components of the medical record.

Communicate your abilities. The key to keeping patients coming back to you for medical care is to communicate exactly what you do, because many of them just don't know. According to the American Optometric Association, patients make 74% of first-time eyecare visits to optometrists, compared to 26% of visits to ophthalmologists.7 And about 66% of patients continue to see their optometrists regularly for all of their eyecare needs, both refractive and medical.

Keep patients satisfied. Patients say the number one reason they're dissatisfied with their allergy treatment is that the doctor doesn't spend enough time with them (Figure 2). Of course, you don't have much time; no one does. But I know that I appreciate the quality of time rather than the quantity of time spent with my physician, so if you take just 30 seconds or a minute to speak to patients about their allergy problem and how it affects their lives, you'll not only be better able to recommend a solution that addresses their specific needs, but you'll help ensure they have a positive perception of the quality of care they receive in your practice.

Figure 2. Patients say the number one reason they're dissatisfied with their allergy treatment is that the doctor doesn't spend enough time with them. Taking an extra minute to discuss their allergies will help ensure they have a positive perception of the care you provide.

Put patients' needs first. Sometimes, it's in our nature to be concerned about our patients' financial situation, but we're in the business of providing medical eye care, not financial assistance. Patients expect us to solve their eyecare needs first and foremost. Therefore, we need to do one thing only: provide patients with a strong clinical statement about how we'll solve their problems. This is what patients seek.

By adhering to these three aspects of the practice model, you'll position yourself to give allergy patients the best treatment possible, while also increasing the profits of your practice.

Economic Potential

Increasing your profitability from allergy alone is possible. But it requires a new state of mind. We can no longer say, "You have an allergy. Here's a sample. Go ahead and try it." We have to treat allergy like the disease it is and take a more proactive role in our patients' overall health care. Ocular allergy is the low-hanging fruit in the total patient care model — you just need to pick it. OM

John Rumpakis, OD, MBA, is founder, president, and CEO of Practice Resource Management Inc., a consulting, appraisal and management firm for healthcare professionals.

  1. Gergen, PJ, Turkeltaub, PC, Kaovar, MG. The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey; J Allergy Clin Immunol. 1987;80:669–679.
  2. Arbes SJ, Gergen PJ, Elliott L, Zeldin DC. Prevalences of positive skin test responses to 10 common allergens in the U.S. population: results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol. 2005; 116:377-383.
  3. National Academy on an Aging Society. Chronic Conditions: A Challenge for the 21st Century. Washington, DC. Gerontological Society of America. 1999. Monograph No. 1.
  4. Mackowiak JI. The health and economic impact of rhinitis. Am J Manag Care. 1997;3:S8-S18.
  5. Practice Resource Management, Inc., 2008. (
  6. Asthma and Allergy Foundation of America, Annual Report, 2005. Visit Last accessed Dec. 10, 2008.
  7. Caring for the Eyes of America 2007: A Profile of the Optometric Profession. American Optometric Association.
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