CONCEPT
Dry eye follow ups are an extension of the initial dry eye clinic, they are an opportunity for the doctor to evaluate how well the patient is responding to their current treatment regimen and to determine if additional treatment measures should be initiated. Quite frequently, these follow ups will be scheduled to also perform a dry eye related procedure. These procedures include Arita, Ilux, BlephEx, Punctal Plugs and Prokera. We will discuss each of these procedures below.
WORKUP ORDER
Complete visual acuity, expedited medical history. Verify the patient’s current treatment regimen and Inquire if the patient has noticed any improvement in their symptoms. If the patient is here for Arita, warm up their dry eye mask in the microwave, and have them use the mask while you go get the doctor.
CHARTING CHECKLIST
Layout: Intermediate.
Hx/Meds: Forward and update
Workup: Enter the patient’s dry eye diagnosis as the chief complaint. Fill in VAs, pupils, and EOMs. Past the OA dry eye evaluation template in the notes and fill each category out as the doctor indicates.
Exam: Forward anterior and posterior findings (delete the posterior findings if the doctor does not complete) and update based on the doctors findings. Forward the patient’s dry eye diagnosis in the plan and make it the #1 diagnosis for the appointment. Update plan to reflect all recommendations from that appointment.
Routing: Confirm with the doctor which office code they would like entered (occasionally the code for the procedure will be used instead of an office code; for example, the code for punctal plugs cannot be used with an office code) for the visit and under additional notes, indicate what and when the patient’s next appointment should be. For Arita, note if this was part of a package or a single procedure. For ilux, note that an ilux was performed. For a Prokera, put the code 65778 (Amniotic Membrane) in the notes box on the routesheet tab.
Arita
Arita is a procedure where the patient’s meibomian glands are manually expressed using a paddle or forceps. When Arita is recommended by the doctor, at either the exam or a dry eye clinic, the patient will usually purchase an Arita “package” which covers three Arita procedures (although an office code will still be posted at each visit) as well as a dry eye mask. During the appointment, check to see how many procedures they have had since they purchased the package, and notate on the notes section of the routing which out of the three procedures it is (i.e. Arita today, number 2 of 3). Please watch the video on Arita below.
Ilux
Ilux is a procedure similar to the Arita, in that the doctor is expressing a patient’s meibomian glands from both the front and the back of their eyelids. Unlike Arita, however, the iLux itself warms the glands from both sides of the eyelid before expression and includes one treatment during one visit instead of three treatments over three visits. During this visit, the doctor will also complete Meibography which uses infared light to take imaging of the patient’s meibomian glands which can show if their meibomian glands are beginning to atrophy. Please watch the following video on ilux.
Importing iLux Meibography
Once the iLux is complete the meibography imaging will need imported into the patient’s chart. When the iLux is brought into the room the docking station will need to be connected to the laptop or desktop via the USB cord.
During the procedure, be sure to create two meibography entries in the testing tab of the patient’s chart, one for each eye.
When the doctor is finished with the iLux they will place it back into the docking station.
This will open the device folder on the local desktop.
Open the folder and the captured images should appear.
Each image should be copied.
And pasted to the server desktop.
They can then be imported into the corresponding testing tab entries.
The video below walks through the process.
BlephEx
Blephex is a procedure where the doctor uses a tool to clean off the Biofilm that accumulates along a patient’s eyelid margins. This is a more effective alternative to hypochlor and lid scrubs. Please watch the video on Blephex below.
Punctal Plugs
Punctal plugs are devices used to limit the draining of a patient’s tears through their puncta. The plug is inserted into the puncta with the hope that it will keep a patient’s tears on their eyes longer before they drain. Puncal plugs can be temporary (dissolvable) or permanent. Please watch the video on Punctal Plugs below.
Prokera
Prokera is a treatment for corneal inflammation that involves placing a piece of amniotic membrane stretched on a ring over the cornea for several days. The membrane dissolves over several days and the patient then returns to have the ring that held it removed. Please watch the following videos on Prokera.
Operative Tab
Some Procedures require an entry into the operative tab (this tab should be on most templates). Of the above mentioned procedures, the ones you will have to create an entry for are punctal plugs and Prokera. To create and entry, Go to the operative tab and use the three dot ellipsis to select ADD.
This opens up a new window. Select the procedure and location you want from the list on the right (the example below would be if the doctor was inserting a punctal plug into the right eye lower lid).
This will autopopulate most of the fields in the entry. Each entry will just need a few possibilities narrowed down (such as whether or not the plug used was permanent or temporary) before saving the entry.
which will add it too the table, as seen below.
