How to Build a Profitable Dry Eye Practice: Systems, Staff and Smarter Patient Care

Dry eye care has become far more than recommending artificial tears and sending patients home. For practices willing to build the right systems around diagnosis, treatment and follow-up, it can become a sophisticated clinical service that improves patient care while creating a meaningful new revenue stream. On the 20/20 Podcast, Dr. Harbir Sian and Dr. Trevor Miranda explored what it takes to build that kind of practice and why success depends as much on people and processes as it does on technology.

Topics Covered: Start With a Clinical FrameworkBuild a Team, Not a Doctor-Dependent ServiceMake the Handoff Part of the SystemTurn Good Ideas Into a Business

Start With a Clinical Framework

Dr. Miranda’s approach begins with what he calls the LION method: lids, inflammation, obstruction and nutrition. Rather than relying on a single treatment or device, the framework encourages clinicians to identify the different factors contributing to a patient’s ocular surface disease and address them accordingly.

That philosophy naturally leads to a multimodal approach. Depending on the patient, Miranda’s clinics may incorporate lid hygiene, medications, nutritional support, gland expression, IPL, radiofrequency or other technologies. The goal is not to fit every patient into the same treatment plan, but to build a system capable of adapting to what each patient needs.

Clinical results, Dr. Miranda emphasized, remain the foundation. When patients improve, they return, refer others and become advocates for the practice.

Build a Team, Not a Doctor-Dependent Service

Perhaps the biggest operational lesson from Miranda’s experience is that dry eye care should not depend entirely on the optometrist.

His clinics employ five “ocular hygienists”—team members trained to understand treatments, educate patients, perform delegated procedures and communicate progress back to the doctor. That allows dry eye services to run alongside primary eye care rather than competing with the doctor’s exam schedule.

Sian has seen a similar benefit in his own practice after training a technician to deliver treatments and document them in the electronic medical record. The shift, he said, took work off his plate while allowing treatment to continue as he performed exams elsewhere in the clinic.

Dr. Miranda believes practices often underestimate what staff members can do when they receive meaningful education and responsibility. His ocular hygienists began by observing doctors as scribes, lea