Eyeworld

62 | EYEWORLD | SUMMER 2026 C ORNEA Contact Ahmad: ashraffreddieahmad@gmail.com Galor: AGalor@med.miami.edu Toyos: mtoyos@toyosclinic.com episodically, like the InflammaDry MMP-9 test [QuidelOrtho]. When the upfront cost has already been paid for, it's more of a sunk cost," she said Getting coverage for dry eye diagnostics or treatment is very subjective based on an indi- vidual's insurance plan and reviewers, Dr. Toyos said. However, she said clear documentation of symptoms, objective findings like corneal stain- ing, tear breakup time, meibomian gland im- aging and descriptions, and a thorough history of failure or intolerance to prior treatments are helpful. Dr. Ahmad also noted the importance of documenting both subjective and objective findings, past treatment history, and response. "This creates a streamlined timeline of what the patient has tried in the past as well as serves as a detailed justification for future testing and treatment," he said. Dr. Toyos said if a proposed diagnostic tool or treatment is not covered by insurance, she has found having a value-based discussion to be the most effective when speaking to her patients. "The value is in understanding and validating symptoms along with the ability to customize treatment (addressing inflammation, corneal nerve density, meibomian gland dys- function) and how aggressive to be in each cat- egory. This ultimately saves time and frustration and helps to deliver results. Patients respond to the feeling of being informed and the ability to take control of what is often a very frustrating, poorly understood condition," she said. Transparency and education are key with these discussions, Dr. Ahmad said. "Patients ap- preciate it when their physician takes the time to explain their condition and the rationale for why certain diagnostic testing is ordered," he said. "We emphasize that these options are not mandatory but can enhance the level of care we provide." Dr. Galor said practices that have a specific focus on dry eye often have payment packages that are like that of cataract surgery that use advanced technologies and lenses beyond those approved by Medicare coverage. "I think some practices make money from dry eye, and for others, it's less of a money maker. Everyone needs to decide what aspects of ophthalmology they want to focus on and whether the econom- ics make sense for them." With dry eye coming a long way since the days of over-the-counter tears, heat patches, and punctal plugs as the mainstays, Dr. Toyos said it's encouraging that more people than ever, both clinicians and industry, continue to develop solutions that focus on dry eye. "Dry eye today is a measurable, multifac- torial disease requiring layered and complex diagnostics and treatment paradigms to address chronic inflammation with structural and neuro- logic components," Dr. Toyos said, adding, "We have had more dry eye approvals in the last 5 years than we have had in the last 25, and I think that we will continue to develop treat- ments and protocols that can help us bring re- lief to even the most difficult dry eye sufferers." With dry eye's chronicity and its impact on the surgical outcomes of other procedures, par- ticularly in the refractive space, Dr. Ahmad said he expects changes within the reimbursement landscape, hopefully trending toward more consistent coverage. Alongside that, he antici- pates that "innovation will continue along with the gap between it and reimbursement, which is why practices that utilize a pay-for-service testing will continue to succeed." Dr. Galor said it's important to recognize with dry eye that "there's not one right way." "You can be a great diagnostician and clini- cian without any fancy equipment. … Until we have companion diagnostics that predict which drop or device patients are going to respond to, everyone needs to look at their own practice and see what makes sense for them," Dr. Galor said. continued from page 61 The InflammaDry MMP-9 test (left) is reimbursable, while confocal microscopy (right) is not. Source: Anat Galor, MD

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