Eyeworld

OPHTHALMOLOGY BUSINESS 106 February 2015 by Vanessa Caceres EyeWorld Contributing Writer Skin allergy testing another option for eye practices congestion as an "extremely bother- some" symptom of their allergies. 1 "When providers were asked about the symptoms causing most patients to seek medical treatment, it was apparent that ocular allergy symp- toms are a driving force, cited by almost two-thirds of the providers sampled," study investigators wrote. When itchy eyes occurred, survey re- spondents said they were most likely to seek treatment from pediatricians (for children), followed by ophthal- mologists or optometrists, and nurse practitioners/physician assistants. Another AIRS survey reported last year that even though ophthal- mologists and optometrists com- monly diagnose ocular allergies, the vast majority (96%) do not administer allergy skin testing. 2 Goals include reducing patient symptoms, building practice A s ocular and nasal aller- gies affect more people at an astounding rate, there's an emerging trend among eye doctors—add- ing allergy skin testing to pinpoint possible allergic triggers and tailor treatment. One reason that ophthalmolo- gists may consider doing this is simply because their patients are tired of itchy eyes. Results re- ported last year from the Allergies, Immunotherapy, and Rhinoconjunc- tivitis (AIRS) surveys found that red, itchy eyes were second only to nasal " At first blush, what we're doing may seem competitive with allergists or ENT specialists, but if we can identify allergies, we've done the patient a favor and generated a referral. " –Robert J. Weinstock, MD Eye doctors already provide relief to patients with prescriptions for appropriate drops or sometimes intranasal sprays, but allergy testing can help both the clinician and pa- tient hone in on the causes of their symptoms. Skin testing has long been the domain of allergists—and more recently some family practitioners, pediatricians, ENTs, and pulmonol- ogists. Physicians outside of allergy will offer it for patient convenience, to confirm a suspected diagnosis (e.g., allergic rhinoconjunctivitis), to direct therapy (e.g., avoidance, allergen immunotherapy), and to help their practice financially, said allergist Fred Schaffer, MD, chief medical officer for United Allergy Services (UAS), San Antonio, and associate professor of allergy, Medical University of South Car- olina, Charleston. United Allergy Services works with several thousand practices to provide what is need- ed for allergy testing and therapy, including at-home allergy shots. He also sees non-allergists entering the area of allergy testing because of the growing number of patients who need testing and therapy—and the projected decreasing number of practicing allergists. Some ophthalmologists be- lieve such tests can serve both as a practice builder and as a way to help improve their allergic patients' overall ocular surface health. "We see patients with dry eye, meibomian gland dysfunction, or allergic conjunctivitis—or a combi- nation of these things," said Robert J. Weinstock, MD, the Eye Institute of West Florida, Largo, Fla., whose practice now offers allergy skin testing. How it works at one practice Allergy skin testing for patients who need it is just one of several tests eye doctors can now offer to pinpoint and treat the ocular surface, Dr. Weinstock said. Other tests he uses include tear osmolarity and a matrix metalloproteinase test. Results from these tests help physicians decide on the appropriate treatment. Dr. Weinstock's office uses an allergy skin test designed for oph- thalmic practices and offered by Doctors Allergy Formula (Norcross, Ga.). Instead of traditional skin prick testing, the test through Doctors Allergy Formula works more like a stamp on the forearm, making it less invasive, Dr. Weinstock said. The company's tests are designed specif- ically for each area of the country and its allergic triggers, in addition to triggers common everywhere, such as dust. Food allergies are not tested as Doctors Allergy Formula tests for the most common ocular- specific antigens in each region, Dr. Weinstock said. The test takes about 20 minutes and is performed by a technician with a physician in the building, in case any issues or ques- tions arise. Dr. Weinstock offers allergy skin testing to patients who are not un- der the care of an allergist and who have not had skin testing before. If the patient does not have a strong reaction that would indicate allergy

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