Eyeworld

107 February 2015 OPHTHALMOLOGY BUSINESS Editors' note: Dr. Weinstock has financial interests with Doctors Allergy Formula. The other sources have no financial interests related to their comments. Contact information Bielory: drlbielory@gmail.com Glazier: aglazier@youreyesite.com Pinto: pintoinc@aol.com Schaffer: fred.schaffer@unitedallergy.com Weinstock: rjweinstock@yahoo.com References 1. Bielory L, Skoner DP, Blaiss MS, Leather- man B, Dykewicz MS, Smith N, Ortiz G, et al. Ocular and nasal allergy symptom burden in America: The Allergies, Immunotherapy, and Rhinoconjunctivitis surveys. Allergy Asthma Proc. 2014;35:211–218. 2. Blaiss MS, Dykewicz MS, Skoner DP, Smith N, Leatherman B, Craig TJ, Bielory L, et al. Diagnosis and treatment of nasal and ocular allergies: the Allergies, Immunotherapy, and Rhinoconjunctivitis (AIRS) surveys. Ann Allergy Asthma Immunol. 2014.112:322–328. digital.ophthalmologybusiness.org Allergy statistics • Allergic disease has been increasing in the industrialized world for more than 50 years. • About 40% to 50% of children are sensitized to one or more common allergens. • Allergic rhinitis affects 10% to 30% of the world population. • There was a primary diagnosis of allergic rhinitis in 11.1 million physician visits in 2010. • Ocular allergy symptoms occur in 64% of people with nasal allergies. 2 Source: American Academy of Allergy, Asthma, and Immunology sensitivity, he will investigate other causes of ocular surface irritation. If the patient needs allergy treat- ment, physicians at his office will educate the person about his or her specific triggers and start them on appropriate antihistamines or other medications. There are certain patients Dr. Weinstock will refer to an allergist or ENT specialist. "I'll refer if a patient's reaction on the test is strong, show- ing a clearly overactive immune system," he said. Such a reaction indicates the patient likely needs systemic treatments and perhaps allergy shots. "At first blush, what we're doing may seem competitive with aller- gists or ENT specialists, but if we can identify allergies, we've done the patient a favor and generated a referral," he said. Another benefit of testing is giving credence to a patient's allergy complaints, which often can be ignored by doctors, Dr. Weinstock said. One consideration for adding skin testing is to find a technician who is a champion for the topic, Dr. Weinstock recommended. His technician who handles testing has their own clinic and schedule, with patients scheduled 30 to 40 minutes apart. That gives the technician time to do the test and another few minutes to go over the results. The technician also can start the patient on treatment drops under a physi- cian's guidance. Reimbursement has been rela- tively easy, Dr. Weinstock said. "We use well-established codes for skin care testing that are used by ENT specialists and primary care doctors. It's a favorable reimbursement mod- el," he said. Clients with UAS almost always offer both testing and therapy, Dr. Schaffer said. However, he sees a possibility for a practitioner like an ophthalmologist to partner with a family practice physician who uses their services and who could provide shots to patients if needed, he said. He also pointed out that the UAS enables patients to do many of their shots at home, which cuts down on office visits. Cautions, thoughts to consider Leonard Bielory, MD, presently principal investigator for the U.S. Environmental Protection Agency on climate change and allergic air- way disease, Rutgers University, and attending, Robert Wood Johnson University Hospital, New Bruns- wick, N.J., has heard of eye practices adding allergy skin testing and even visited one in Florida. (Dr. Bielory is also a co-author on two of the AIRS studies cited earlier in this article.) As allergy testing in eyecare is such a new area, he would like to see ophthalmologists get a firmer grip on referring positive skin results to allergists and have a clearer under- standing on what insurers will cover if ophthalmologists handle allergy treatment in-house. It would be helpful for oph- thalmologists considering the idea of testing to know if allergists in their area will retest new patients, something that commonly occurs to make sure patients receive compre- hensive testing, Dr. Schaffer said. "It depends on the nature of the testing, the panel given, and the doctor's philosophy," he said. Practice management consul- tant John B. Pinto, president of J. Pinto & Associates, San Diego, has some cautionary words. "For more than two generations, eye surgeons have been searching for a 'holy grail' supplement to the core profession of providing eyecare," he said. "It's too early to tell if providing allergy services will be a hit or a fad. I'm inclined to forecast the latter. For the vast majority of eye surgeons, sticking to the knitting is most ap- propriate." Another way to address aller- gies more comprehensively is with the creation of a dry eye center of excellence, a branded effort some eye practices are using now. At Shady Grove Eye and Vision Care, Rockville, Md., Alan Glazier, OD, FAAO, provides a battery of diag- nostic tests and treatments related to dry eye and ocular allergy within arm's reach. Although skin testing is not offered, he will clinically assess for ocular allergies and talk with patients about the circular relation- ship that dry eye and ocular allergies often have. He often refers patients to other specialists if he suspects strong allergies. 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