Contact lens dropout rates have not changed appreciably in nearly two decades. Although new materials and pre-

servative-free products have helped, neither was the tipping point we hoped for in contact lens practice. What’s more, as clinicians, we now face even greater challenges than we once did. The explosion in digital device use has placed an unprece-dented burden on the ocular surface, erecting yet another hurdle to com-fort. If there is one thing we have learned about contact lens dropout, it is this: We are less likely than ever to overcome it using traditional strategies. It’s time to start thinking outside the box.

In our clinical experience, and in that of many of our forward-think-ing colleagues, the most eff ective way out of what is otherwise sure to be a downward spiral is to catch as many patients as we can as they come in for their annual exams. In other words, we need to identify which patients are at risk of drop-ping out prior to fi rst fi ttings and before refi ts.

In this three-part series, we will explore how osmolarity testing

can be the catalyst for change that the contact lens industry has long sought. This surprisingly simple ap-proach is both practical and profi t-able. In this fi rst installment, we will make the case for how point-of-care osmolarity testing can benefi t your contact lens practice. We will also explore diff erent ways you can inte-grate it into your practice routine. In parts two and three, we will explain how osmolarity can help guide lens selection, setting the stage for better patient education, less dropout and a better bottom line in terms of reim-bursements.

STRATEGIES FOR TESTING

NEW WEARERS

While many clinicians believe that osmolarity testing is most appropri-ate for monitoring disease progres-sion, an even better use of tear osmo-larity testing is to determine whether a patient has dry eye disease, espe-cially in its early stage when other dry eye signs may give confl icting information. In a recent study by the National Health Service (Great Brit-ain, UK), osmolarity was shown to have the highest positive predictive value for dry eye disease compared to other routine dry eye diagnostic

tests.1 Furthermore, TearLab Osmo-larity testing is not only the most predictive test for dry eye, it’s also the fastest, requiring fewer than 30 seconds from test to result.

There are several ways to approach dry eye diagnosis at an initial lens fi tting. Some practices fi nd that the best approach is to perform osmolar-ity testing on every new contact lens patient using the TearLab Osmolarity System while others wait to perform osmolarity testing pending other in-dicators, such as a poor score on a subjective questionnaire.

If your decision to perform osmo-larity testing depends on subjective symptoms or surveys, bear in mind that dry eye disease is often asymp-tomatic—until the ocular surface is “challenged” by a contact lens, so adopting a protocol like this requires greater clinical diligence. In fact, re-search suggests that relying on symp-toms to diagnose dry eye would pro-duce a missed or incorrect diagnosis more than 40% of the time.2-4

HOW TO APPROACH REFITS

Have 50% of your current lens wearers mentioned that they have dry eye symptoms? Probably not. Yet dry eye aff ects nearly 30 million

30 REVIEW OF OPTOMETRY MAY 15, 2016

A GAME-CHANGING

APPROACH TO HELP OVERCOME

CONTACT LENSDROPOUT How point-of-care testing can grow your contact lens practice by aiding in lens selection, treatment recommendations and patient education.By Paul Karpecki, OD, and Ian Benjamin Gaddie, OD

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Americans—including 50% of all contact lens wearers.5-9 The “don’t ask, don’t tell” strategy is not work-ing for the contact lens industry and largely explains why about 16% of contact lens wearers drop out every year.10-11

A more proactive approach is clearly required. We suggest one of three options: Ask the right ques-tions, perform diagnostic testing on all lens wearers or, better yet, do both. The following probing ques-tions can help tease out information that will let you know whether a pa-tient is at risk of dropping out:• Do your eyes ever feel dry or un-comfortable?• Are you bothered by changes in your vision throughout the day?• Are you ever bothered by red eyes?• Do you ever use or feel the need to use drops, especially after pro-longed lens wear?

A yes to any of these is a red fl ag. But even if a patient reports none of these problems and is currently asymptomatic, osmolarity testing might reveal early signs of dry eye.

One of the most convenient as-pects of the TearLab test is that it can be performed while wearing contact lenses. When this quick test shows that osmolarity is high, you can use this information to guide lens selection and treatment. And, since the TearLab provides an objective score—correlating well with sever-ity—it helps encourage compliance with your recommendations. All you have to say is, “This test shows that your tear chemistry is out of normal range, which indicates that you have dry eye.” Then you can detail the steps you’ll take to lower the “score” and help patients under-

stand why you recommend a certain lens option, such as a daily dispos-able modality, which may help with comfort. We’ll discuss this in greater detail in Part 2 of this series.

SPECIAL CONSIDERATIONS

FOR PRESBYOPES

Multifocal contact lens patients can be one of the greatest profi t cen-ters in an optical practice, but can also be one of the most challenging ones since this group is at particular-ly high risk of developing dry eye. On a case-by-case basis, success with a multifocal contact lens almost al-ways hinges on ocular surface integ-rity. For this reason, we recommend that all patients who wish to be fi t in a multifocal lens be tested fi rst with the TearLab Osmolarity System.

If osmolarity reveals that there’s a barrier to successful wear, we treat it fi rst, so we have the best chance of keeping the patient happy in their lenses. The osmolarity score also aids in setting realistic expectations with a multifocal lens. When patients know that their osmolarity score is too high, they’re less likely to con-clude that multifocal contact lens-es—or worse, your clinical skills—are to blame.

In some cases, when scores are high or there is signifi cant disparity between the left and right eye, we may recommend shorter wearing times or simply waiting for the score to improve before moving the pa-tient to a multifocal lens.

THERE’S NOTHING WRONG

WITH DOING WHAT’S RIGHT

Whether a patient is male or fe-male, young or old, and wearing a daily or a specialty lens, we can help

maximize their contact lens success by proactively identifying and treat-ing patients who have tear fi lm in-stability—indicating a compromised ocular surface. Osmolarity testing allows us to catch early patients at risk of dry eye, fi t patients in lenses that they’re most likely to wear with success, and set appropriate expec-tations. It shows the need to address contact lens fi tting from a proper and essential clinical perspective, and dif-ferentiates you from the “800 Con-tact Lens” competition. This, in turn, lessens the likelihood of contact lens dropout and makes for happier, more loyal patients. In fact, the beauty of this approach is that everyone wins. Patients succeed, contact lens practice fl ourishes and doctors enjoy doing what they do best—off ering complete vision and wellness solutions.

1. Wong K, Din N, Ansari E, et al. Tear osmolarity prevalence in general NHS ophthalmic clinics and relation to clinical examination of dry eye. Poster presented at: The XXXII Congress of the ESCRS; London, UK; September 13–17, 2014. 2. Bron AJ, Tomlinson A, Foulks GN, et al. Rethinking dry eye disease: a perspective on clinical implica-tions. Ocul Surf. 2014Apr;12(2 Suppl):S1-31.3. Sullivan BD, Crews LA, Messmer EM, et al. Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications. Acta Ophthalmol. 2014 Mar;92(2):161-6.4. Fuerst N, Langelier N, Massaro-Giordano M. Tear osmolarity and dry eye symptoms in diabetics. Clin Ophthalmol. 2014 Mar;8:507-15.5. National Eye Institute. Facts about dry eye. Available at: https://www.nei.nih.gov/health/dryeye/ dryeye. Accessed: January 2015.6. Begley CG, Caff rey B, Nichols KK, et al. Responses of contact lens wearers to a dry eye survey. Optom Vis Sci. 2000;77(1):40-6.7. Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol. 2003;136(2):318-326.8. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the beaver dam off spring study: preva-lence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806.9. US Census Bureau. Age and sex composition: 2010. www.census.gov/prod/cen2010/briefs/c2010br 03.pdf. Published May 2011. Accessed June 19, 2015.10. Nichols JJ. 2010 annual report on dry eye diseas-es. CL Spectrum. 2010;15(8):22.11. Key JE. Development of contact lenses and their worldwide use. Eye Contact Lens. 2007;33(6 Pt 2):343-5.

OSMOLARITY EXPLAINEDAs the volume of the aqueous component of the tear fi lm declines, the salt concentration in tears increas-

es. This brings the tear fl uid out of homeostasis, and adds insult to the ocular surface. The TearLab test

indicates whether or not the patient has a higher salt content than normal. Therefore, hyperosmolar sta-

tus, resulting from either decreased tear production or an increased evaporative state, indicates reduced

aqueous levels and is an important indicator of ocular surface health.*

*Baudouin C, Aragona P, Messmer EM, et al. Role of hyperosmolarity in the pathogenesis and management of dry eye disease: proceedings

of the OCEAN group meeting. Ocul Surf. 2013 Oct;11(4):246-58.

31REVIEW OF OPTOMETRY MAY 15, 2016SPONSORED BY TEARLAB

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While switching materials and solutions can’t solve every pa-tient’s contact

lens woes, making a change is not without virtue in many cases. The key to success lies in making educated de-cisions that can be measured versus following the well-tread trial-and-er-ror path.

Part of the reason why 16% of contact lens wearers drop out every year1,2 is because patients and doctors hesitate to move into a more appro-priate lens. More often than not, such wavering is driven primarily by fear of the increased expense with little re-gard to the long-term consequences of discomfort.

Similarly, it’s equally precarious to switch patients into new lenses if we’re not quite sure whether the new lenses can offer any meaning-ful improvement. TearLab osmolar-

ity testing can directly address these challenges by providing an objective measure that offers peace of mind to both patient and doctor alike.

BE DIRECTIf you ask a patient how he’s doing

with his contact lenses, he will likely say he’s doing “fine”—even if he’s taking his lenses out as soon as he gets home from work. Patients are afraid that you will either tell them they can’t wear their lenses anymore or you will try to prescribe a more expensive lens. To combat this, it’s important to ask specific targeted questions such as, “Do you feel like you need to take your lenses out when you get home from work?” Any patient who says “yes” is a dropout waiting to happen. Or ask how the comfort compares when first inserting the lenses to when removing them at the end of the day on a 1 to 10 scale. What’s more, these patients don’t merely drop out

of lenses, they tend to drop out of the practice as well. Missed annual exams are a common byproduct of contact lens dropout with consequences that can far outweigh a conversation about pricier contacts.

STAY ONE STEP AHEADDry eye affects nearly 30 million

Americans—including 50% of all contact lens wearers.3-7 Therefore, even if a patient is asymptomatic, we must be diligent about address-ing the ocular surface before it’s too late. Indeed, research suggests that relying on symptoms to diagnose dry eye would produce a missed or incorrect diagnosis more than 40% of the time.8-10 Without the use of mea-surable clinical indicators, these pa-tients are at risk of one day dropping out of contact lenses.

For this reason, anytime a contact lens patient shows a sign or symp-tom of dry eyes, we test their osmlar-

CASE #1 A 36 year-old female presents wearing Acuvue 2 monthly replacement (OD -2.75, OS -3.00). The patient reports that her eyes are irritated and she needs to take out her contact lenses when she gets home from work. She also reports that her wearing time has diminished and comfort has decreased. Slit-lamp exam reveals clear corneas and Grade 1 GPC OU, with all other findings normal. Osmolarity scores are 308 OD and 311 OS. We recommended switching to a daily replacement lens, but the patient was wary of the increased cost. The patient agreed to try Dailies Total One for one week to see how her eyes would feel.

At the one-week visit, the patient commented on how much better her eyes feel, adding that she now has to remember to take the contacts out before going to bed. Slit-lamp exam showed minor GPC with no in-jection. Osmolarity scores were lowered to 299 OD and 300 OS. Convinced, the patient is currently wearing the new lenses.

30 REVIEW OF OPTOMETRY JULY 15, 2016

FITTING WITH

CONFIDENCE How osmolarity testing can help guide contact lens selection and make patients feel good about choosing healthier options—even when they cost more. By David Geffen, OD and Paul Karpecki, OD

ity with the existing contact lenses in place. One of the most convenient as-pects of the TearLab test is that it can be performed while wearing contact lenses.

If osmolarity is out of range, we recommend that the patient trial a dif-ferent lens. Explain that there is no ob-ligation to switch. You are simply test-ing out the new lenses to determine whether it will make a difference. Most patients are eager to try new lenses when there is an understanding that it’s just a test drive.

After the trial is over, check osmo-larity again and compare the num-ber with what you measured in the initial lens. Present this data to the patient and ask if they also feel any different. When patients are present-ed with hard numbers on top of the general improved comfort that they often experience, they are much more likely and willing to make good choic-es—regardless of cost. Indeed, an im-proved osmolarity score goes a long way toward justifying increased con-tact lens expenses and a better patient experience.

Keeping presbyopes in contact lens-es can be especially challenging since this group is at particularly high risk of developing dry eye. Patients who wear multifocal lenses tend to have dryer eyes to begin with and are a lot more likely to drop out. As clini-cians we tend to regard prebyopes as a group looking for simplicity and we sometimes ask ourselves “why fight it?” Yet keeping this population happy does not need to be complicat-ed. When you check the osmolarity scores in a presbyope’s current lenses

and then compare them to improved scores in a different lens, these pa-tients readily recognize the healthier advantages. Switching alone without producing an osmolarity score, on the other hand, is more challenging. We have found that some of the newer technology lenses help significantly regarding osmolarity improvement of the tear film.

EVIDENCE DEMONSTRATES VALUE

Osmolarity testing allows you to justify your clinical decision-making in a way that patients can easily un-derstand. When this quick test shows that osmolarity is high, it opens the door to a conversation about why try-ing something new is in the patient’s best interest.

TearLab osmolarity testing is one of the few tests we have to confirm dry eye, and it’s the most predictive test for dry eye. It provides scientific, objective proof and reasoning for our recommendations. It’s also the fastest

test for dry eye, requiring fewer than 30 seconds from test to result.

As we discussed in part one of this series, the most effective way to com-bat dropout is to identify patients who are at risk before they start to complain (see A Game-Changing Approach to Help Overcome Contact Lens Dropout, May issue, page 30). Once a patient is com-plaining it’s often too late. We need to identify which patients are at risk of dropping out prior to first fittings and at each exam thereafter. The TearLab test makes this easy to accomplish. And, in the event you need to ask a patient to spend more money, you can be sure that the patient can see real value in the objective evidence that you present.

1. Nichols JJ. 2010 annual report on dry eye diseases. CL Spectrum. 2010;15(8):22.2. Key JE. Development of contact lenses and their worldwide use. Eye Contact Lens. 2007;33(6 Pt 2):343-5.3. National Eye Institute. Facts about dry eye. Avail-able at: https://nei.nih.gov/health/dryeye/dryeye (last accessed June 13 2016).4. Begley CG, Caffrey B, Nichols KK, et al. Responses of contact lens wearers to a dry eye survey. Optom Vis Sci. 2000;77(1):40-6.5. Schaumberg DA, Sullivan DA, Buring JE, et al. Prevalence of dry eye syndrome among US women. Am J Ophthalmol. 2003;136(2):318-26.6. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the beaver dam offspring study: preva-lence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806.7. US Census Bureau. Age and sex composition: 2010. http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf (last accessed June 13, 2016).8. Bron AJ, Tomlinson A, Foulks GN, et al. Rethinking dry eye disease: a perspective on clinical implica-tions. Ocul Surf. 2014 Apr 12(2 Suppl):S1-31.9. Sullivan BD, Crews LA, Messmer EM, et al. Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications. Acta Ophthalmol. 2014 Mar;92(2):161-6.10. Fuerst N, Langelier N, Massaro-Giordano M. Tear osmolarity and dry eye symptoms in diabetics. Clin Ophthalmol. 2014 Mar;8:507-15.

31REVIEW OF OPTOMETRY JULY 15, 2016SPONSORED BY TEARLAB

CASE #2A 33 year-old male reports that his contact don’t feel as comfortable as they used to. He has been wearing Frequency 55 (-5.00 OD, -4.50 OS) for the past seven years and reports that he replaces them about every month. He uses Kirkland disinfectant. Slit lamp reveals Grade 1+ Papilla OU and minor injection OU. Osmolarity was 307 OD, and 312 OS.

We recommended that the patient switch to a daily lens to im-prove comfort and compliance. Though the patient was wary of cost increase, we asked him to trial Biotrue ONEday.

At the one-week visit, the patient reported great improvement in comfort and much clearer vision. He says he can now wear lenses all day and not think about them. Osmolarity dropped to 300 OD/OS. The patient purchased an annual supply of the new lenses.

CASE #3A 59 year-old female presented wearing PureVision2 multifocal (+1.00 high OD, +1.25 high OS). She reported that comfort has consis-tently decreased with her contacts over past five years and her vision has become more variable. She is thinking of giving up contacts for glasses, concluding that her lenses are “not worth the hassle.” Slit-lamp exam reveals G1 MGD, dry eyes, and grade 1 injection OU. Osmolarity is 319 OD and 320 OS.

We educated the patient about new innovative technology in the ULTRA for Presbyopia lens material and described how this would be better for her. We also ask her to use artificial tears, start Omega fatty acids, and use a Bruder mask for 10 minutes a day.

At the one-week visit, the patient feels much better in her contacts. She reports that her eyes feel much less dry, and her vision is not variable throughout day. Her osmolarity also dropped to 307 OD/OS. Considering the great overall improvement, she proceeds with the ULTRA for Presbyopia lenses.

Like doctors in almost ev-ery other sector of health care, today’s optometrists face signifi cant challenges. For example, we are in-

creasingly aff ected by health care re-form, vertical integration, changes in patient benefi t structure, third-party plan participation, increasing over-head costs, and more. All of these im-pact our traditional revenue streams. Yet even in the face of these hurdles, we strive to deliver improved clini-cal services. The evolution of point-of-care laboratory testing has been instrumental in our ability to do this.

In many ways, point-of-care testing helps us to overcome fi scal challenges while simultaneously elevating the standard of care. As such, diagnostics like TearLab osmolarity testing, are quickly gaining traction in the average optometric practice and are weaving their way into daily clinical regimens.

In part 3 of this series on how osmo-larity testing can benefi t your contact lens practice, we will discuss how the clinical value of TearLab testing off ers a hidden revenue stream that extends far beyond direct reimbursement.

CONSIDER THE CLINICAL VALUE

The majority of the point-of-care testing that’s currently performed in eye care practice is related to the an-terior segment. Within this segment, the largest area of potential is ocular surface disease. Dry eye aff ects nearly 30 million Americans, including 50% of all contact lens wearers.1-5 Further-more, research suggests that if we

were to rely on symptoms to diagnose dry eye, this would produce a missed or incorrect diagnosis more than 40% of the time.6-8

Without question, there is an oppor-tunity here to improve care as well as quality of life for contact lens wearers. Despite a 20-year parade of contact lens improvements, dropout rates have not fallen. About 16% of contact lens wearers drop out every year.9-11 As we discussed in the fi rst two install-ments of this series, osmolarity test-ing can be a catalyst for meaningful change in this regard.

Osmolarity testing allows us to de-termine objectively and quantitatively the quality of the tear fi lm in dry eye and the severity level of the condition, off er appropriate treatment as needed, determine the likelihood of imminent contact lens dropout, and fi t patients in lenses based on clinical variables in-stead of monetary ones that are based on a patient’s knee-jerk decision to se-lect the least expensive available lens. This alternative, proactive approach

sets the patient up for success and, in so doing, helps strengthen your practice.

WHERE TO START

Like many of the tests that are per-formed at the point of care, to perform and bill for TearLab osmolarity testing, your offi ce will need a CLIA waiver license. By defi nition, CLIA stands for Clinical Lab Improvement Amend-ments. This means that your offi ce will need to be designated as a CLIA-ap-proved laboratory, and one of the doc-tors must be designated and approved as a clinical lab director. To begin this simple process, you’ll need to apply through CMS to get your CLIA certi-fi cation.12 The cost is only $150 for two years.13

You may have heard the argument that point-of-care testing isn’t worth-while because the reimbursements aren’t substantial. This is only half true. Indeed, point-of-care testing is rarely a huge profi t center from the myopic perspective of direct reimbursement, although reimbursement more than

FIGURE 1

Number of annual patients 3,100

Percent of patients who wear CLs 34%

Number of contact lens patients 1,054

Average annual value of a contact lens patient $275

Average contact lens dropout rate 16%

Average number of contact lens dropouts 169

Annual economic value of your contact lens

patients

$46,376

Lifetime economic potential of eliminating your

contact lens dropouts

$2,086,920

22 REVIEW OF OPTOMETRY AUGUST 15, 2016

By John Rumpakis, OD, MBA, and Paul Karpecki, OD

THE VALUE PROPOSITION: CLINICAL LAB TESTING IN

OPTOMETRIC PRACTICE

covers the cost of the disposables. However, tests like TearLab are fi nan-cially rewarding when they help you maintain and grow your contact lens practice by providing accurate clinical assessment at the point of care. Con-sider the benefi ts of knowing whether a patient has a healthy and stable tear fi lm so you can choose the most suit-able lenses and treatment to help that patient maintain healthy, comfortable wear. Osmolarity testing also helps you manage dry eye more effi ciently because, even though symptoms are usually the last thing to improve, im-provement in osmolarity scores off ers piece of mind that the patient is on the right path.

It’s also important to clarify that, in terms of growing the contact lens segment of your practice, success with the TearLab test is not dependent upon whether you perform testing on the same day as the primary visit or if you bring the patient back for a dry eye evaluation. In either case, the advantage stems from the value of the data itself and what that data enables you to achieve clinically in terms of outcomes in your contact lens patient population.

THE HIDDEN PROFIT CENTER

The direct reimbursement for Tear-Lab osmolarity testing is a modest $22.50 per test/per eye—or $45 per pa-tient since two eyes must be tested—according to the 2016 CLIA Medicare Fee Schedule.14 Commercial payers pay slightly less. But consider what this test allows you to achieve in terms of patient care. If this test leads you to properly diagnose ocular surface dis-ease and prevent contact lens dropout, the economic return potential is sig-nifi cant. In addition, there is revenue upside in dry eye treatments such as omega-3 supplements, MGD treat-ments, punctal plugs, etc.

Consider that the mean annual val-ue of a single contact lens patient is about $275. Assuming your practice has a 16% dropout rate—which is low compared to data in many studies—you could be missing out on millions of dollars in revenue over the course

of about 45 years (see Figure 1).15 And most importantly, you would allow patients who want to wear contact lenses to remain in them.

Figure 1 shows a lifetime impact of contact lens dropout of more than $2 million. For the sake of argument, let’s look at these fi gures even more con-servatively. Since the prevalence of ab-normal osmolarity is 62%, at least 50% of dropout should be due to dry eye disease. This would still provide an impressive lifetime value of $1 million. And this does not account for any ad-ditional revenue that you would gen-erate treating this dry eye population.

Osmolarity testing allows you to get ahead of dry eye in your contact lens wearers and enables you to justify your clinical decision-making in a way that patients can easily understand. This may mean the patient needs treat-ment or it may mean the patient would benefi t from a higher-end contact lens. In either case, you are staying in front of the problem instead of falling victim to its consequence.

Also, consider that losing a contact lens patient not only costs you the ma-terial revenue stream, in many cases you also incur the “replacement cost” of bringing in a new patient to replace the one who has sought out a solution from another provider.

When clinical tools like the TearLab test help you keep patients comfort-able and happy in their lenses, they are of tremendous value—in every respect.

CHANGE FOR THE BETTER

They say that necessity is the mother of invention. That certainly rings true

regarding the role of TearLab testing in contact lens practice. Instead of al-lowing changes in health care to take the wind out of our sails, we ought to anticipate change, embrace it, and di-rect it to help deliver better clinical out-comes and stronger bottom lines.

1. National Eye Institute. Facts about dry eye. Available at: https://nei.nih.gov/health/dryeye/dryeye(last accessed January 2015).2. Begley CG, Caff rey B, Nichols KK, et al. Responses of contact lens wearers to a dry eye survey. Optom Vis Sci. 2000;77(1):40-6.3. Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol. 2003;136(2):318-26.4. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the bea-ver dam off spring study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806.5. US Census Bureau. Age and sex composition: 2010. http://www.census.gov/population/age/data/2010comp.html. Published May 2011. Accessed June 19, 2015.6. Bron AJ, Tomlinson A, Foulks GN, et al. Rethinking dry eye disease: a perspective on clinical implications. Ocul Surf. 2014 Apr 12(2 Suppl):S1-31.7. Sullivan BD, Crews LA, Messmer EM, et al. Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications. Acta Ophthalmol. 2014 Mar;92(2):161-6.8. Fuerst N, Langelier N, Massaro-Giordano M. Tear osmolarity and dry eye symptoms in diabetics. Clin Ophthalmol. 2014 Mar;8:507-15.9. Rumpakis J. New data on contact lens dropouts: an international perspective. Rev Optom. 2010 Jan;147(1):37-42.10. Nichols JJ. 2010 annual report on dry eye diseases. CL Spectrum. 2010;15(8):22.11. Key JE. Development of contact lenses and their worldwide use. Eye Contact Lens. 2007;33(6 Pt 2):343-5.12. http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS116.pdf13. https://www.cms.gov/Regulations-and-Guidance/Legis-lation/CLIA/downloads/clia_certifi cate_fee_schedule.pdf (last accessed June 3, 2016).14. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/clinlab.html15. Rumpakis J. Economics of apathy: Doing nothing is easy, but expensive. Review of Optom. 2013 Oct;150(10):65-72.

HOW TO CODE FOR THE TEARLAB OSMOLARITY TEST

CPT coding for TearLab is straightforward:

CPT 83861: Microfl uidic analysis utilizing an integrated collection

and analysis device, tear osmolarity.

If I were testing both eyes and coding for it, this is what the claim

form would look like:

• 83861-QW-RT (paired with appropriate ICD-10, coded for laterality)

• 83861-QW-LT (paired with appropriate ICD-10, coded for laterality)

Clinical lab tests can be performed and billed for on the same day

as any offi ce visit, including a vision visit, whether a 992XX or 920XX

code, so you don’t have to reschedule the patient to perform the tests

or to get reimbursed for the tests.

WHY TEARLAB?

TearLab osmolarity testing

is one of the few tests we have

to confi rm dry eye. It’s also the

most predictive test for dry eye.

It provides scientifi c, objective

proof and reasoning for our

contact lens recommendations.

It can be performed on patients

while they are wearing their

lenses, and it requires fewer than

30 seconds from test to result.

23REVIEW OF OPTOMETRY AUGUST 15, 2016SPONSORED BY TEARLAB