Episode Transcript
[00:00:00] Speaker A: Welcome to the Dry Eye podcast series. Click on dry Eye, your insider paths to the most exclusive dry eye topics. The series will raise awareness about the current and future state of ocular surface disease. The podcasts will focus on a variety of topics. Before we get to our next episode, here's a quick word from our sponsor.
[00:00:21] Speaker B: This episode of Dry Eye Coach is sponsored by Tea Pharma, Inc. The makers of Ivisia and Iuza. For more information on Tea Pharma Incs portfolio, please visit teaharmainc.com. that's Thea pharmainc.com.
[00:00:39] Speaker A: Welcome to the podcast Doctor Jason de Sucker. He is in a very unique practice that we're all going to be learning about in our conversation today. So welcome, doctor. Why don't you tell us a little bit about yourself and a little bit about what you've been up to lately.
[00:00:58] Speaker B: Awesome. Well, first off, it's such a pleasure to be here. Thank you Doctor Dahl, Doctor Whitley for inviting me to be on your podcast.
It's so awesome to be in the presence of such great clinicians and educators, and it's just really an honor to be here. And thank you for anybody who's watching or listening this.
You must really care about this disease state if you're listening to this, and we appreciate your passion in that as well.
So like doctor Dahl said, I'm Doctor Jason Bsecker. I'm the founder of Envision specialty Eye Care and Dry center in Meridian, Idaho.
Founded the clinic in July of 2021. Cold start founded the practice. No optical, no contacts, no glasses, just mainly all dry eye all the time. We do a little other disease. I help out some other doctors with some emergency things, but mainly the dry eye. Built off referrals from other optometrists and other ophthalmologists was the idea of the clinic.
[00:02:04] Speaker C: So did you model this clinic after something? Because this is unique.
We hear of a couple referral practices that are optometry referral practices.
How did you come up with this and what was your previous experience before? Were you in private practice? Were you at the co management center or. Tell us more.
[00:02:24] Speaker B: Yeah, I was in a referral based cataract and Lasik center is kind of one of the premier ones in our area. So we had a lot of doctors, a lot of optometrists and some other ophthalmologists referring over their LaSIK patients and their cataract patients and oh jeez, it was probably about four or five years ago I started noticing every time I opened up my gmail there was something new about dry eye. There's dry eye this, dry eye that, and it's still that way to this day. Every time I open my email, maybe it's the things that I follow, I don't know. But that was around the time Zydra was coming out. Tear care IPL started gaining a lot more traction. So we started to have a lot more opportunities to help these patients. And, you know, I saw that opportunity. I went to the owners of the practice and said, hey, we have these opportunities. We can help these patients. And they really just wanted to focus on the cataracts and LASIK, which is great. I like that they have their focus and they wanted to stick with it, and they said, well, we'll let somebody else do that. And I think little did they know that I was going to be the one who set out and did that. Kind of based it off of their model of referral base for cataracts and Lasik. I figured, you know, I could possibly do the same thing with, with ocular surface disease.
[00:03:56] Speaker A: So you're immensely passionate about this. Was. I knew an idea that just, you know, came out of that Comanche setting, which makes perfect sense. Can you speak to how many of the patients that you've seen in that co management center that were experiencing dry eye around those procedures?
[00:04:12] Speaker B: Oh, man. I mean, there's definitely a lot. I think, you know, most of us know that dealing with, you know, post post op cataract patients, it's. It's not uncommon to have, have dryness. And a lot of the times these patients weren't experiencing dryness before, and then they have cataract surgery, and all of a sudden they have dryness. And so in their mind, you know, cataract surgery gave them the dry eye. And same with Lasik that, you know, that similar, similar type of situation. So there was a. There was a large. A large number of patients. I don't know exact numbers, but, but there's a. There was a large number. And especially, you know, I was dealing with a lot of elderly populations with cataracts, and they're going to have a lot of dry eye as well. So there was, you know, a large number of patients, a great need that I saw that was really not being met in our community. There wasn't a lot of. There wasn't a lot of other doctors, you know, bringing on this newer technology, doing the, the higher level of care for these, these patients. So there was really a, a big unmet need that I saw in the community, a big opportunity to help these patients that were, a lot of them just get pushed to the side, unfortunately.
[00:05:21] Speaker C: Yeah, we've talked about this before, especially with cataract or any surgery you identify before surgery. It's the patient's problem. If you identify after. It's a gift that keeps on giving. And actually had a patient the other day that was, she just had surgery maybe a month out, complained about dry eye. She goes, you know, my eyes are really bothering me. And she goes, she goes, I never had this before surgery. And I said, okay. And one thing that we do is we do the speed two questionnaire on all the patient and her number 20. And I was like, ma'am, actually, you've had this for a while. It's just you're notice, you're more aware of your eyes more. But then she goes, oh, yeah, you're right. I've had it for a while. But documentation is important, especially surgical practice.
[00:06:02] Speaker B: Oh, yeah. 100%. Hundred percent.
[00:06:06] Speaker C: So you started. Go ahead, Chris.
[00:06:08] Speaker A: I think we were gonna ask the same question. You ask it, Walt.
[00:06:10] Speaker B: How do you go?
[00:06:13] Speaker A: So you decided that you had this passion, and then, you know, where did you start from there? How did you decide what type of technology you were going to put in your clinic? How did you determine that?
[00:06:25] Speaker B: So, so I was planning the clinic probably for two years, maybe two to three years before I actually opened it.
Cause I was looking around and not many people were doing this. In fact, I couldn't really find anybody that was doing this. A cold start, no optical, no contacts. I've seen people build it out of their primary care clinics, but as far as just cold starting to dry eye, I haven't seen that. I know doctor Laura Perrimanden has, has done that, and, you know, she has a little bit different position, but. So I wasn't even sure if it was something that could be done. And so I just started doing a lot of research and looking at different things, learning a lot more about dry eye. That was during the time where Doctor Art Epstein, he was doing a lot of the dry eye master classes. So I was watching all those. So I learned a lot from him. You know, a lot of what I do is based on how Doctor Epstein would manage his patients.
And so, yeah, just doing a lot of research and researching at that time. Lipiflow tear care, IPL, looking at the results, what's going to get us the best results. So just a lot of research beforehand to try to figure out what was going to be best to bring into the clinic.
[00:07:48] Speaker C: Yeah, I mean, that research is going to be key. And you got to know your numbers because, well, first you need to get that loan to start, to start the practice. But, you know, in business, if you don't know your numbers or anything, you don't know your numbers, you're not going to grow. And so knowing what those numbers for doing an IPL procedure or LLT or whatever it may be, you know, how much is that over a lifespan of a patient, whether it's going to be a year, whether it's ten years or whatever, but that's always important numbers, especially if you're growing any practice and try to take it to the next level.
[00:08:23] Speaker A: So what did you buy first?
[00:08:29] Speaker C: So we're gonna go with diagnostics first. If you have a diagnostic, which is the one you go with first.
[00:08:35] Speaker B: So, oh, man, that's tough because I'm big on imaging. You know, how I drive. Compliance, I feel with my patients is imaging and education. So I spend a lot of time with my patients, educating them about the conditions and showing them the pictures. So pictures, I think the old adage picture says 1000 words. It really goes a long way. So, I mean, slit lamp camera is gold in my book. You start showing them pek on the surface of their cornea instead of just trying to explain to them what's going on, and then they realize, oh, that's why my vision isn't good. I'm looking through this windshield that's been sandblasted.
My biography, I think, is very important as well, to be able to show them their glands. You know, I have a 40 inch television. I put their my biography on a 40 inch television, and I have a huge Meibo scale blown up next to it so they can see where they're at, where good is, where bad is, where they don't want to be. And I explain to them these things. You know, hey, this is where you're at on the scale. And, you know, this has been going on for a long time. You didn't just get here overnight. But what we also want to prevent is getting from down here, like level four. You don't want to get great for my biography. That's when you're going to have a lot worse symptoms and just things are a lot harder to manage. So imaging, I think, is really important as far as diagnostics. So I don't know, it'd be hard to say. I'd probably have to go with a slip lamp camera over my biography, but I think they're both very important diagnostics.
[00:10:01] Speaker C: All right, Tracy, I'll let you play pick one.
[00:10:05] Speaker A: Okay. So when I didn't start a cold practice, but I joined one that didn't have a dry eye center, and that's what they wanted me to put in. So I got a diagnostic that had my biography in it, because I did find that when patients see that their anatomy is missing, they're very motivated to do something about it. So my biography is probably the biggest motivator when it comes to my boming gland dysfunction. But, yeah, I did want something. Had some, a little bit more imaging capabilities so that I could show people their crusty demodex lashes, and I could show them that, that corneal and conjunctival staining, because if you can show a patient what's wrong, they're definitely more motivated to get forward. So I have an oculus keratograph. I find that it does a really good job and has a nice printout for the patients to follow in instructions, but that's, that's what I have at my clinic for advanced imaging.
[00:11:01] Speaker C: I'm going to play, too. And since you already made an answer, I could pick something else. Just because I'm going to say speed to, and just because it's an object of, of a subjective, you know, disease where everybody feels it differently. You can get your baseline, you can determine if you're getting better or worse on whatever treatment, whether it's pharmaceuticals, whether it's a procedure. And so that's a low hanging fruit. And anyone that has a score of seven or higher, those are patients that I'm going to be doing an evaluation on.
What score do you all use? I heard someone do a three the other day.
[00:11:35] Speaker B: Oh, geeze. I mean, I'm lucky if any of my patients get below seven, honestly, because a lot of them are kind of far down the. Far down the line. So if anybody's below a seven, I kind of think, well, you don't really have drug in my clinic.
But that was.
[00:11:51] Speaker A: I totally agree. I totally agree. I'm like, if we can get you below an eight, was that cut off for symptoms? We're doing great.
It does feel really good when you see people that just draw a line down the one side of the column, and then when you get to the end of your induction therapy, they draw a line down the other side of the column. That's the best feeling.
[00:12:10] Speaker B: It is. And good point. With the speed, I like speed as well. Not only to determine where your patient's at at the time, but a lot of the times it takes several months, even up to a year maybe, depending on how far down the line, the patients get, before they really get help to really gain a lot of improvement. And so they forget where they were at. Then you show them their speed score from six months ago, and like, hey, six months ago, Miss Jones, you were a 20 out of 28, and today you're a ten out of 28. So according to the symptom questionnaire, you've improved quite significantly.
[00:12:48] Speaker C: All right, let's move to procedures. There's a lot of different procedures. How did you decide? How'd you make your decision?
[00:12:56] Speaker B: Well, with having a specialty dry eye clinic, I wanted to make sure I had multiple different modalities of treatment. So I made sure I had based treatments, heat based treatments. You know, we process serum tiers in our clinic. We more recently brought on PRP tiers in our clinic that we're. That we're processing here at our clinic, trying to make things as convenient as possible for patients as well. And I feel to address a multifactorial condition, you need multifaceted treatments. You know, you can't just have one treatment option for these patients. Feel that you're going to be able to properly serve them. But if I had to choose one IPL all the way right there in the background, because it addresses so many aspects of the ocular surface conditions. You know, it kills demodex, it decreases inflammation, kills bacteria, modifies structure and function of glands. I always, or I should, most frequently, I'll express afterwards. So you help remove blockages. There's newer data coming out showing it can modify corneal nerve function as well. So you're just hitting so many areas of the condition with one device, you know? So if I had to pick one, that's. That's what I would go with.
[00:14:17] Speaker A: I totally agree. You've got, if any patient that walks in, I consider to be an candidate for intense pulse light, just because it does work so well for different types of dry, whether it be evaporative, whether it be aqueous deficient, whether it be autoimmune related or skin condition related, a lot of people overlook the skin, right?
[00:14:35] Speaker B: So, yeah, no, 100%. I agree.
[00:14:39] Speaker A: So which brings us to the question. You know, you're obviously operating this clinic, so I get asked this question all the time. So I'm going to ask you, how do you get your patients to do these things when not all of them are covered by medical insurance? How. How do you have that conversation? How do you get them to do it right? How do you get them to take care of themselves?
[00:14:57] Speaker B: Again, back to the imaging and education. I think if you educate these patients well, you show them where they're at, you show them where you don't want to be. A lot of my patients have seen five other doctors over the last seven years, and they're just continuing to get worse. So they're pretty motivated to improve.
If you show them and you explain to them how your treatments are going to help, how this is a chronic condition, nothing's going to fix it forever. I use the dental model a lot. I'll refer back to the dental model. I think dentists have done a great job of educating the general public on the importance of brushing and flossing and seeing the dentist every six months to get your teeth cleaned.
I refer back to that a lot. This is a chronic condition, just like you brush your teeth and floss. There's certain things that we're going to do daily. They're going to help prevent this from, from getting worse. And, you know, with IPL, that's an easy one. You know, every six months you go and see your dentist, right? Well, you know, every six months you can come in here, get an IPL, and we can keep those glands functioning. Well, you know, the dentist doesn't wait until you have a cavity or need a root canal to tell you, hey, maybe you should come in and have your teeth cleaned and maybe brush and stuff. You know, they do it as general maintenance to prevent. And I'm kind of leaning more and more into that with my IPL these days. I used to wait further and further down the line before I would recommend it, and then I started thinking, well, why am I doing that? Like, this is something that can prevent them from getting far down the line. So maybe. So I've been kind of introducing it earlier and earlier these days.
[00:16:30] Speaker C: You know, what you said is navy brush.
I hope people maybe brush their teeth.
[00:16:35] Speaker B: Maybe brush maybe at least once a day. The floss, I don't know, that one's kind of too. But, you know, it's just educating the patients. I feel that's how I'm able to get people to do the procedures, because they do want to improve.
They're in your chair, they want to get better. And I think it's our job to let them know this is what is going to help you. This is going to help you not only get better, but prevent things from getting worse over time.
[00:17:04] Speaker C: Hey, Jason, we've gotten to know each other over the last year, become friends over this past time, and one of the things I do commend you on is your networking skills. You're always out there. You're meeting, writing, shaking hands. You're doing whatever it takes to help, to connect with others, but also help increase education and find ways, not just for patients, for our colleagues as well. One of the things that Tracy have talked about over the last however many years is about collaboration and intraoptimetric referrals. You have an optometric referral practice. What are some of the keys to optometric co management that you can offer our viewers?
[00:17:42] Speaker B: No, that's a great question, Walt, and no, that is one of my big missions, actually, right now, is to inspire and guide optometrists to specialize and collaborate, provide the highest quality patient care and optimal outcomes.
We have this great opportunity. There's so many subspecialties that are coming out now in optometry and just eye care in general. With all the advents of these sclera lenses and different specialty contact lenses, ortho K, neuro optometry, vision therapy, low vision, there's all these areas that we can specialize in and just be able to enhance that care to our patients and enhance the patient experience as well. Because, man, if I were to try to fit a sclera lens, I probably could figure it out 1015 times. But, you know, somebody else down the road can do it in one or two settings, you know, and that's going to be a lot better experience for that patient than coming back in 15 times. And then the end of the day, the fit wouldn't be as good because I don't. I don't really do that.
So I feel that people, you know, develop a passion for an area in optometry that they really enjoy and just really dive in on that passion and, you know, just read about it. You know, I read about dry eye. I talk to everybody about dry eye. I listen to podcasts on dry Eye. All the webinars I do are dry eye. Whenever I go to a meeting, it's all dry eye. You know, that's really all I do. And I think that's how we can, you know, when other people see your passion for that state, and I think they're more likely to refer people to you because they understand that that's what you like, that's what you want to do. And it just provides for me so much satisfaction. I'm way happier now than whenever I. When I had to do general care. You know, there are certain things that I didn't like to do, like contact lenses. So whenever I had to walk into a contact lens exam, you know, I wasn't all in it. And that's not good for my patient, either. You know, it wasn't good for me because I'm like, oh, man, a contact lens exam. But then I'm not all in for my patient either. But now when I walk into a dry eye exam, I mean, I'm all in all the time because I just love it. It's just that passion. I developed a passion for it.
[00:19:53] Speaker C: Hey, I just thought of this. This is not a podcast. This is a vlog cast that we're doing right now.
I want to do one more thing before Tracy close us out. All right. So I'm a. I'm an optometrist in your area, Jason. You're coming to me to talk about, you know, working with you. What is that conversation? What are you asking me? And, you know, telling me, oh, I'm happy to help with your dry eye page going at, I think you know where I'm going with this question.
[00:20:21] Speaker B: Yeah, yeah. No, no, for sure. Yeah. So when I first started, I, you know, I hit the ground running, and I was just visiting practices, and I would just show up. You know, people will ask me that, well, how do you do it? I just show up. You know, just show up, go on their practice, and ask the front desk to see the doctor. I let them know who I am. Most of the time, you can end up seeing the doctor. If not, I would give the front desk my little spiel, and I have a little packet that has all the trifolds of different services that I can provide and just let them know that, you know, what I'm doing is a little bit different than what they might be doing for dry eye. I have other services that can help. I'll describe quickly how the services that I provide can help their patients and then how I can also relieve some strain on their clinic. Because a lot of these doctors, they don't have the tools to be able to manage it at the highest level, and it gets frustrating for them.
I let them know, hey, I can relieve some of the strain on your clinic from these patients that just keep coming back and back, don't have any more options for them. So let them know how it can help their clinic as well. Not only help their patient, but also help their clinic. It's kind of how I present with that, and I try to keep it to a three minute, little quick thing. I don't want to take too much of their time. Leave them all the information and leave them some business cards, and that's it.
[00:21:42] Speaker C: And ask for business. That's the other thing. That's the only other thing I would add to that.
[00:21:49] Speaker B: Yes. Yeah. And it works, you know, over, I been doing this now, what, two, a little over two years, and I have over 70 doctors that refer their dry eye patients to me. So if you put in the work, it happens. If you're, if you're passionate about it, I think other people see that and they're more likely to send their, their patients over to you.
[00:22:12] Speaker C: That's awesome.
[00:22:13] Speaker A: We really appreciate your passion, and we really are super thankful that you came on to give our listeners just an idea of if they're interested in getting started, how to go about it, and passing a little bit that fire. And I hope that we helped you to achieve a little bit of your personal mantra about helping to reach and educate other doctors. So thanks for being with us. We just. It was great to have you on.
[00:22:34] Speaker C: Thanks, buddy.
[00:22:35] Speaker B: Oh, my gosh. The pleasure is all mine, guys. Thank you so much. You guys are amazing. I've looked up to you guys for many, many years. Surreal being here, just talking to you as colleagues.
[00:22:50] Speaker A: Thanks for listening. Join us for our next episode soon. Find us online at www.dryeyecoach.com and all major podcast platforms.
