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Dry eye care has become far more than recommending artificial tears and sending patients home. For practices willing to build the right systems around diagnosis, treatment and follow-up, it can become a sophisticated clinical service that improves patient care while creating a meaningful new revenue stream. On the 20/20 Podcast, Dr. Harbir Sian and Dr. Trevor Miranda explored what it takes to build that kind of practice and why success depends as much on people and processes as it does on technology.
Topics Covered:
Start With a Clinical Framework
Dr. Miranda’s approach begins with what he calls the LION method: lids, inflammation, obstruction and nutrition. Rather than relying on a single treatment or device, the framework encourages clinicians to identify the different factors contributing to a patient’s ocular surface disease and address them accordingly.
That philosophy naturally leads to a multimodal approach. Depending on the patient, Miranda’s clinics may incorporate lid hygiene, medications, nutritional support, gland expression, IPL, radiofrequency or other technologies. The goal is not to fit every patient into the same treatment plan, but to build a system capable of adapting to what each patient needs.
Clinical results, Dr. Miranda emphasized, remain the foundation. When patients improve, they return, refer others and become advocates for the practice.
Build a Team, Not a Doctor-Dependent Service
Perhaps the biggest operational lesson from Miranda’s experience is that dry eye care should not depend entirely on the optometrist.
His clinics employ five “ocular hygienists”—team members trained to understand treatments, educate patients, perform delegated procedures and communicate progress back to the doctor. That allows dry eye services to run alongside primary eye care rather than competing with the doctor’s exam schedule.
Sian has seen a similar benefit in his own practice after training a technician to deliver treatments and document them in the electronic medical record. The shift, he said, took work off his plate while allowing treatment to continue as he performed exams elsewhere in the clinic.
Dr. Miranda believes practices often underestimate what staff members can do when they receive meaningful education and responsibility. His ocular hygienists began by observing doctors as scribes, learning not only the clinical information but also how treatment recommendations were communicated to patients.
Make the Handoff Part of the System
Identifying dry eye is only the beginning. What happens after the diagnosis can determine whether patients actually receive care.
Instead of asking front-desk or optical staff to explain specialized treatments, Miranda’s practice routes those conversations to ocular hygienists. If one is unavailable at the time of the exam, the patient can be contacted afterward for education and scheduling.
The distinction between roles is deliberate: the doctor diagnoses the condition and recommends the appropriate treatment opportunity; trained team members then explain logistics and costs and help patients move forward.
That system also allows the practice to offer structured pathways for different needs, including rosacea, chalazia and hordeola, and ocular surface optimization before cataract surgery.
Turn Good Ideas Into a Business
For Dr. Miranda, building the service also requires measurement. His recommendations include establishing a dry eye revenue goal, identifying a “dry eye champion,” holding quarterly team meetings and tracking internal referrals and other key performance indicators.
Training must continue as well. Team members attend conferences, learn from industry representatives and stay involved in patient education. The objective is to create staff members who understand not only how to perform a treatment, but why it is being recommended.
That emphasis on execution may be the episode’s clearest takeaway. As Miranda put it, ideas are widely available; implementation is the harder part.
