How to get eye doc to give PROSE referral?

[smthcorona]

I recently learned there is a PROSE provider in Chicago, 3 hrs from where I live in Wisconsin, so I have decided to start the process. First step will be to get my cornea specialist to do a referral for the consultation, then see if my insurance will cover it. I have an appointment with my eye doctor soon and plan to discuss it. I'm worried she'll say I would not be a candidate for PROSE, maybe that my eyes aren't bad enough. She might be right, although they certainly seem bad enough to me and nothing helps much anymore, but I won't know if I don't try. I also look at it as kind of a second opinion on my dry eye from someone who is more of a dry eye specialist. Any suggestions for how to approach it?

[Rebecca Petris]

I'm worried she'll say I would not be a candidate for PROSE, maybe that my eyes aren't bad enough. She might be right, although they certainly seem bad enough to me and nothing helps much anymore... Any suggestions for how to approach it?

There's two faces of "bad enough". I think you only need one to be a candidate, at the end of the day, though not all corneal specialists will necessarily know this on their own:

Bad clinically speaking, and/or

Bad symptomatically - especially when nothing gives relief.

I know many people who went after PROSE solely because of symptoms, who had no severe clinical signs.

So if you think you might not technically have severe enough clinical signs (i.e. dry eye test results), I would focus on finding ways to quantify and describe your symptoms, their impact on your daily life, and elaborating the things you have tried that have failed.

[Guest]

Totally agree with Rebecca!

If you have signs that are obvious to your doctor, it should be fine... if you don't have obvious signs, like Rebecca said, you will probably have to explain exactly how your eyes are impacting your day to day life

ex. I need to use drops every ____ minutes/hours otherwise my eyes feel like __________
I can't do _______, ___________ or ____________ because it makes my eyes too painful (or however you'd describe it)
I feel some level of discomfort in my eyes all the time, most of the time, or occasionally etc.
Even though my eyes are being treated with ____, ________, and ___________ I am still unable to do _________ because my eyes hurt too much (or however you'd describe it)

I think unless we spell it out, it's hard for them to know exactly how bad we are, especially if our eyes appear to be in pretty decent shape to them.

Also, worst case, if your dr. isn't aware of the role of PROSE lenses in the treatment of dry eye, you could bring a copy of the DEWS report along (google it, and it comes up first)

Good luck!

[PotatoCakes]

I got my referral simply by asking. That said, it didn't make a difference because there aren't any in-network providers in my state. My insurance covered it at out-of-network rates, which aren't great but still, better than nothing.

[Blinks]

Make it easy for your doctor to say "yes".

I got my referral by asking. My doctor encouraged me to exhaust all avenues before submitting to another eye surgery.

I went to the Boston Foundation site and printed out the referral form and handed it to the doctor so all he had to do was fill in a few boxes, sign it, and hand it off to the tech. The doctor faxed it while I was in the exam room along with my EHR records. Amazing! I also had printed a couple of pages about PROSE so in case the doctor wasn't aware of this prosthetic, he could have it. It showed him I was serious and had done my homework.

Here's the link to the form: http://www.bostonsight.org/Content/E...rm-7-16-12.pdf

I received a call from the PROSE people about a week later saying they felt I might be a good candidate and the next step is an onsite consultation.

You may want to fill out the OSDI and hand it to your doctor. http://dryeyezone.com/encyclopedia/documents/OSDI.pdf because it is "clinical" and doctors accept this well. (I fill one out every few months to see how I'm progressing). Keep a copy for your records, too!

Good luck!

[smthcorona]

Thank you all for the great suggestions. I have the referral form printed and will be taking that with me tomorrow as well as other info on PROSE, although I feel confident she will at least know about it. If not, I better find another doctor! Of course, if she does know about it, then I wonder why she hasn't ever suggested my looking into it?! In the past she has at least been willing to let me try new things: DHEA drops, rapeseed oil, prog/test drops, which were all things "I" found, not her and things I don't think she knew much about. I have had schirmmer's tests of 1 and 2 not that long ago. I may ask her to do another one. If it's still that low, I would assume that would be good evidence/"signs" for her to put in her notes that they will see.

Thanks again for all the great ideas!! I have not posted a lot on here over the years, but have read a lot, gained a huge amount of knowledge and learned of treatments that were some that helped me the most.