Eye related problems make up a large number of medical cases in Canada, and Dry Eye is one common complaint. Helping people suffering from dry eye has been Dr. Bruce Dornn’s calling. Dr. Dornn has built a busy and successful dry eye practice, in which he has performed hundreds of advanced dry eye treatments such as radio frequency (RF) and IPL. In this episode, Dr. Dornn shares his insights with Harbir Sian into how ODs should start to build their dry eye practice. We also hear the key steps that have made his practice so successful.
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The Business Of Treating Dry Eye: A Discussion With Dr. Bruce Dornn
I'm very excited to come back again with a wonderful guest here on the show, bringing clarity to optometry, business, entrepreneurship, and life, all of it. As always, before we get started, I would like to ask one little favor, and that is, if you get any value out of this episode or any other episode, please do share this show. Subscribe, follow and like. Do all the things that you think should help us grow. It has been an amazing journey so far, and I appreciate all the support that we have received. Thank you for that, and thank you in advance for all of the future things that you do to help support the show.
As I mentioned, we have a wonderful guest. His name is Dr. Bruce Dornn. He graduated from the University of Manitoba with honors in Microbiology. He attended the New England College of Optometry in Boston. He practices in his own practice, Dornn Eye Care. He also started, in 2012, his own company called Eye-Revive, which is a company that sells an extensive line of dry eye products available exclusively through optometry practices. He, himself, has a pretty extensive dry eye practice, and we are going to be talking a lot about dry eye and the business of dry eye. Thank you very much, Dr. Dornn, for joining me here on the show.
Thanks a lot for inviting me to the show. I'm excited to be here and talk with you. This is a topical issue for a lot of optometry offices now. It's good timing.
Dry eye is one of the hot topics in our industry. What you have said to me a few times is it's starting. We are growing this thing now. It feels like maybe we have been talking about it for a while but the place that we are going with dry eye, that we are at the beginning of it, we are still at the tip of the iceberg. Tell us a little bit about your practice in general, and then we will go into some specifics as well.
My wife and I started our practice about several years ago, where we are located centrally in Winnipeg in a major thoroughfare. We bought an old bank, renovated it, and we started this practice. It has been a long journey. My wife is an optician. She has been very instrumental. She set up our dispensary. She does all the HR and the staffing. She has been great on that side of it. We have slowly grown our practice over those years, as most people do. It has been several years ago when we started to get interested in dry eye. We try to diversify and make a subspecialty of a dry eye in our practice. That's where we focused our energies.
Several years ago, it was pretty early in the dry eye game. The fact that you started your other company almost several years ago, it's pretty impressive. Someone like myself, for example, has only been dabbling for the last few years, so you've clearly got a lot of experience in that area. If we could talk a little bit about how you’ve got into that, how you decided to start getting into the dry eye, and what were some of the early steps that you took in your practice to make that sub-specialty part of your practice.
There was a day and a patient where something clicked in my head that dry eye is the way for us to go and become fully invested. A patient came in, had dry eye and concurrent blepharitis. We have seen thousands of these patients. The patient was in my office, and I recommended some things. I said, "You need to go home and do some warm compresses. I'm going to give you some sample lid wipes and sample artificial tears. In about ten days, I would like you to come back, we will talk it over and see if you have improved and how things are going."
This patient comes back ten days later, sits down on my chair, and I say, "How's it going? How are things?" He goes, "I feel terrible. Nothing is improved. I'm not feeling any better at all." I'm like, "Describe to me what you are doing at home." He goes, "I took this base cloth. I put some warm water on it. I slapped it in my eyes. I did it once or twice. I didn't do it that often." I said, "Did you use the samples that I gave you, the lid scrubs?" He goes, "No, not really." "Did you use the artificial tear I gave you?" "No, I didn't even open the bottle."
At that moment to the realization was I had given him those things as samples, they were free, and to him, they had no value. They were these free items. His impression of what I did was, "He's not very invested. He gave me a couple of samples. He doesn't care that much about what I'm feeling." What I decided to do was bring in products that I would sell to patients. I would describe what they have. I'm going to give them my treatment plan, and then I'm going to get them to buy the products.
If they believe in what I'm saying and are going to be invested because this is an at-home maintenance treatment, I would like them to buy the product. It's going to be financially healthier for our practice but not only that, if somebody buys a product, they are invested. They are going to be a lot more compliant if they spent their own money.
We went out, sourced products, went to trade shows, looked at things, and we developed this product line that we are going to have in our office. I started noticing my compliance rate didn't just go up a little bit, it was a night and day difference between what I was doing before and the results I was getting now. That changed my mindset. I thought to myself was, "Dry eye, go all in. Do everything you can possibly do for a patient or refer that patient, or let somebody else deal with that." That's when I decided we were going to make a subspecialty out of the dry eye.
That's amazing that you thought to do that because of the thing that you were doing initially, "Go home and do some warm compress. Here's a sample." That's what the majority of our profession, including myself, were all doing for so many years. I found it was hard for me to make that switch to selling products. I felt like there was something uncomfortable for me when I was selling the drops to the patient. Now, I don't feel that way but a few years ago, I did. I feel like there are others out there who feel the same way. Is there something that you could say to encourage people to make that step, to start carrying these products in their office?
Dry Eye: Something that we've started to learn over the years is how important it is to have good staff. It's vital.
We all feel this, and I'm not sure why this sense of maybe subtle guilt that the patient has to spend their own money and buy products in our own product but the reality is if they don't spend that money in our office, they are going to go to a pharmacy, not knowing what to pick and what's appropriate. They are going to spend that money. They are more frustrated because they get the wrong thing.
Patients are much more satisfied if you say, "These are the exact things I want you to buy and the exact procedures I want you to do in this sequential order." When they see that, especially if you include a follow-up with that. I always follow up on my patients. I never say, "Go out and do hot compresses. I hope that works. See you in a year or two." I always have a quick follow-up in 10 days or 2 weeks. It doesn't blow up my flow or my routine. It's very easy to fit these patients in.
When they see that you are invested, they will invest. They know there's a problem. They are coming to you for that problem. They want your expertise. No one has more expertise in this field than an optometrist. We are the people that spend the time and the effort. We look at every part of eye health. Optometrists should think about that, and their recommendations hold a tremendous amount of weight with these patients.
From that point, you started carrying the drops and some of these other products, and now, you have some more advanced technologies that you are using in your practice. Can you tell us about where you are at now, what type of technologies you are using, and how long you have been using them?
I would break up our dry eye practice into three aspects. One is we have all the at-home maintenance products that the patients can get when we treat their dry eye. This is a condition you maintain. I described this to patients a little bit like if you are a diabetic. If you are a diabetic, you go to your doctor, your doctor first diagnosed you. They do some tests. They diagnose it.
They prescribed something or they treat you with insulin but they were also going to ask you to go home and say, "I want you to change the way you eat. I want you to exercise and lose weight." That is an at-home maintenance that you are expected to do on your own on a daily basis. To me, dry eye is very similar to that.
What we did was we broke our dry eye specialty into three types. We do the diagnostics. I went out and invested in some good diagnostics that I would be able to show my patients what it is I'm seeing. If patients see images of meibography, noninvasive tear break-up times, tear meniscus height, and they seem normal compared to what they have, very powerful images that they see.
Second of all, we obviously invested and got a line of products that we can give them to go home and maintain. We have all these products ready for them. A person comes in for a dry eye consult. For every single adult in my patients, we do a baseline meibography and noninvasive break-up time because half your dry eye patients are very symptomatic but the other half are asymptomatic.
If you want to find out about other groups, we started doing meibography on adults. We have two pieces of equipment. We have an OCULUS K5M, which is an exceptionally good machine. It's a little bit pricey but it's very good as far as diagnostics. We also have a Firefly, which is a slit lamp type device that you can do all the same tests, plus you can do a video when you are doing gland expressions and things like that. Those two devices were critical in being able to describe the patients and diagnose patients.
Thirdly, instead of prescribing, let's say, Restasis or Xiidra, we went out, and we decided we were going to the early adapters of new technologies like RF and IPL, which are revolutionary. Instead of treating dry eye medically, which surprisingly, in a lot of cases, doesn't work as well as we would like. We have all been through this.
We have given that prescription, the patient comes back 2 months, 6 months, and they were like, "My eyes are killing me. It's no better." It's frustrating because you have no recourse. What do you do now? Whereas once we started adapting RF and IPL, we can still use those medical treatments but now we have a very powerful treatment modality that is far more successful for my patients than using medical treatment.
Which devices are you using specifically? Do you have both RF and IPL?
If we could do something that's more effective than our old ways of doing things, that would be a breakthrough.
We do. InMode has a tremendous workstation. It's called the InMode device. It's got both an RF and an IPL in one machine. The IPL is the Lumecca. They have developed a special handpiece that's just for eyelids for their RF, the radio frequency. It's a tremendous piece of equipment because we can use this right on eyelids with no shield. It's a bipolar type of technology.
What they have done that makes this very applicable to optometry is when you use a bipolar type of RF energy, you are very precisely controlling where that energy goes. It creates a very low-level electrical current when you place that on the eyelid, that current is precisely controlled, and as the current goes through, the skin creates a bit of resistance, which creates bulk heating.
That bulk heating is very specifically confined right in the dermis, right where the meibomian glands are. We can bulk heat those, which we are always trying to do with hot compressing. That has always been the goal here. We are able to do that right at the level of the gland itself. Whenever I do RF, I immediately follow that with a gland expression. Manual expressions are much more effective when I use RF.
We have combined that RF procedure with the IPL when we are doing patients because the IPL now we are treating on the superficial part of the skin, the epidermis, and we are able to get rid of a lot of those small neovascular vessels. We are stopping the inflammation. It's a little bit like dentistry and that you are brushing and flossing, doing two different things but they are very important, and they both have their function.
I have heard different things from different practitioners, and because I'm early into the game, I'm not doing some of the more advanced stuff. We do IPL and RF but we do them separately for different people. You are saying that you are doing both, so you will do RF first and then do an IPL on top of that. Are there benefits to doing it that way?
There are benefits. We were an early office that had the InMode technology and the RF and the IPL in it. At that stage, it wasn't being widely used in Canada in optometry offices. The company was great. They sent me trainers. They gave me lots of support and marketing, but in reality, they weren't the expert in eye care. They knew they had great technology.
They knew this works well in the dermatology world but now optometrists had to start using the technology, which is excellent, and trying to use that in a way that's going to be the most effective for dry eye, especially MGD. There are an awful lot of MGD out there. If we could do something that's more effective than our old ways of doing things, that would be a breakthrough.
I slowly getting a little more experience and learning on what's effective and what's not effective. I started playing with the energies. I started to combine the technologies together at the same time. InMode didn't recommend this to me. They weren't saying do them together. That wasn't their recommendation. This is something that I started to do off label on my own.
I suddenly discovered when I did my post-treatment meibography and noninvasive tear break-up times, I was seeing two big changes with my patients. Those noninvasive tear break-up times would go way up. I could start to see differences in the meibography, in the health of the glands, and the like. You could see in dermatology, the collagen would start to grow, neocollagenesis and the glands would start to rejuvenate themselves.
I wanted to see that myself. I have done over 700 of these procedures already. I have had a lot of chances to try this and try that. We have come to the conclusion that using this combination therapy with manual expressions in my office has been successful. I would say for the majority of my patients, we are getting between 85% and 90% success rates. Again, we are seeing the patients multiple times. We are educating the patients. When we do the procedures, we try to do everything we possibly can to get them back to that normal state.
The fact that you have done that many procedures gave you the ability to test and see what works better and what doesn't work as well. That's pretty amazing. You gained the confidence to do those things because you know exactly what are the results you are getting, or if there are any side effects or other benefits that may come from doing it a certain way, which I'm not quite there myself yet. I'm always following exactly what the prescribed settings are. When you start to venture out a little bit and do those other things, you start to get amazing results 85%, 90% of your patients are noticing an improvement. That's huge.
Not even them anecdotally noticing the improvements. Before we start, we do all meibography and tear break-up times, and we look at the glands, and then we compare that to after post-treatment. Several weeks later, we look at this. I wanted to see for myself, "Is there quantitative values that tell me that the tear break-up times are improved, that the patient is feeling healthy? There is less keratitis." That is the proof that I needed that this is effective.
Dry Eye: You have to combine your in-office treatments with at-home treatments. When you start doing that, your practice is going to become far more financially healthy and your success rates are going to go way up.
When you have that proof, you become more confident. I am very confident in recommending these procedures to my patients. They sense that. When patients sense that you are like, "This is going to work." We have a procedure and technology now where we can treat this condition that you have had for many years. I'm very confident we are going to have a good prognosis here. That comes across to the patients when you start getting that experience, it helps them be confident in you doing these things.
I can speak from my own experience there as well. I find it funny that when you start promoting these types of treatments and options that you have, the first people who come to you are the ones who have the most chronic refractory condition that nothing else has helped them. They are like, "I'm willing to try whatever." That also puts a lot of pressure on you then as a practitioner to fix a problem that no one else has been able to fix.
With RF, I have had a few patients who were using drops every 30 minutes to an hour for years, and that was the only way they’ve got even a subtle bit of relief but now they are down to using their drops maybe a few times a day and able to get through the day, sometimes they forget to use their drops. It has been pretty amazing to see that again, both anecdotally and physically, in the tear film, meibomian gland, and all that. I could speak to it, my experience is a fraction of yours but it's nice to see that it parallels what you have been seeing as well.
What I say to patients is, "My goal here is to get you to not use drops." The ultimate goal for dry eye treatment is to get the patient producing their own tear. Not only is that way more convenient for the patient but it's healthier. When you produce your own tear film, things are going to be better. That cornea is going to be healthier. There is a cost associated here. A lot of doctors worry, "Are patients going to be willing to pay the cost of what these procedures are?"
You have to look at it again from the patient standpoint, if you write a prescription for Xiidra, Restasis, or they are buying artificial tears very chronically, look at the cost of the patient there. They are spending sometimes $2,500 to $3,000 a year on drops. They are forced to use drops continuously throughout the day. This is not a great scenario for the patient, and they are doing that for the rest of their life. The costs associated with that are much higher than you doing four treatments of RF and IPL and getting them to produce their own tears now, and they may not put any drops in their eyes whatsoever.
It seems to resonate a lot with patients when you tell them, "I would like to get your eyes functioning in their normal way. Let's get you back to normal functioning, so you don't have to depend on drops or medications." That resonates and I feel like there's more of a movement of this holistic health and natural versus medications and things like that.
I often tell patients like a holistic approach, talking about Omega 3s and all these other things as well. Patients appreciate it but the cost conversation happens frequently. What would you suggest to optometrists who are guilty, scared or whatever it might be to have that conversation to say, "I’ve got this treatment option for you, but it will cost you. This is how much is going to cost you $1,500, $1,800 or $2,000 or whatever over the next 4 or 5 weeks?" What would you suggest to that person as far as getting over that hump and getting comfortable talking about it?
Most ODs that are not in this field yet or looking to get in this field that's the number one thing in the back of their mind. That was in the back of my mind when I first bought this equipment because it is a big investment to go in and get something like this. The key is combining this technology with diagnostic technology.
A Firefly Slit Lamp is a fairly inexpensive item, you could easily put it in place of your current slit lab. You would now have the ability to do meibography and noninvasive tear break-up times, which is very important that you can do noninvasive tear break-up times. Tear meniscus height, shoot videos, and show patients the keratitis on the front of their eye when you put fluorescein on.
What's important is you need to do the diagnostics. You need to be able to show that patient, what their gland situation or their corneal health looks like compared to normal. I always have these comparisons. "Here's a patient with normal gland tissue. Here's you, you've got 75% of your gland tissue and are dropping out. The sooner we treat this, the better. This is like any other eye condition I treat in my office. If I see glaucoma and AMD early, I want to treat it early. A dry eye is exactly like that. The sooner we treat this, the better your prognosis is going to be."
I give patients the option. I tell them. "We have two ways we can approach this. I can prescribe you medications." I described what those medications are. "You are going to be on these drops for the rest of your life. I have to be honest, they are fairly expensive, especially if you don't have insurance. When we use these medications, we are not rehabilitating your glands. We are stopping the attack on the glands but we are not rejuvenating the health of those glands. That's one option. We can do that."
I do have some patients that do that or they start with that. They may switch later but that's what they want to do when they start. I say, "We also have these procedures, RF and IPL." I described them very basically. "The RF is going to treat in that dermal layer deeper down where the gland is. The IPL, that's going to treat more on the superficial part of the skin. We are treating the neovascular blood vessels. This is absorbed by any red or brown pigment. These vessels are leaking. They are abnormal. We want to get rid of them. That's what these treats are, not only does it treat but they will treat some of your Demodex and your blepharitis. We get a double benefit there.
It's not just what you do in your office. It's what the patient does at home.
I also described, "We are going to do the gland expressions because we want to get you producing your own tear film and manual expressions are critical." If you don't see what's going on from treatments 1, 2, and 3 like with LipiFlow in some of these devices, you don't see what's happening. It's important that the doctor looks at that between treatments so that they know what's happening with that expression of meibo.
When I talked to them about that, they heard that, "I could be on this drug for the rest of my life. That might be $2,500 a year." They can do the math in their head. That's expensive. My treatments are $400 per treatment. I tell them, "It's going to be a minimum of four treatments. It may be more. I have severe rosacea patients where I have treated them 6 times, some patients, even 8 times." They understand that.
I don't do a package. I don't do a discount. I say it's $400 a treatment. They understand that I'm not apologetic about it because I know what works. In the long run, you are saving money. I feel good about it because I'm doing something that's incredibly effective. I'm saving them money and aggravation and not having to put drops in over the course of their lifetime. To me, that's the discussion that works well. Those are the key points that I try to use.
All of that is important but the visuals, especially the meibography and stuff like that. It could be a big turning point for anybody who's maybe not getting the conversion or uncomfortable about having that discussion. Somebody who's starting on this, maybe they don't have any advanced technology in their office. Would you recommend that's where they start? Start by getting a good diagnostic tool first, and then look at the treatment technologies after?
It's almost something you could get at the same time. If I was starting from scratch, knowing what now, what's going to be effective and what maybe wasn't effective for me, as I was going through this journey, if you think about how much this technology costs in your global investment, I would get the diagnostics and the treatment together. I would get them both because when you pair those things together, you get a powerful tool that you can show people what's going on.
A lot of ODs don't realize, and that's something that turned the corner for us is we started doing meibography on about every adult patient. You will be shocked at how many of those patients come in here with more than 50% gland loss. The thing that I have learned more than any other thing in this journey is that auto-immune disease is far more prevalent out there than we think. As optometrists, we can start diagnosing and seeing this. I deal with rheumatologists GPs, and specialists far more now than I ever did before the dry eye.
I am writing a report to a rheumatologist at least ten times a week. I'm sending them copies of the meibography and saying, "Here's a twenty-year-old patient with 80% gland loss. What is going on? Could you do a workup and see?" You would be shocked. How many of my patients come back and they have Hashimoto's disease or JRA, and they didn't know it. I have had a number of cases like that.
Young patients that if I weren't doing these baselines, they weren't going to bring it up to me. They thought, "My eyes always burn, sting, and hurt me. I thought I'm a person who has burning eyes." That's the way it is for me. That has changed the way that I look at things, and I'm way more invested in systemic medicine than I ever was before I started dry eye.
It's not surprising, and we understand that there is that connection between these systemic diseases and dry eye for so many years, we have said, "It's dry eye." Now, we know that there's so much more potentially happening in the background. Again, coming from somebody who sees a lot of these patients and treats a lot of them, it's pretty interesting to hear how many you found to have that connection. That will wake up a lot of us and our colleagues too to look into that a little bit more.
Taking a step away from dry eye, I know that's our main focus here, but in general, your business and practice as a whole, are there a few things that you can think of that have helped your practice grow over the years? Whether it's creating a subspecialty or it's training your staff a certain way, or anything else that you could think of?
It's a very generic question but I wanted to make sure I put it out there. A couple of things that somebody else might be building their practice. A friend of mine or someone I know who might be building their practices a little earlier stage. What kinds of things you might recommend or suggest to someone in an earlier place?
The most valuable thing we have here in our office is our staff. Our staffs are amazing. The patients interact with the staff more than they interact with me. They are talking and asking them questions about the products we sell and the procedures we do. Whenever patients come in for RF, I have four techs. One of those techs is doing the RF. I'm not doing that on the patient. I'm coming in, and I'm doing the IPL or the manual expression after.
Dry Eye: Dry eye is universal. You don't have to go out and advertise for these patients. 30% of people walking into your office have dry eye. A lot of them don't report it, but it's there.
It's important that you train your staff. Good staff doesn't happen by accident. It's a product of including them, letting them know about this technology, educating them because they want to know. The thing that shocked me when we first brought the InMode, the RF, and the IPL, my plan was to train one of my more senior techs. She was going to be the one that primarily was going to do this procedure. We did train her, and we did have the other staff watching when the trainers came in. One by one, almost immediately after, the other techs came to me and said, "I want to do this. I love this."
Women love skincare. A lot of our staff are females. They are very invested. They know a lot about this. They do skincare routines and regiments at home. They were super interested in all of this. I was amazed at the buy-in. Now, we have four staff that are able to do this. We rotate them through. We do a lot of these procedures.
It's nice to have more than one person being able to do, check people in, do the consents, get them, worked up, get the ultrasound on there, do the RF before, so it saves me huge amounts of time. I can focus with the patient on educating them and talking to them about where they are at. That has been the single most important thing that's grown my dry eye practice is the involvement of my staff. Don't be afraid to teach them things because they want to learn.
Something that I have started to learn as well over the years is how important it is to have good staff. It's vital. I don't know if there's anything more important than that. Also, I have learned that I like to include the staff in everything I can, whether it's meetings with reps, bringing in new products, getting everybody trained up so we are all on the same page. The staff has reported to me, they like it as well, being included that way. They are not just an employee, they are part of the business and part of the practice as well.
They want to be included in making decisions and giving input and ideas. They are all wanting to be invested that way. The second thing that has been invaluable is having products in our office. The patients buy stuff that we have sourced. We have the Tranquileyes XL Kits that we sell for hot compressing.
I always have my MG patients going home with that kit, and doing at-home moist heat, compressing is important. I have a tea tree foamer that we use as part of our product line with Eye-Revive but all my patients with blepharitis will maintain some of these good results we get, which have to be maintained over the months and years following.
We also have a line of skincare. We've got something called E9 in our product line, which is a product we developed with my parent company, Eyeeco out of California. We initially use it with patients who are on Xalatan. The side effect of Xalatan, they start to get these dark circles. This E9 product is a nonsteroidal anti-inflammatory. What it will do over, let's say, four weeks of putting it on nightly will take away about 38% to 40% of that dark area and all the darkness under their eyes.
It has been a great product. I said, "If it works so great for this, why don't I try it on some of my patients that have contact dermatitis and the flaky skin on the lids?" I started doing that. It was remarkably successful for that. I could avoid using a steroid, I would use this instead. Once we brought RF and IPL on, now I would use this as my post-treatment product. I would sell them some of this. They would go home.
You can see when you have a dry eye patient, and that dry eye patient has bought into your treatment plan. They are going to go through four RF and IPL gland expressions. They do this to be successful, and they want it to last as long as possible. We always give them at-home maintenance products that they can use on their own to try to make the benefits of this last as long as possible. That's a real key with dry eye. It's not just what you do in your office. It's what the patient does at home. That part of our business has grown exponentially.
The nice thing with that is patients come back, they buy again on their own. I don't see them. They are coming in. They are buying more E9. They are buying more lid scrub. We've also got an overnight sleep shield, which I use with a lot of my patients. There are tremendous amounts of lag of the thalamus out there. The silicone shield seals all the way around your whole socket and traps humidity as you sleep. It creates such a hyper humidity chamber. Even if there is that little gap, it helps prevent that overnight dry eye.
That's something that a lot of ODs should look at because there's a tremendous amount of people that wake up and they say, "When I open my eyes in the morning, I'm afraid to open my eyes because they hurt so much.” You have to combine your in-office treatments with at-home treatments. When you start doing that, your practice is going to become far more financially healthy. Your patients, your success rates are going to go way up.
That's all advice that we can implement now in our offices. The subtitle of the show is Business Entrepreneurship and these different factors but the entrepreneurship part is something that I focus on with a lot of guests. I specifically bring a guest on who has this entrepreneurial streak, and you do your perfect example of that.
Dry Eye: Dry eye is universal. You don't have to go out and advertise for these patients. 30% of people walking into your office have dry eye. A lot of them don't report it, but it's there.
Not only with your own office but now with Eye-Revive is this other company that you have started many years ago. If you could share with us what motivated you and what got you over that hump? There's always a hump that people have to get over before they take something from being an idea in their head to an actual tangible company or product. What was it that got you through that?
The story is I had gone to a trade show down in the states. This was a Vision Expo East of New York. I saw some products I liked there. I thought, "These are the products I'm going to incorporate in my office." I met Eyeeco, which is the parent company that I distribute products for here in Canada. They had some products that I have never seen before like the sleep shields. The moist heat compresses, instead of doing a generic microwaveable mask. This was a very precise way to do hot compressing. I brought them back. They were very successful. When I initially came back from the trade show, I brought a lot of products with me, and I was surprised how quickly I burned through all these products.
I called the company back up and I said, "I would like to order more." They said to me, "We don't have a distributor in Canada. You have to get it in the United States." I said, "That's a problem because I don't live in the United States, and I can't wait six months or a year to go back down there and get some more." They said, "Why don't you figure out how to bring it up? You could be a distributor. We will sell it to you, and you can sell it to other doctors if they need it."
I had to get it myself anyway. It's a lot of rigmarole, learning how to import things, and how to deal with Canada Food and Drugs. I brought it in. I brought a little extra product. If they had a doctor that called from Alberta, BC or Ontario, and they wanted to try something, they would direct them to me, and I would sell them something. It started pretty small that way.
What I started to see was in my own practice, how this grew so quickly because I would prescribe something to the patient when I saw them on their annual exam but throughout the year, they would come in, and they would buy it 3, 4 or 5 more times in the year. Suddenly, we are selling five times more than what I'm recommending. That started growing.
I thought, "This is a real opportunity." I started to attend trade shows. We developed the Eye-Revive company. I partnered with a company called Neutrogena out of San Diego. They had some Omega 3 supplements that are amazing. The Eyeeco company started developing new products. They asked me to come onboard and start helping them.
With the help of another ophthalmologist, we developed their Tea Tree Lid Cleanser. We developed E9. We created bigger goggles that were proprietary for optometry because they were using these goggles as a moist heat in a spa-like environment. We created something that's more medicinal. It kept adding. The key is, get yourself involved.
If there's something you are passionate about, you are interested in, get yourself started, and then once you get started, you will see one thing will lead to another. They are all little building blocks, and there's this natural evolution of the way that your company, your business or your online products it's going to grow itself. You will see that it will start to take off. You have to try to bring in new ideas. That's the number one thing that I could recommend to people.
You were confronted with a problem. I feel like this is where a lot of businesses and an entrepreneurial journey start is you are confronted with a problem, which is you wanted to get this stuff in your office but importing was all of that. Instead of using that as an obstacle or as a roadblock, you thought about how you could turn that into something even bigger or better, which was amazing.
That is inspiring. Any aspiring entrepreneurs out there, maybe look at problems that you are facing as the thing that might propel you into starting a business. I'm big into philosophy and stoicism, and Marcus Aurelius is an ancient stoic philosopher and emperor, and one of the sayings is, "The obstacle is the way." Ryan Holiday's book named that as well. It's relevant in an entrepreneurial journey. If there's an obstacle, that's often the way you have to go to get to your next step.
That was similar to what you had to go through. Dr. Dornn, there are two questions I would like to ask everybody at the end of each episode. Before we get into those questions, I would like to offer you a chance to let people know where they can get in touch with you or learn more about Eye-Revive or anything else that you would like to share.
I would be happy to answer any questions that people want to email me. My personal email is DornnEyeCare@Shaw.ca. They can contact our online company, Eye-Revive.ca. I have a great staff. We have a chat line. It can be completely anonymous. They can go on the chat line, they can ask a question about a product, and we will respond to them right away and describe how the product works and how they would use it.
The Obstacle Is the Way: The Timeless Art of Turning Trials into Triumph
We do have special vendor pricing for optometry offices so that they can sell this product in their office. We don't sell our products to any pharmacies, anyone but optometrists. We sell to the public, and we sell the optometrist. We have a lot of great customers. They buy a lot of products from us. They have successful dry eye practices. I have learned a lot from them. Optometrists, we can learn a lot from each other. There are a lot of successful people out there that are doing some pretty amazing things in the dry eye space. I try to learn as much as I can from them because they have some tremendous ideas.
What's exciting to me, we are at the stage where optometrists are poised to do more than just diagnostics and refraction. We are at the stage where we are going to do procedures now. What's happened in my office that I never anticipated, when I started doing this, my goal was to treat dry eye. I had no plans on doing anything but that, but what ends up happening is when you do IPL and RF, especially IPL, that energy from the Lumecca can treat any brown lesions.
When you have a patient coming in, and they have damaged sunspots and brown lesions around their eyes and on their face, you can treat that. When I'm doing my procedures, I tell patients, "I'm going to treat that." It works remarkably well. When people have fine lines and wrinkles, and people are all concerned about our appearance, and we want to look good. This comes from the dermatology world. I tell my patients, "This comes from dermatology. They have been using this for years to treat dry eye and wrinkles."
One of the early patients that I treated and was an interesting case. She had bad rosacea. Right around her eyes, I did the treatment. It worked extremely well. She came back after her fourth treatment and she goes, "I have a complaint. The skin around my eyes looks great. Except as soon as you get below where you didn't treat, it's now all wrinkly. I've got that crepe paper skin. I want to treat it all." I was so amazed by the difference between around her eyes and lower down on her face that I did it for free. I treated all the rest of it to see, "What benefit is there to the skin?" It's remarkable. She was in her 70s. This was an older patient.
What I have seen happen is the medical aesthetics of this, and a lot of ODs are like, "That's not for me. I'm not going to do that," Think about this, if you have a rosacea patient and you treat their dry eye because they have bad ocular rosacea, you are very successful, and they are going to say, “You are a good doctor." If you treat all the redness on their cheeks and all over their face, where they have all these neovascular blood vessels they are like, "You are a great doctor." Their wife says, "Look at my husband, and he looks so young."
I have had patients where the wife was upset because the husband's skin look too good, and she's like, "We spent all this money on him. He looks way better than I do now." We have branched off a little bit into this medical aesthetics, which to me is exciting. It's easy to get into once you have good equipment. There's no question about this, InMode got some of the best technology on the market.
Their RF is bipolar. That's second to none. I never have to use a shield. I never have to worry about side effects on patients, and we can do upper and lower lids. The Lumecca is the strongest source of IPL energy that you can get on the market. It is extremely effective. If you are interested in dry eye, if you want to get into this field, you should look into this stuff.
As someone who's getting into it now, I will be looking to you, and I have already attended one of your lectures to learn more about how you have brought it in and in the settings that you use and all these things. Any aspiring ODs out there who are looking to get into it, do reach out to Dr. Dornn. He's got an amazing wealth of knowledge. For Eye-Revive. It's Eye-Revive.ca. The last two questions I like to ask every guest, number one is, if we could hop in a time machine and go back in time to a point in your life where you were struggling, what advice would you give to yourself at that time?
If I was starting out, knowing what now, I would invest in the dry eye technology as soon as I started my practice because when you start your practice, you are not busy. You have the time to spend with patients. Dry eye is universal. You don't have to go out and advertise for these patients. They are 30% of people walking into your office have dry eyes.
A lot of them don't report it but it's there. The patients coming in, if you have the technology and the time, you will be able to spend that time learning while you are starting. If I were a new OD, this is the way that I would start my practice. I would delve into dry eye become specialized in it. It is a tremendous way to grow your practice.
I would go out to my local GPs or even if there's a rheumatologist in the area. I would introduce myself, and I would say, "I have a solution for your dry eye patients. They want a solution." That's one of the things I did early on when I started doing this. I went to my local GPs and I said, "I have a way to treat these patients, especially patients you have with arthritis, rosacea and any auto-immune like thyroid patients," and they started feeding me patients. You would be amazed how quickly that grows. If I'm a new doctor, that is something that I would recommend to anybody because those GPs want to work with you. They want a solution for their patients. There's no one better suited to do that than an optometrist.
Creating those relationships with other professionals, who could then refer to you. You have said that. That has been a huge factor in the growth of your dry eye practice, those referrals from other professionals. Maybe there's a bit of shyness or fear around approaching others about this stuff but obviously, there are huge benefits to doing it. Thank you for sharing that. The final question is, with everything that you have accomplished through your practice, your business, and everything else, how much of it would you say is due to luck and to hard work?
You can create your own luck. You just have to keep working hard.
It's a combination of both. There's the old saying, "You have to be good to be lucky." If you work hard, things are going to come your way. If you work at things, you get experience and confidence, and then you can sometimes create your own good luck in your own good fortune. In optometry, there are a lot of things happening now.
In Ontario, there has been some labor action, and we have been in Canada a little bit dependent on provincial healthcare and what has been fantastic about this is I have seen our practice grow into something that we control our destiny. The patients come to us. We do these procedures. It's a self-pay type of thing. What has been satisfying is the efficacy of this, "How much improvement I have been able to see?" Not only from their anecdotal reports but when I look at them quantitatively. You can create your own luck. You've got to keep working hard, and there are a lot of smart ODs out there that could do well with this.
Thank you very much, Dr. Dornn, for taking the time to join me here, sharing all your expertise, knowledge, experience and everything. I'm going to be back in touch with you. I've got a lot more to learn from you.
Anytime, let me know. I would be happy to share my experience. I will share as much knowledge as I have. I love training ODs. They are exciting and a great group of people to be around. If anybody’s got questions, drop me a line.
Thank you, everybody, who's tuned in, whether you are on Apple or Spotify, thank you very much for taking the time. Thank you for all your support. Don't forget to hit like, subscribe and take a screenshot, put it up on Instagram. Tag me. Let me know what you thought, what was your takeaway from this episode. I always love hearing you guys' feedback. We will be coming back with another episode. Take care, guys.
Important Links
Book - The Obstacle Is the Way: The Timeless Art of Turning Trials into Triumph
Apple - The 20/20 Podcast
Spotify - The 20/20 Podcast
About Dr. Bruce Dornn
Dr. Dornn graduated from the University of Manitoba with a honours degree in microbiology. He attended the New England College of Optometry in Boston, MA, graduating in 1997 with his Doctor of Optometry degree. He worked in Denver, Colorado until 1998 and returned to Winnipeg where he founded Dornn Eye Care.
Dr. Dornn is also the founder of Eye-Revive.