Retinal Physician Article Submission Guidelines-Prescribing for Astigmatism and Presbyopia


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Article Date: 4/1/2008

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How to Make Your Practice Ageless

How to Make Your Practice Ageless

Don't let "age discrimination" get in the way of your success. Here are tips for a robust pediatric contact lens specialty.

Dr. Brujic: We have established how much contact lenses can help a child's vision, lifestyle and confidence. Now, let's turn our attention to the positive impact pediatric contact lens fitting can have in our practices.

Dr. French, you care for children exclusively. Do you benefit from fitting young children in contact lenses?

CONTAGIOUS SUCCESS

Dr. French: The benefit to the practice is awesome. I often see patients who have been unsuccessful at other doctors' offices. My staff does a great job of working with these patients after my diagnostic evaluation. As a result, my practice does well financially. It's also very rewarding personally.

Dr. Sindt: My practice is not exclusive to children. However, fitting young patients in contact lenses still contributes significantly to our success. I've had parents get fitted for the first time after we've fit their children successfully. You can grow your practice because other doctors are not willing to fit children.

Dr. French: When we fit a young patient, especially one who has been trying contact lenses on and off for a while, our staff cheers, and this enthusiasm wins over other patients in the office.

Dr. Rah: Fitting children brings an energy to your practice that positively impacts other parents and other patients.

Dr. Walline: Kids and their parents are the best referral sources. This is about the moms at soccer games who are talking to other moms. They notice when one of the children isn't wearing eyeglasses, and they talk about it. When we do studies, we notice that we'll recruit children from one community and then a cousin from another community finds out, and we'll start getting referrals from the second community. The enthusiasm spreads.

FITTING CONSIDERATIONS

Dr. Brujic: Drs. Walline and Rah, based on your work on the CLIP Study, can you identify special considerations for fitting children, such as the keratometry readings, the interpalpebral aperture and so on?

Dr. Walline: Kids' eyes are basically the size of adult eyes by age 2. Some small children have smaller palpebral apertures, making them more challenging to fit. But because so many modalities are available, almost any child can be fit with contact lenses. The main difference between children and adults is that children are more anxious. You have to allay their fears and do so quickly.

Dr. Rah: And you have to be a little more patient. I repeat what I say many times. "These are the rules," I'll say, "and if you obey the rules, you are less likely to have any problems."

FOLLOW-UP STRATEGIES

Dr. Brujic: In your follow-up visits, do you typically have a parent in the examination room?

Dr. Rah: It depends on what the children or parents prefer.

Dr. French: I agree. It's driven more by personality than age.

Dr. Brujic: What about the anxiety that Dr. Walline mentioned? How do you deal with that?

Dr. Sindt: I slow down my approach, yet the whole process doesn't necessarily take more time. I talk more slowly and often allow the patient to hold and touch the contact lens. I very explicitly explain what I'm going to do, so as not to surprise the child.

"Practitioners who have children wearing contact lenses are perceived as more knowledgeable, with higher quality practices."

Christine W. Sindt, OD, FAAO

Dr. French: I tell the child that the lens will feel like an eyelash in the eye or like getting splashed in the eye while swimming, but that the feeling will go away. Tell the truth and they're fine.

Dr. Walline: I speed up my approach, which only shows that doctors' personal styles can vary. I am talking constantly, getting the kids to talk. I'm getting them to think about anything but the contact lenses until I'm ready to apply the lenses.

Where to Start
If you are just beginning to fit children, these are the first patients to try:
■ Full-time spectacle wearers, particularly children who frequently break their eyeglasses. You may need to educate the parents, pointing out that the reasons their children break their eyeglasses may not be a factor when they're wearing contact lenses.
■ Active kids who participate in organized activities, such as dance, karate, football, basketball, baseball, soccer, gymnastics, cheerleading, and any kids who like very vigorous, if not organized, activities like skateboarding, riding bikes and climbing trees.

Dr. Brujic: Letting the child see the lens is important. Describing how it functions avoids myths, such as a fear that the lens will roll behind the eye.

Dr. Sindt: I let them touch the lens, which is also a good time to emphasize the importance of washing their hands.

JUST DO IT

Dr. Brujic: What would you tell practitioners who are convinced by the CLIP data but still trying to figure out how to incorporate pediatric contact lens fitting into their practices?

Dr. French: You and your staff have to make the commitment. Discuss the options with the children and parents and be yourself.

Dr. Rah: You have to genuinely like kids, or hire a staff member who genuinely likes kids. Trying to pull off a magic show won't work for everyone, so figure out your style and apply it consistently.

Dr. Walline: I recommend that you schedule a half day exclusively for kids, because your learning curve is so much faster if you examine and fit them consecutively, instead of seeing one on a Tuesday in April and waiting until the middle of May to see the next one.

Dr. Sindt: Even if you don't want to fit kids, you should become familiar with the CLIP information and send these patients to another doctor.

Dr. French: On the other hand, I have a friend with a mostly Medicare practice who fits kids because he likes them.

Dr. Rah: I have a binocular vision pediatric clinic right down the hall. The doctor is not comfortable fitting contact lenses, and I'm not comfortable doing vision training. We have a beautiful working relationship that allows patients to schedule two appointments, one for me and one for the vision training specialist.

ELEVATE YOUR STATUS

Dr. Sindt: Practitioners who have children wearing contact lenses are perceived as more knowledgeable, with higher quality practices. Not only do they attract other family members to the practice, but they also elevate themselves in the status of the community. From that point, parents are less likely to take their children elsewhere once they've had a good experience in your practice.

"I recommend that you schedule a half day exclusively for kids, because your learning curve is so much faster if you examine and fit them consecutively."

Jeffrey J. Walline, OD, PhD

IT'S YOUR TURN

Dr. Brujic: Our discussion today focused on removing barriers and dispelling myths surrounding prescribing contact lenses for kids, which we did with the help of the professional experiences of our panel and supporting data from the CLIP study. We also described the patient and practice benefits of prescribing contact lenses for kids and provided practical tips for doing so successfully. We encourage readers to apply these strategies for a rewarding and profitable practice. CLS



Contact Lens Spectrum, Issue: April 2008

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