contact lens economics
Follow Your Patients --
Not Their Contact Lenses
BY GARY GERBER, OD
While speaking about a new continuous wear contact lens, a doctor in the audience of one of my lectures asked, "What's your follow-up schedule for continuous wear lenses?"
"I don't have one," I replied.
"What!? You let patients sleep in their lenses for 30 days and you don't follow up with them?" the doctor asked incredulously.
"I didn't say that. What I said was I don't have a follow-up schedule for continuous wear lenses. I do, however, have one for each patient," I calmly stated.
It's About Time
Time management is an issue for any size practice. Even clients whose offices we've helped open from scratch report being strapped for time. And ultimately, what we "sell" to our contact lens patients is our time.
Therefore, to remain profitable and operate a successful practice, we must carefully analyze the parsing of time. We must realize that following up with our contact lens patients -- while certainly the right thing clinically to do -- is also expensive. That's why it is important to tailor your follow-up schedules to each individual patient. Take the following two examples.
A patient has been affiliated with your practice for 20 years. He has worn conventional hydrogel extended wear lenses for the last 12 years and has not experienced any problems. The patient admits, however, that instead of following your recommended wearing schedule of one week he has been stretching it out to about one month!
Based on this patient's admitted noncompliance, you decide to refit him with a new hyper Dk silicone hydrogel lens. After all, you hypothesize, if he is going to sleep in his lenses, then he might as well wear the best soft lenses available. After fitting the lenses, you must now make a decision about when to have the patient return for follow-up care.
"I'll see you in two weeks. If everything is okay at that visit, then I'll see you two weeks after that." You reason that if this patient can abuse a weekly lens by wearing it for a month, then surely he can tolerate a much more breathable lens for two weeks.
Another patient is brand new to contact lens wear. Also wanting him to have the newest and best technology available, you decide to fit him with the same lenses you used for the patient in scenario #1. However, once you complete your exam and fitting you tell him, "If these feel comfortable, your vision is good and everything seems okay, then come back in three days. If everything is okay at that visit, then I'll see you about one week later and then about two weeks after that."
Your thinking here is contrasted with the first patient because hyper Dk or not, he's never worn lenses before.
Provide Custom Care
Setting up your follow-up schedule in this way can save hundreds of hours of valuable chair time each year without compromising clinical care. You can take the concept a step further and do what we've done for many of our clients.
The amount of time for each visit will vary with each patient. For the first patient, most doctors could spend about five minutes and be clinically satisfied. For the second patient, 10 to 15 minutes might be more appropriate (to include extra counseling and a review for new wearers).
Time is money, but we need to take care of our patients, which takes time. Get the clock back on your side by following your patients and not their lenses.
Dr. Gerber is the president of the Power Practice a company offering consulting, seminars and software solutions for optometrists. You can reach him at (800) 867-9303 or at
Contact Lens Spectrum, Issue: August 2003