Physician extenders can significantly enhance the quality of the patient care within your office, regardless of your practice’s size. As a provider in a large group practice that includes ophthalmologists, optometrists, and physician assistants (PAs), delegating tasks has been critical to our success. Our ODs provide full-scope care practicing up to the fullest extent of their licensure and comfort, while our MDs focus their time and attention on especially challenging cases in our in-house surgical suites. We believe that it’s truly a perfect marriage that allows superior care for our patients.

Our practice has experienced a growing demand for our services. In an effort to maintain market share and patient satisfaction, physician extenders have been especially helpful for us. Our MDs have relied on PAs for years to handle pre- and post-operative tasks as well as for clearing patients for ocular surgeries. Because it proved effective on that side of the business, we wondered how ODs could use that model to make themselves more efficient in the clinical realm.

This article is advocating for well-trained technicians who have attained certification—such as those available from the National Contact Lens Examiners (NCLE)—to handle much of the contact lens fittings, training, and adjustments in any practice. Through proper identification and training of proficient members of the staff, eyecare practitioners can essentially create an extension of themselves to handle all routine contact lens duties.

However, before we discuss training technicians to have contact lens expertise, let’s first discuss the development of a standard technician. Workup technicians and scribes have become common in eye care; so much so that providers may take them for granted. The steps that trained clinical staff already perform before practitioners encounter their patients in the examination chair are simply accepted as normal. By allocating routine testing to technicians, the flow of a clinic can be smoother.

Because the technicians have already completed these assigned tasks, much of the testing and relevant information has been collected and is easily accessible by the time that patients see their eyecare professional. This makes creating a treatment protocol significantly easier and allows it to be done in a timely fashion.

In our experience, having technicians and scribes on our staff has had a significant positive effect on our productivity. To start, the work that the staff does goes a long way toward improving patient access to care professionals by allowing an increased number of patients to be seen each day, which then improves the clinic’s financial viability. On the whole, patients are healthier, the staff is satisfied, and the providers are happier.

Utilizing technicians and scribes allows for an increase in productivity and patient care both before and during the examination. However, contact lens technicians can help a provider increase his or her efficiency even further. Depending on where your practice is based, it may be in a prime location to get specialty contact lens patient referrals from a larger geographic area than what it normally serves.

In our office, our technician Robin fills the role of “extender.” Because Robin has a keen interest and is skilled in fitting standard GP lenses, I will often defer the fitting to her, as I genuinely believe that her experience makes her a superior GP lens fitter. She has full authorization to practice to her highest level of comfort under my license in a manner very similar to what a PA is permitted to do in a general medicine scenario. This allows me to focus on more difficult and time-consuming fits.

How the Practitioner Sees It

The handing over of any clinical duties may be a cause for concern for many eyecare practitioners. But, by finding someone who has a passion for contact lenses and patient care, not to mention a strong clinical acumen and an affable personality, your office could benefit exponentially from allowing a physician extender the opportunity to care for patients. After all, they are merely an extension of you.

Many providers within our practice work with Robin in different ways; some allow more independence than others do. In my experience, I have been able to save a great deal of time and improve patient satisfaction by having Robin perform one-week contact lens follow-up visits. In addition, she can change or alter the contact lens prescription, if necessary.


After more than 27 years in the eyecare field as a certified ophthalmic assistant, I have found my niche as a contact lens fitter. For the past four-and-a-half years, I have successfully run contact lens departments in Austin, TX and Nashville, TN and have just recently found my way back home to Williamson Eye Center in Baton Rouge, LA.

At Williamson Eye Center, my scope of practice is as a nationally certified contact lens examiner; I am an extension of Dr. Davidson. In his busy specialty contact lens practice, I work in tandem with him to provide the highest quality of care and service to our patients.

I see our regular soft contact lens patients for follow-up visits to make sure that their vision is optimal, that they are happy with the prescribed lens brand, and that the lens fit is ideal. I also seamlessly finish the exams by walking patients through checkout and making sure that they maximize their insurance benefits when they place their order.

This allows Dr. Davidson to see and examine more patients throughout the day. In addition to the soft contact lens follow ups, I also help with scleral lens fittings. I make sure that we have topography maps and that all necessary fit sets, filling solutions, and plungers are ready in the exam room before Dr. Davidson enters. I am then responsible for gathering all testing results once patients have sat with the trial lenses. To that end, I obtain images of central clearance and of the edges of the lens with optical coherence tomography (OCT). I also check patients’ vision and perform over-refraction.

Outside of contact lens fittings, I also perform refraction rechecks when patients are having difficulties with their new spectacles.

Overall, I serve as a team player (and team leader when needed) and help out in any aspect that I can at the clinic. I am responsible for teaching new and established technicians the ins and outs of the business, working side-by-side with the physicians, and comforting patients or cheering them on. I truly love it all. I’m fortunate to be able to do what I love, day in and day out.

Of particular note is the fact that each patient is given Robin’s personal cell phone number and email address. She serves as a liaison between patients and practitioners. In our practice, she is the patients’ “contact lens concierge.” Patients seem to enjoy this concierge terminology, and we have found that it helps them buy in to the practice even more. We have also noticed that this helps increase contact lens sales because Robin has the time and knowledge to explain, in detail, all of the possible rebates and benefits that patients can receive by purchasing their lens supply from us.

In addition, by giving Robin “the keys to the kingdom” to handle all of the contact lens-related issues, I am able to have more time in the exam lane with patients. Her skill in informing patients of their contact lens benefits, financial options, and requirements for filing for medically necessary contact lenses, combined with her amiable nature, has allowed my practice to flourish both professionally and financially. Not a day goes by in which I don’t consult Robin’s advice on something related to the contact lens aspect of our practice.

Finding Your Robin

Finding staff members who share your passion and who have the desire to advance their career through hard work and the achievement of further certification is no easy task.

The strategy in our office is to hire personality and train skills. Luckily, Robin came to us already having extensive training at the practices where she was previously employed; she, in turn, has helped further develop our contact lens practice. We are currently in the process of evaluating our in-office talent base. We plan to identify and train some of our high-performing technicians to be contact lens specialists in each of our five offices.

To accomplish this, Robin will be creating and implementing a rigorous training program for these technicians. This process is expected to take numerous months and should result in allowing all of our ODs to become more efficient, increase their contact lens sales, and make their patients happier and healthier.

We believe that by finding someone who shares your passion for contact lenses and high patient satisfaction, you can easily elevate your practice. CLS