When I entered optometry school, I envisioned pursuing an ocular disease residency and someday owning my own practice. Toward the end of my years as an optometry student, however, I fell in love with specialty contact lenses and chose to do a cornea and contact lens residency at the University of Missouri-St. Louis College of Optometry. During that time, I learned a great deal about fitting and managing complex corneas and difficult contact lens fits, as well as how to successfully operate a specialty lens clinic in private practice.
After completing my residency, I joined my childhood optometrist, Stuart B. Adams, OD, in practice in my hometown of Lake Havasu, Ariz. Lake Havasu is a rural community with a population of approximately 53,000 and a median household income of about $38,000 (compared with the national average of $54,000 and the Arizona average of $50,000). The closest large city is about 200 miles away.
When I joined the practice in 2012, Havasu Eye Center’s patient base was mostly comprehensive eye examinations, eyeglasses, soft contact lenses, and ocular disease management. I knew it would be a challenge to integrate specialty contact lenses into my new practice, because that service had never been offered. Equally challenging was the rural location of the practice along with the small population of the city. Could such a small town with a low median household income support a specialty contact lens service?
PLANTING THE SEEDS
Initially, I performed mostly routine comprehensive eye examinations until I became comfortable with the staff, equipment, and examination flow, but I was passionate about specialty contact lenses and anxious to offer this new service to patients in my hometown.
I offered specialty lenses to every patient whom I thought would benefit, and I discovered many candidates among our existing patients during their comprehensive examinations. These were patients with:
- fluctuating vision post-radial keratotomy
- corneal scarring from trauma or herpes simplex
- extreme dry eye who had tried artificial tears, gels, and medicated eye drops
- transplanted corneas who wanted to improve their vision
- normal corneas who were unhappy with their vision or comfort with soft toric lenses
- high astigmatism
- presbyopia, seeking the best possible vision at distance and near
- irregular astigmatism, seeking the best possible vision.
My partner was a huge help in referring patients requiring complicated contact lens prescriptions or those with irregular corneas to me. We developed a system whereby I would complete a consultation on the patients he referred to me, including topography, slit lamp examination, pachymetry, and specular microscopy, and report my recommendations for treatment options.
In the beginning, I would explain almost all treatment options (along with the associated costs) to each patient, but that became overwhelming, as some patients had more than 8 different options. Now, I usually discuss the top two treatment options for a particular patient based on his ocular condition, lifestyle, and any other relevant circumstances. I am happy to explain all options, but I have found making a strong recommendation for one or two specific treatments has streamlined the process.
WHERE TO BEGIN
If you want to start prescribing specialty lenses in a practice that currently does not offer them, I recommend blocking out an hour or more for your first fittings. In the beginning, your technicians will not have the knowledge or experience to assist you, so you will be doing almost everything yourself.
When I started fitting specialty lenses in my current practice, I would have a technician in the room to assist me, but I would do everything from lens preparation, application, evaluation, diagnostic imaging, lens removal, and lens disinfection. I also had to teach patients how to apply and remove their lenses, because none of the staff knew how to do this. Over time, I was able to teach my technicians almost the entire process except lens evaluation, which has created efficient patient flow. Now, I simply select the diagnostic lens I want the technician to apply to the patient’s eye, and the technician completes the process minus lens evaluation and over-refraction.
The technicians are also now fully trained in lens application, removal, and care, so they can work with patients and teach them appropriate techniques. This system has enabled us to serve more patients per day.
REMOVE COST FROM THE EQUATION
Some eyecare professionals feel uncomfortable presenting what they might perceive as a costly service. Get this idea out of your head immediately and charge what your services are worth! Fitting specialty contact lenses is an extra skill, and it takes more time to manage patients along with a higher level of decision-making, so be sure to bill appropriately for your services.
Similarly, never judge a patient’s ability or desire to pay for specialty contact lenses. If I believe someone could benefit from a specialty lens, I will offer it, no matter what I think the patient’s financial status is. In fact, I do not discuss cost until the end of the visit. Many patients, even those with limited incomes, will do anything it takes for good vision. If a patient says no, at least you did your duty by presenting all treatment options. It is possible the timing for such a purchase is not optimal for the patient, but maybe next year he will ask for those special contact lenses.
I practice in a low socioeconomic area and if cost were the deciding factor, very few of my patients would be wearing specialty lenses. If you believe in something and are passionate about it, you will succeed.
WHEN PATIENTS THINK THEY HAVE NO OPTIONS
By offering specialty contact lenses to my patients, I have helped many who thought they were completely out of options and had given up hope. Helping these people see clearly is truly rewarding. Every week, I see patients who say, “I didn’t even know I could wear contact lenses” or “I had no idea that a special type of contact lens could help me see better.”
For example, I am constantly surprised at the number of patients I see who have had corneal transplants and had no idea they could wear a contact lens to help their vision. Recently, I saw a 28-year-old woman who had a transplant at age 21 because of a herpes scar. I asked her if anyone had ever told her she might be able to see better with a special type of contact lens. She said, “No. I just thought this was how my vision would be for life.”
Please explain these options to your patients even if you think they may have heard about them before. You will be shocked by the number of patients who have irregular corneas and have never heard of specialty contact lenses.
FOSTER PATIENT LOYALTY
Patients who wear specialty contact lenses will become some of your most loyal patients. They understand that their situation is unique, and if you earn their trust and respect, they will stay with you forever.
Some of my patients travel hours for their eye care. Some have even moved to another state but still travel to our clinic for their specialty lenses. If you offer specialty lenses to your patients, consider them lifelong patients.
CULTIVATE PROFESSIONAL RELATIONSHIPS
Many practitioners have no desire to prescribe specialty contact lenses. When they find someone who is an expert in these complicated lens fits, they are happy to refer them.
I have great relationships with other eyecare professionals in my area who refer their patients to me for specialty lenses. I always send the referring doctor a letter after the consultation, explaining the treatment plan, and I always send the patient back to the referring doctor for any other eyecare services and products. This builds trust and keeps these relationships strong.
Another referral source is contact lens manufacturers. For example, practitioners in other states may have patients who live in Arizona during the winter, and they need an eyecare practitioner who can help with their specialty lenses. If the practitioner does not know a specialty lens doctor in Arizona, they may reach out to their lens manufacturer for help in locating a doctor who can see their patient during the winter.
The specialty lens community of fitters is quite small, and you will quickly develop connections and build a network with practitioners throughout the nation or the world.
UNCOVERING A NEED FOR SPECIALTY LENSES
A 59-year-old woman who had undergone RK in 1991 came to our office for a comprehensive eye examination, intending to update her eyeglasses. She had great unaided vision until 2002, but has worn eyeglasses since then. With a new refraction, she achieved 20/30 visual acuity with each eye.
After completing her examination, I asked if her vision ever fluctuates during the day or seems unstable. She said her vision was different when she woke up in the morning compared to at lunchtime, in the afternoon, and in the evening. I told her, “There is a special type of contact lens called a scleral lens that may be able to help stabilize your vision. It is unique and custom to your eye, and it has worked well for many of my patients who have had RK surgery. Is that something you would be interested in?” I give this same speech to many patients whom I feel might benefit from specialty lenses. Many of them are not interested in contact lenses, but I feel it is my duty to let them know about all of their treatment options. The patient agreed to a trial and now enjoys 20/25 visual acuity. She says her vision is much more stable than it has been in years.
SET YOURSELF APART
Considering how many patients would benefit from specialty contact lenses, very few eyecare practitioners prescribe them. By offering this specialized care, you will create a name for yourself. Our practice was recently named one of the “Top Ten Eye Care Practices in America,” and we feel a large part of that was because we have helped many patients with specialty lenses.
I attribute much of my success in building my specialty lens practice to simply recommending them to patients I feel may benefit from them. By doing so, I quickly grew my specialty lens patient base from essentially zero in 2012 to more than 1,000 patients in just 4 years. That goes to show you that even in a small rural community, there are definitely patients who need specialty lenses. If you explain all options to your patients and always keep the patient’s best interest at heart, you will be pleasantly surprised at how many opt for the best treatment. CLS