How to Build a Specialty Contact Lens Practice: Webinar

Full dictaction of the webinar:

Ed Bennett: Good evening, everyone and welcome to the GP Lens Institute's monthly educational webinar. My name is Ed Bennett and I'm the executive director of the GPLI. As you know, the GP Lens Institute is the educational division of the contact lens Manufacturers Association. It was independent laboratories and … manufacturers who responsible for the high quality GP and custom soft lenses we see on the market today. If you're new to the webinar, we thank you for attending, you know, have the opportunity in a few times during the broadcast and at the conclusion to type in questions on that panel on your right. And we'll try to answer as many as we can during the session and at the end.

We all approach, the year 2020; the year of vision with great anticipation if not excitement, we never in our wildest dreams expected to face what we're experiencing now and in the future. That said, one huge take home lesson is we learn where our income is derived. It's derived from contact lenses. Notably being proactive with approaching our contact lens patients and need a lenses or soon to be in need of lenses, because we know if we don't, especially with standard lenses, there are companies out there we're very interested in having that contact lens business, which makes specialty contact lenses that much more valuable to the practice. These patients typically come back and of course, our friendly seal and member laboratories are working hard with you to keep your specialty lens patients satisfied.

Some of you may have been on the Friday webinar in which two exceptional contact lens specialist Dr. Sue Resnick and Jeff Santino did an excellent job telling us how we can manage our contact lens patients today, and how to prepare for the time when you open your practice back up for routine patient care. The webinar is archived on the website and there's an accompanying PowerPoint that you can download from the website as well and that'll be up tomorrow. Tonight you're in for a real treat. Two individuals, who between them have established many specialty contact lens practices, and they're going to share their expertise with you. Dr. Stephanie Woo is a graduate of the Southern California College of optometry where she was the recipient of the gas permeable lens Institute award for Clinical Excellence. She then completed accordion contact lens residency, and I'm sure glad she did at the University of Missouri, St. Louis. For several years she was a partner in a multicenter practice based in Arizona where she single handedly built especially contact lens practice. Pretty recently she took the leap and established the contact lens Institute in Nevada, a practice totally dedicated to custom contact lenses in Las Vegas. She's published extensively and you may have read her columns and contact lens spectrum review of Korean contact lenses. She's a fellow of the American Academy of Optometry, and a fellow and past president of the … and active member of the GPLI advisory board. And in her spare time, she's an active wine collector and has a level of level two [INAUDIBLE 03:09]

Dr. Elise Kramer is another rising superstar and especially contact lenses. She's a graduate of the University of Montreal, College of optometry and then complete a residency, the Miami VA Medical Center where her residency included training the [INAUDIBLE 03:26] Eye Institute. She then established the Miami contact lens Institute, which focuses on eyes compromised or damaged by surgery, trauma or disease and emphasis on keratoconus, severe dry eye disease and no surprise to anybody, she's really established a very, very active scleral lens practice and is one of the experts in the country in that area. She's a fellow of the American Academy of Optometry and of the scleral lens education society, where she's currently public education chair elect. She's an advisory board member the GPLI and liked Dr. Woo has many other abilities, including being a very talented musician, and having the ability to speak numerous languages.

Speaking on the topic of how to build, especially contact lens practice, please welcome doctors Stephanie Woo, and Elise Kramer. Elise?

Elise Kramer: Hi, everybody, and welcome to this webinar. It's really an honor to be here to speak about this topic, it’s something I'm very passionate about. And also to speak about it with Dr. Stephanie Woo, who is not only someone I admire immensely, but also a very close friend of mine. So, we're really excited to be here with you. And thank you for joining us tonight.

So, this slide here that I'm showing you is an image that's real, and it's unfortunate, but this is happening. Actually, a friend of mine took this photo when they went to the World Cup in Russia, and you can see here that basically, this is a contact lens vending machine. And what you do here is you put in your prescription, put in some money and then get your contact lenses that way. So it's basically a way to completely bypass the practitioner. And I think it's scary because it's something that may happen, you know, here and it's happening in more and more places. Actually, Dr. Ed Bennett said something one time. He wrote this in one of his articles, saying that patients deserve more than the simple option of receiving lenses from an available inventory. And, he's truly correct because there are so many people who can do this, and there's even machines who can do this. And so it's very important to specialize. And we want to specialize because we don't want to compete with vending machines or online refractions or those huge chains of optical chains. We want to provide something that cannot be purchased online that can be purchased in a vending machine. We know that no two eyes are the same. All eyes are very different. And so it's extremely important to tailor what we do to each individual eye. And I'm not just talking about eyes from one patient to the next, but also eyes from the right eye, the same patient and the left eye of the same patient. So every is completely different and deserves its own lens. Also, we know that one size does not fit all. And again, the importance of specializing and realizing that what fits one person is not going to fit another, and what fits one is not necessarily going to fit another. So just tailoring that, tailoring each contact lens to each individual eye and specializing that way.

So what is a Specialty Lens Practice? And I will have Dr. Woo elaborate on this point.

Stephanie Woo: Yeah, and this is something that it's such a special topic, because Dr. Kramer actually was one of my mentors when I was creating this clinic. I called a lot of different doctors to get advice and I kind of took everybody's advice, and then created something of my own, and Dr. Kramer was just such a huge influence. So a lot of what we're going to talk about today is stuff that we actually have talked about many, many times on the phone. And a Specialty Lens Practice can be many different things and in every practitioner will have their own way to do that. But the most important thing is that it's a focus on contact lenses. And, for me, especially, contact lenses are the primary focus, not the optical, and in my practice, actually, I don't even have an optical, I realized that many practitioners do both. And in my last practice, we had everything kind of private practice and optical regular contacts, specialty contacts and things. But if you are going to try and become a specialty lens clinic, it's really important that you have experience fitting multiple modalities. And we know that sclera lenses are such a huge thing nowadays, and everybody seems to be fitting them and some of the corneal gas permeable lenses, hybrid lenses intro limbals are almost like a lost art. It's something that we've kind of talked about over the last few weeks. Now, we've had a lot of time, together with some experts, but it's really important that you know how to fit many different types of lenses. That is crucial. You can't just know how to fit one lens and then never fit anything else. You should also have a multitude of fitting sets. So you should have a corneal GP set, you should have an intra limbal set, you should have a hybrid set, you should have a scleral set. And you should just have a lot of different sets so that just like Dr. Kramer said, not every patient is going to be the same and even between their eyes, it may be different. I have many patients that were a different lens in each eye. You also want to have innovative technology. So you want to make sure that you have different pieces of equipment that will help you manage your practice at the highest level. And this is something that Dr. Kramer and I talked about a lot over the past year kind of developing my practice and What we thought would be very, like a must have and then maybe must be nice or you know, might be nice thing. So we'll get to that a little bit later in the hour.

Elise Kramer: And I agree with you i think the optical is, you know, sometimes it's absolutely, you know, it's not absolutely necessary and I think and we're going to get to referrals also. And I think that's a really good point of just focusing on contact lenses and not having an optical may generate more referrals later on.

Stephanie Woo: Yeah, and I totally agree with you, Dr. Kramer. And something else that I know that we have talked about before with a lot of our colleagues is that it's not just fitting contact lenses, but it's also focusing on treating anterior segment eye disease. So something really important in specialty lens fitting is you have to be committed to the underlying disease because you are going to be managing that. I think some doctors might forget that or they might not think of that off the top of their head. But if you are wanting to develop a specialty lens clinic, you need to remember that this is also going to be focusing on anterior segment disease. So that can involve treating whatever the problem is, rehabbing their eyes. So they may have had a terrible experience with LASIK or RK scarring. And now their eyes is completely messed up and you have to kind of rehab them. And then just protection. So I have many patients that have ocular surface disease, or dry eye and that the lens actually protects their eye from the outside environment.

Elise Kramer: Yeah, and so when we talk about developing a specialty lens practice, want to know how … what is this practice and really what it is is a niche. So it's a really strong focus. It's a it's a it's a subspecialty Within optometry. And we did a Google search to see you know, what are the most common conditions that people look up for contact lenses or that could be related to contact lenses and we see you know, Stevens Johnson’s keratoconus to Regina, and then a few others that are maybe less popular in terms of online research. Then if you compare that to diabetes, which is huge, and glaucoma, you can see how little those other things become. And then if we look up, for example, Kim Kardashian, you can see even more how that reduces, you know, the amount of Google searches on you know, the actual conditions in which fitting a specialty lens is needed. So what does this mean? This is just a niche. It is an extreme niche, but there are still a lot of people researching this and there is a high demand it within that niche and that's where we come in.

So what is the place and status of this specialty within our profession, we know that most contact lens specialist practice in OD only private practice. And so if you look at the chart just on the right side you can see or that schematic there you can see that 52% is going to be an ODs and private. 19% of them in university, 29% are going to be OD MD private practices. And optometric specialties are not really officially recognized. It's something that we've created and of course, it's important there are so many different parts of the eye in which we can specialize but it's not an official specialty, but referrals are very commonplace. So self referrals, you know, patients who, again, are looking things up online and decide and they find you as a specialist and come in. And these are going to be a huge source of referrals. And we're going to elaborate on that. Peer group referrals and of course, other ODs, so ODs, let's say, who don't, who specialize in something else, or who don't have the research or the resources or interest in really dealing with specialty lenses. So those are also an important source of referrals.

Stephanie Woo: So some question that we always get is, where do referrals come from? Or where can they come from? So we want to spend a few minutes kind of talking about that. So in my practice, when I started with a private practice that didn't have any specialty lenses, but they had other aspects of optometry. So they had regular eye exams, glasses and contacts and managing diseases. Most of my referrals in the beginning came from myself. So I would see a patient, and let's say they had RK scarring. And they just came in for their annual examining to get their glasses. And then I would be the one to ask them a little bit more questions. Do you ever have fluctuating vision? Do you have any problems with dry eye? How's your vision at nighttime, just kind of those things. So in the beginning, I was my own referral source. And I definitely reached out to a lot of other different doctors, like different optometrists within the community just to let them know that I have this specialty that I love, other ophthalmologists in the community. But in the beginning, it was definitely myself that was kind of growing this specialty lens practice. Then going … talking to other practitioners that specialize in this like Dr. Kramer, and Dr. [INAUDIBLE 16:02] and Dr. Santino and some of these people that have been doing this a long time. I kind of reached out to them too. And they said, well, don't forget about your general practitioners out there, and I will be honest that my dad is an MD of primary care. And he did not know that diabetics were supposed to get eye exams. And so once I was going through optometry school and explaining to him how important it was for diabetics to get eye exams, he started sending me every single diabetic patient, saying it's important that you get your eye exam every year. And so that kind of transitions into other things where general practitioners, they have patients that have conditions that they might think of you and then Dr. Kramer from this list as well, do you find that some of these other specialties like oncology and endocrinologists and rheumatologists, are they referring to your practices as well?

Elise Kramer: Yes. So actually, oncologist is something that you know, what can be drier than a graft versus host, you know, eye, for example. And so if you just tell them these things they will realize, and a lot of them don't know exactly what it is that we can do for these patients. You know, sclera lenses are relatively new. And so I find it useful to speak to all of these people, endocrinologist also, a lot of people with hormonal issues will have severe you know, ocular surface issues, same with rheumatologists. And EMTs, I get a lot of referrals from EMTs. But one thing that you said was really interesting, and that's that you converted your own patients, your own, you know, just general, you know, patients who are coming for an annual, let's say and converting them into a specialty patient. And that's really interesting. And that's exactly what I mean by transforming your practice into a specialty practice, just looking at it from another perspective. Finding those patients who have dry eye maybe giving them a solution that they never heard of, or never thought of before.

Stephanie Woo: So how do you become a specialty lens expert? Well, there's a variety of ways that you can do that. Of course, during school, you can make sure that you request a fourth-year site that specializes in contact lenses, if that's not a requirement for you. I know that during fourth year, I was really interested in doing a residency and so I spent extra time with the resident at SCCO, Dr. Brooke Messer, who is another one of my good friends now. And so she kind of allowed me to kind of observe what she was doing from day to day, and that was super helpful. And then, if you are really passionate about it, I personally think a residency is one of the best things that I could have done in my career hands down. Not only did it help me learn many different lens designs and modalities, I got to see so many patients with completely different conditions. Normal corneas, and then super, super irregular and I'm not sure if I would have gotten that, if I had just gone from school right into practice, but that absolutely doesn't mean that you can't be a specialty lens practice. You just have to find different avenues on getting the information and really committing to that. Some of the things that you can also do are some of the CE events, especially right now going on there's a lot of Zoom webinars and free webinars going on and a lot of free CE that might be an option. And then if you are really interested and you want to take it to the even next level is becoming a fellow. And so either a fellow of the academy or a fellow of the scleral lens society or becoming a diplomate and some of these other organizations, you know, there's the Ortho K Association, DCLA, I mean, there's a lot of different ways that you can differentiate yourself. And Dr. Kramer, out of this list of things that we've come up with, is there something on there that you would say like for sure, this is probably the most important?

Elise Kramer: Oh, wow, that's a really good question. You know, I also did a residency. It wasn't a contact lens residency, but I got really lucky and ended up working with a cornea specialist and fitting a lot of, you know, specialty lenses during my residency, which is kind of a fluke. But I also had very good training in school, I would say both optometry school that are now starting to really, you know, bring in specialty lenses and residency are probably the two most important things. But there's something also on your list that is very interesting, and that's apprenticeship. So do you mean by that, like, I guess, someone that you really admire in the industry, and you can go shadow them? Is that what you had in mind?

Stephanie Woo: Yeah. I would say I mean, there's several different meanings to that. So it could be a mentor, even during school. So there's a lot of optometry students that work at practices when they're in school just to, of course, make some extra money, but then also learn a little bit more. So I think if you are in an area where you can do that, that would be a really good way to learn more during your schooling. Also, I would say just when you're a fourth-year student, if you are interested, then you should really try to pursue a practice where somebody can mentor you during one of your externships. And so if you do pick one of your externships that specializes in contacts, or at least they are very contact lens focused, that is going to do leaps and bounds for you compared to not doing that, because you'll get so much exposure, and also learning how the practices run. I mean, in St. Louis, when I was there, just being able to go to the [INAUDIBLE 22:28] associates and see how they run their clinic gave me so much inspiration for how I wanted my clinic to be.

Elise Kramer: Absolutely, I couldn't agree more. I think having a mentor and just being able to see what they're doing is so key in success there.

Stephanie Woo: And then also, there are few other ways to kind of differentiate yourself or become more invested in specialty lenses is leadership and giving back. So we've come up with a list of things that we thought would be important. So levels of leadership and that can just be your local optometry organization or even like your rotary clubs, key clubs, lots of different things, church groups, there's a lot of different things within your local community that don't even necessarily have to be optometry related. But then also of course, the different local, state and national organizations for optometry. Mentoring, so like, for I know you and I, Dr. Kramer, we both have students that come in shadow us, ask questions. We, you know, you I know how to have students that actually works for you as well. I mean, having that experience just with somebody that you look up to and admire is, I think so, so important. And then writing. So writing different articles, even if it's not for any money just for, you know, kind of getting yourself out there that can also help differentiate you as a leader in the field. And then of course, lecturing, if that's something that you like doing. Some doctors, that's just not their thing. And that's totally fine. But this is just kind of a list and I'm sure Dr. Kramer, you have some advice regarding this list as well.

Elise Kramer: Yeah, I think you know, the more research you do, not only are you learning a lot, but you're also putting your name out there. So it's like a win-win situation. Because you have to do so much research in order to publish, even if you have a really interesting case that you saw. If you want to publish that case, you really have to dig in to like a lot of information and gather information and learn. You end up learning so much. And at the same time, you end up getting, you know, a little bit recognized for having published something, like I said a win-win situation.

And Dr. Woo, you touched on this, the importance of, you know, joining different associations, there are so many out there, these are just a few examples of different, you know, association, different resources that we have that can help you specialize. So, the scleral lens education society is a big one and JCF, you know, these are just a few. But the more you can get involved, the more you're going to learn, and the more people you'll meet, and sometimes just having a conversation with someone at one of these meetings is sometimes the best way to learn. I'm sure you would agree with that, Dr. Woo?

Stephanie Woo: Yeah, absolutely. Just networking at some of these meetings and just meeting some of the people that you admire, I think is very huge. So getting to sit in on their lectures and learning from them. I mean, I remember being so admired with Christine … as she was like, this amazing person that I knew never would have thought in a million years I'd be friends with her. But at enough meetings and kind of at these events, as we know, it's a small community. So now it's like she's one of my greatest friends and mentors. So it's just going to the meetings and networking is huge.

Elise Kramer: I feel the same way.

Stephanie Woo: So creating a specialty lens practice, we just came up with a few things on how to create a specialty lens practice, because this is something that a lot of doctors asked Dr. Kramer and I a lot about.

So where do you want to locate? I thought that I could speak to this because this is something that was really important to me. And being from a small town then trying to figure out well, if I want to specialize in contact lenses, where am I going to go I Think I can go to another small town I really need to get to somewhere bigger, a bigger market. So where I'm from the populations like 50,000 and so I looked into different communities that were a lot larger. So I contacted a lot of optometry friends in the area. So in Nevada, I called a lot of eye doctors and said, hey, do you have somebody that you refer to for specialty lenses? And enough of them said, not really. There's no one here that like really does specialty lenses that are really high level or at least markets themselves that this is something they really like doing. And so I thought, wow, that's a really good opportunity. And so that's why I picked Vegas because there wasn’t anybody else that had a purely dedicated specialty lens clinic, and it was just a bigger market for me. And Dr. Kramer, I'm really curious for you. How did you pick Miami?

Elise Kramer: Well, I did my residency here. And for personal reasons, I decided to stay and obviously, you know, Miami is a little bit saturated, but I made it, you know, a mission to just stand out. And I think, you know, just learning from practitioners like yourself and going to meetings and just really being passionate about it. Even if there are a lot of, you know, other specialists in the area, a lot of people who work with specialty lenses, I think, you can truly just tailor your practice, differentiate yourself if you really want to. So I agree with you. I mean, obviously, if I had a choice, you know, and I could choose anywhere, I would pick somewhere where there was very little competition and just, it would be instant, you know, just having all those referrals and all those patients. So if I could choose, I think that would be ideal, but if you have to live somewhere or you want to live somewhere for other reasons. I think there's still a way to really stand out. Just be passionate about it and persevere.

So I think we're going to pause here for some questions. Dr. Bennett?

Ed Bennett: A couple comments just to make and that's excellent from both of you. When you're talking about the types of things that you can do to really be able to … because I know we have a lot of people online tonight that are in private practice, and really think about how they can optimize their practice in contact lenses. And some of the comments you made in terms of what you can pursue writing. Once you get your name in print, I think with me it was a pair optometric journal right after I graduated and I was on a high for months. And I think you know, I can speak for kind of like spectrum and it doesn't have to be kind of one spectrum but you can submit to or email and editor or people associated with the journal and that's really good. If you have your fellow in the academy, think about the deployment. If you fit sclera lenses become the fellow in the scleral lens education society. A big meeting like and again I have to give a disclaimer there too. But the global especially lens symposium is certainly a good way. But I think the networking part is really critical that the least Kramers and Stephanie Woo’s of the world, there's all that there's many contact lens specialists out there all seem to be a very nice and giving community. So people who have questions can email them and form that connection. And then if you wanting to build more of a contact lens practice, you really establish that connection or you want to become a diplomat or whatever you want to do with some really good people. Stephanie had mentioned a Christine … or Brooke Messer, these people are great. And they're always good about communicating and they want to, so I couldn't agree with that more. A couple other comments, we'll take some questions.

I always recognize our advisory board members who run and we have quite a few tonight. And Bob Gurley, Bruce Williams, Craig Norman, Long Tran, Ray Brill, Robbins [INAUDIBLE 31:32] and Tiffany … are all on. I also want to mention we have some new resources that I'd really love for you to check out if you want to. We have established the COVID-19 module and it'll be finished tomorrow. But it'll have the webinar from Friday on how to handle your contact lens patients today and tomorrow, as well as a PowerPoint of the company that you'd be able to download. But we also have information on contact lenses. We all know what happened there and everybody exploded. And so we put together our own document that you can download and put on social media or email a patient that talks about the safety of contact lens where during COVID-19, and it's sourced and has all the appropriate sources on there.

And the other one is we have a disinfection card under our resources, printed resources area on the web and it's how to disinfect reusable lenses in the office, that your squirrels and other lenses that you use in the office, the appropriate flowchart and how to do that and you can download that easily as well.

We do have some questions, and I'll get to at least a few of those. Nicole Cohen had a couple, and I apologize if you've answered these and I was answering other questions, but her first question was if you have a contact lens only practice, does that mean you don't take VSP? I made it etc. Since those insurances require having frame lines in the office?

Stephanie Woo: That's a really great question and something that I actually looked into because I wanted to have a specialty lens clinic and I did not want to have an optical at all, and so I thought well, I could still take VSP and I met … and all these insurances and just take the medically necessary part. But you're right, you have to have an optical of a certain amount of pieces of inventory, and you have to practice primary care, and those were two things that I did not want to do. Now that doesn't mean you can't have a specialty lens clinic and still do all those things like Dr. Kramer does all of those things. She has an optical, she does primary care, she's got specialty lenses, but if you are only going to have specialty lenses, you would not be able to accept those vision insurances because they do require that you have to have an optic.

Ed Bennett: Okay. Very good. Other question was, and you may have addressed this tonight and I may have missed it, but I know you've approached MDs, especially, you recently Stephanie in going out and launching your own practice in Las Vegas. How did you go about meeting the MDs? What was your approach in that regard?

Elise Kramer: So, when I started at the beginning, I was literally knocking on doors so just making an appointment with ophthalmologists was obviously at the top of the list for me, corneal specialists especially, but I would go from practice to practice, I even brought like a fitting set with me, showed them what I could do, and gave out cards, rack cards, explaining you know, a little bit about my training, a little bit where I was located, and also tried to schedule a meeting time with these people, whether it's lunch or happy hour just to get to know them and see how we can work together and have a symbiotic relationship. And then I started doing that for other MDs and optometrists as well. What about you, Dr. Woo?

Stephanie Woo: Yeah. So I think that that was very similar to my experience, and I'm still in that, you know, knocking on doors and things until this thing all happened. But that was what I was doing was kind of just cold calling different ophthalmologists. And that's where I'm at in my stage of people that I'm calling on is I'm just kind of cold calling and making appointments for coffee or lunch or if they don't have time for that just even a quick phone call and just kind of explaining. And I think Dr. Kramer is completely right when she says you want to make sure that you talk to them about, I really want to know about your practice as well. It can't just be about you, you can't say, I'd like to meet you for coffee so that I can tell you about my clinic, and my patients and how you can help me. It has to be a symbiotic relationship. And you genuinely need to know who the best doctors are, so that you know who to refer to, because you're still going to have things that come up, and you want to know kind of who's going to work with you, and who you can work with. So I think it's huge to have a very mutually beneficial relationship.

Elise Kramer: And Dr. Woo, you said you're still in that, to be honest, I'm still in that too. I don't think it ever stops. I think there's, you always need to reach out, you always need to remind them you're there. Make sure that you remember their birthdays or you know what I mean? Like you know, just make sure that you keep that relationship like kindled all the time, you know?

Ed Bennett: Well then you also have the situation when you're trying to build a new practice which is specializing in custom contact lenses. So you're, you differentiate yourself from other optometrists in the area. And this is a Craig Norman question by the way and unlike ophthalmology who refer patients routinely. How do you build trust with other optometrists to refer their specially consequence patients to you?

Elise Kramer: I think especially if you don't have an optical, it's a lot easier. Having an optical is a little bit of an obstacle for having optometrist referred to you. But you build relationships with optometrists and remind them that you're not, I call myself a contact lens doctor. So a lot of patients will come to me and say, hey, can my you know, brother come to you? Can I just come to you and not see the other person, and I say, listen, I'm your contact lens doctor. And that's it. You're a general optometrist. And that way I send the patient back and I try to really maintain that so that I don't feel like I'm taking patients away from these optometrists. Like I said earlier, a lot of optometrist don't have the resources or interest in doing this type of work. And so, if everyone has the best interest of the patient at heart, they will send you patients.

Ed Bennett: I might add that Dr. Woo and Dr. Kramer are proactive in really going out there and that's a huge, huge factor that if you want to build that contact lens practice, you're going out there, meeting people and building that trust with them as they've done. Final question. There are couple of questions about sclera lenses, and you can kind of lump them together in terms of a lot of practitioners are fitting sclera lenses today. Obviously, you two of the experts. What makes your practice different to come to you, for example, for sclera lenses?

Stephanie Woo: So is the question, why would they come to see one of us instead of another doctor who also fits sclera lenses?

Ed Bennett: Well, if they … if, for example, with as many people fitting sclera lenses, let's say you have doctors that are somewhat casual, they fit, they dabble in it and they fit a few. And I'm just trying to interpret the question, but what is it? I could answer it for both of you, by the way, and I'm not going to do it. But why would a practitioner refer somebody to Dr. Kramer. Why would they refer someone to Dr. Woo? Even if they do fit sclera, it might even be very casually?

Stephanie Woo: Yeah, well, that's an amazing question and something that I had to think of when I was building my clinic. Why would another eye doctor refer to me, Stephanie Woo, compared to Dr. X down the street who also fits specialty lenses, so you, you do have to do some extra work in trying to differentiate yourself by some of the things that we've said. So either doing a residency or doing a mentorship or doing publications, authoring and having some ways that you can really stand out. And then I think having a lot of different pieces of technology and equipment and expertise. I mean, that just kind of goes along the way and this might be like a really dumb analogy, but it's kind of like a cardiologist if you could go to a cardiologist and they do a whole bunch of different surgeries, or there's a cardiologist that all they do is quadruple bypass surgeries. They don't do anything else, does nothing, nothing, nothing. They don't do anything else. It's kind of like well, who would you want to go to? And for me, I want to go to somebody that does this day in and day out. And Dr. Kramer and myself, we live and breathe specialty lenses. So I think when other doctors realize that this is something that you do every single day, many, many times per day, that can really help them understand why they would maybe refer to you instead of just someone else that also does sclera lenses. Dr. Kramer I'm sure you have more to add.

Elise Kramer: Well, and I think maybe I've gotten referrals from optometrists who fit sclera lenses here and there. And maybe they feel comfortable fitting like a mild keratoconus patient, but the minute they see a patient with a transplant or something way more advanced, they might just not feel comfortable doing it. And so that like Dr. Woo said, this is something that we do every single day, all day, you know that we're in in the office. So I just think that that level of experience and the fact that we've just highly specialized ourselves would and people know, because we put ourselves out there, would generate those referrals, whether they come from an optometrist who does this some of the time or from an ophthalmologist.

Ed Bennett: I think that says of the mouse well as you can say, all right, Dr. Woo, Dr. Kramer, please proceed.

Elise Kramer: So, when I first started my contact lens practice, I really started from scratch and I really … all I had, and I was renting a small office within an optical so it was really basic at the time. All I had were auto Ks like from a you know, auto refractor and I had a slit lamp and I had a fit set. And I did it you know, obviously I had floor seen and I had sailing and all those extra things, but what do you really need, you know, for a specialty contact lens practice? And Dr. Woo touched on this earlier, she said, you know, and we talked a lot about this, what should she absolutely get and what is like a more of a bonus? Really all you need is, you know, topographer, a slit lamp, and, you know, and a fit set, and obviously phoropter and you're fine. But obviously, the more of these things you can get, the more you can really specialize. So there's basic, you know, essentials, and then there's things that you absolutely, you know, just are complete bonus, but add a lot to your practice. So, these are just a few things if you look on the left side of equipment, so you know, typographers, sclera profiler, OCTs, lens [INAUDIBLE 43:53] and we'll go through a few of these important ones and then on the right, you know, fitting sets, which is actually indispensable, you know, mirrors, cleaning and storage solutions, plungers, artificial tears and more.

Stephanie Woo: So then we also wanted to kind of discuss what baselines are really important. And these are some, and we don't need to go through this whole list. But these are just some things that are important kind of starting points. And the lads have done a really good job at creating fitting sets where they've got instruction. So if you are more of a novice, you can look at it and say, okay, well I've got this cone. What did I even start and sometimes they'll tell you, okay, take the K max or take the highest elevation point or take X. And so they've all developed their your unique fitting sets and different fitting guides on kind of where it stuck. So you definitely need to collect baselines. Not only is it Important so you know where you're starting. But then also you have some points of reference for later in the future to see if things are changing, and like we said in the beginning, not only are you fitting specialty lenses, but you are managing anterior segment disease. So you do need to have a way to be able to detect if keratoconus is progressing or if a transplant is rejecting. These are things that are super critical to the patient's health and their success. So just need to make sure that you do have some baselines and some measurements that you can take before starting to fit.

Elise Kramer: So corneal topography is something that's really really important. like Dr. Woo mentioned for disease management, remember, don't forget about the eye you're actually taking care of, but you know, even for something that's more elective, like orthokeratology, if you want to, you know, for example, you know see the progression of how your treatment is going. That is really again necessary to have topography. But what it can do is it also helps you diagnose different conditions. You can use the curvature and elevation maps to help you diagnose, again, different conditions, can give you anterior posterior. We know that some conditions like keratoconus will start on the posterior surface of the cornea. So if you have that, you're really a diagnosis early and get the patient taken care of. Again, these are just examples, but so important to have corneal topography, not only as a baseline, as Dr. Woo mentioned, but also to look at, you know, the progression of treatment if you're doing a treatment or to help you diagnose different conditions.

So again, other things that this can do is help you evaluate if you have lens flusher so that's important. If you put on the lens and you can do typography over that mild quality. It will give you an idea of the ocular surface condition. It will give you an idea of what the tear film quality is. And that's also really important. If you have patients who have certain irregularity, corneal irregularity, they can also have ocular surface disease. And so these machines topographers can be so rich in the information they provide really helps you take care of the entire anterior segment.

Profilometry is one of my favorite instruments and I think Dr. Woo would agree. It’s just something that's extremely efficient imaging scleral shape. So that's extremely unique because most practices that specialize in eye care do not have this machine. Most ophthalmology practices don't have this type of device. And so this is such an amazing technology that will give you information that you otherwise wouldn't have obtained. It can help you design contact lenses that are way more comfortable, that are way more precise. And it can also give you information about sagittal height of the eye, which is something of the surface of the eye, which is just something that previously we had a very difficult time measuring.

So there's three different ones on the market right now and they've just been an amazing you know, godsent to my practice. Also, patients are extremely impressed with this and I know Dr. Woo, you feel the same way about this machine.

Stephanie Woo: Yeah, I agree. I think that Profilometry has become such a huge part of my clinic and it's one of those things that once you get you can't live without. And so this is something that I wasn't able to afford you know right off the bat, but for my other practices but as I gained more income, this was one of the must have things on my list. And now with my new practice, this is absolutely a must have on my list of equipment.

So also important if you do have an OCT, it really can help not only with ocular disease aspects and for me it was important to have an OCT that checked the posterior and anterior segment of the eye, but if you're using it to fit specialty lenses, it has to be an anterior segment OCT or have some sort of adapter to have that capability. There are still some OCT's on the market that only do posterior and those wouldn't be that helpful for specialty lenses. But I use my OCT every single day on every specialty lens patient, so I can check the edges, double check what I'm thinking I'm getting for clearance. Or if you have an area where you're not quite sure what the clearance is or is it going over the limbus, not 100% sure, you can use this to kind of just double check your work.

Also, photography, I think is very important, not only to manage the disease and kind of monitor it over time, but also be able to show it to patients as a visual. So something that's become really important in my new practice is I'm able to take photos of the eye and then show the patient so that they really know what's going on the surface of their eye. And I can actually point out things that maybe no other doctor has ever shown them before, and they love learning about their eye. They love being educated about their own unique case. And so I think answering segment photography is absolutely essential in having a specialty lens clinic.

Elise Kramer: I agree. Some patients, it's like they've had seven surgeries, but they've never seen their actual eye before. So you have this, it's just really great to show them.

Another thing that's very important if you can, I unfortunately don't have this technology in my office, but I do co manage a lot of, you know, I guess, a compromised endothelial cases with ophthalmologists but if you do have this, it's even better. So what this specular microscope does is it will evaluate the quality of your endothelial layer of the cornea. So this is really important if you're fitting specialty lenses on patients, post penetrating care to plasti or with poor endothelial health like patients with endothelial dystrophy. And so it can give you just a lot of information on whether this patient is a candidate for specialty lenses, especially when we talk about sclera lenses, which can induce a little bit of [INAUDIBLE 52:12] in these cases, and again, you know, there's no real contraindication but just having this information can just give you an idea and help you monitor also. It gives you not just the cellular density, but also the quality. So poly magnetism play on morphism and a lot of information there.

Aberrometry is also something that unfortunately I don't have, but that's an amazing technology if you could get it. A lot of patients with irregular corneas. For example, those with keratoconus will have a lot of vertical coma. And so sometimes if you're fitting in lens on this patient, they're just not getting the acuity that you want. And so having this type of device could help you design a lens in order to correct for these aberrations. And so I think this is really the future and hopefully, I can have something like this. Dr. Woo, do you have this type of device in your office?

Stephanie Woo: Yes, I do. And it's an amazing piece of equipment. And I totally agree with you that I think this is the future as far as optics go with specialty lenses, because being able to correct for some of these things that we've never been able to correct for is going to be huge. I've got patients that have keratoconus that I can only get to 2030, but because of their eye aberrations, and with this new technology, one of my most recent patients, you can see 2020 now, I mean, it's absolutely amazing technology, it's only going to continue to get better and better, and it's really easy to use as well.

Elise Kramer: Maybe my next birthday present

Stephanie Woo: And then it's also important to have lens and device monitoring pieces of equipment and instruments. So I have a radioscope and I definitely, I know Dr. Kramer does, I can't even imagine not having one. And it was for some reason during like, third-year clinic, I was like, when am I ever going to use this stupid thing? Like, I mean, you're lining up these Meyers who knows like, I'm never going to use this. And now I'm like, Oh my God, thank God I have this thing, because that's the only way to really verify base curve. So if I have a contact lens I also going to compare what the lab order says compared to what I'm actually getting, or checking someone's lenses after they've been wearing them for a year to see if they have worked at all? Most of us have gotten loops in school. I know that SECO, you have to buy a seven by to make sure that you can check the diameter of the lens and the edges as well. I don't have a shout out box to check the edges but I know a few doctors that do, and that could be helpful if you do a lot of specialty lenses. And then lensometer you can do you know, have a manual one or a automated one, whatever you have now is probably fine. And for me, being a new practice, I got a used one because I didn't think that that was where I needed to spend money on having a brand new machine that was thousands and thousands of dollars. So these are things that are critical, but they're actually not very expensive.

Elise Kramer: I agree with everything you said. I mean, radioscope is something that is just so essential to my practice.

Stephanie Woo: So another question that we get asked a lot is, what are some other really important tips and tricks for building a specialty lens practice? Something that I know Dr. Kramer and I both believe in is everyone has to be on the same page. That means your staff, if you decide that this is something that you want to do, make sure that you are telling them that this is something that you are offering to patients now. The worst thing that can happen is a patient calls and they say, Hey, I heard that Dr. Kramer does sclera lenses, and the staff member says, um, yeah, I'm not sure. Let me go find out for you. So that is very … that just doesn't look good. So you want to make sure that the staff are very well educated on what you're providing, and get them used to some of these terms. So in my other practice in Arizona, I had to tell patients or tell the staff members, these key words such as keratoconus, such as [INAUDIBLE 56:47] coil transplant, things that they've never heard of before so that when a patient calls and says, Is this something you can help me with, they automatically say yes. so super important to get your staff on the same page so they know exactly what you're trying to do.

Elise Kramer: Yeah, and there's different roles. You know, I don't think there's a rule as to what you absolutely need for a specialty lens practice. But technicians are amazing. These are … or contact lens technicians are people who I think are very important for a contact lens practice because they're going to be the ones that are helping patients with application and removal, which, as you guys know is probably the biggest challenges for patients and contact lenses, especially novice wears, sclera lenses, but any type of lens.

a contact lens coordinator could be someone who discusses you know, price points with your patient, who discusses care, so storage, you know, cleaning. Again, you can have a technician do that, have this role as well. And then obviously billing if you're doing insurance receptionist opticians. Remember that optician of course, if you have an optical. But remember that patients, before they see you, they're seeing your staff and even sometimes after they see you they're seeing your staff. So your staff really have to be on the same wavelength as you. It's a team, you know, and everyone wants the practice to succeed. Obviously, you have being the owner, of being the person in charge, no one's ever going to care as much as you. But if you get your staff to be on the same page as you and if you get your staff to be well versed in keywords like Dr. Woo mentioned, I mean, you're golden. And you just make it a win-win situation for everybody, you know, working in the office. So the culture is really important. Want to work as a team, want to have a clear purpose. You want everyone to feel happy to be there. If you're practices innovative, and you know cutting edge, your staff will be excited about that, about showing patients what you have. Communication is super important. And just constructive feedback. It's important to also have your staff have access to resources. So I bring a lot of new technology in my office, you know, as it comes out, I like to have a lot of the new things that are just coming out all the time, and I want my staff to be as informed as possible. And so a lot of the time I'll do like a lunch and learn. I'll have you know, company’s industry come in and teach them about it so that they can answer phone calls so that they can talk to patients about it. And so I think the values of having, you know, your staff feel important, informed is very important. And I know you have similar feelings about this, Dr. Woo.

Stephanie Woo: Yeah, absolutely. Just like you said, Dr. Kramer, everyone's got to be on the same page. And they usually are so excited the staff when you're offering new stuff, they love it, they love being known as the practice, it's able to help these patients. So having an incredible team that really you can't put a value on that.

Elise Kramer: So, a contact lens coordinator, I touched on this a little bit, but again, you can, you don't have to have a specific person designated for this that's different than the technician in my office. My contact lens coordinator happens to also be my technician. But of course, if you have a big, you know, practice with a lot of exam lanes or a lot of patients, then you might want to have a separate person. But basically, it's really important to have someone designated to be well informed on contact lenses. They're that concierge point of contact with patients, especially when we're talking about medically necessary contact lenses. These require a lot of attention. Patients have a lot of questions, they have a lot of concerns and they need to have someone that they feel comfortable with that may not be you necessarily, you can't always be available all the time because you have patients to see. But to have someone there who is really informed, and educated and competent in contact lenses that can help patients is really important.

So what does this person do? Well, they can help schedule patients, they can answer questions, they can help with, you know, any signing of forms, track lenses. So sometimes we order them we want to know where they are. So these people can call labs and find out and also you might want to have them take care of that side of the billing, if you want to.

Stephanie Woo: So building a demand. There's a lot of different things that we can go through and of course Dr. Bennett, I know that we're kind of going over. So just feel free to jump in anytime. If you're like, Okay, it's time to stop and you just let us know. But this is just it's so exciting for us because we love talking about and we feel like we have so much to share. So yeah, you just chime in anytime if we're going over too much.

But super important is making sure that you are discoverable. And Dr. Kramer's an expert in this, I know that for a fact that sometimes you can type in keywords like contact lens or scleral, or keratoconus, and oftentimes, I will see her website pop up on Google as one of the like top things which is awesome. So we could do a whole lecture just on building demand based off of like social media presence and website and things. And I think that, and of course, Dr. Kramer I'd love to hear your thoughts too. But the most important thing I think is face to face marketing, building a relationship with other doctors, if you are depending on referrals, I think is huge. And even I've done some random lectures at like schools and we're talking about myopia control or you know, things that so going directly to the consumer instead of just a doctor. But when people get to see your face, and they kind of get to meet you and realize, wow, this person really knows what they're talking about. I think that that can be huge.

Elise Kramer: Yeah, I agree. And you never know, the source of referral. It could be a friend, it could be a family member, it could be another doctor. It could be, you know, patient self-referring. And being discoverable. I mean, is so essential. There's no point in having a beautiful website. If it's lost among the billions of other websites out there. You have to make sure that we can find it. And I don't think you can, like you said Dr. Woo, you can never underestimate those face to face encounters.

Stephanie Woo: So this is something that I have only recently become aware of being in a rural town, there was only like three other eye doctors and two of the practices that I owned, we were the only eye doctors so these types of things were not super important, but now that I'm in a bigger market and there's other people that have rankings, like I was so confused, I'm like, how come when I type in sclera lenses, Las Vegas, I'm like nowhere to be found. And it has to do a lot with these AdWords and SEO. And I know Dr. Kramer has his she's such an expert in this type of, of area. And for me, I don't really know a lot about this. So guess what I do? I just hire it out. I have no clue what I'm doing. So I just say you know what, I really good at contacts. I'm not good at this stuff. So I'm just gonna pay someone that knows what they're doing.

Elise Kramer: I do the same and I definitely even if I wanted to do this, I don't understand, it's very complicated, a lot more complicated than anything. And I think it's extremely important. You want patients when they look up, you know, contact lenses or orthokeratology or sclera lenses in a certain town to be able to or city to be able to find you and at the top because no one goes to the third, fourth, fifth page of Google. So I also outsource this and I do invest heavily in this and I think it's really important.

Other things, of course, these are free. So you know, obviously, unless you do promotional, you know, advertising, but these are two free ways to get patients, and if you can increase your popularity just organically by being proactive on Facebook, on Instagram, just create a business page. People are on these all day, especially now, but in general, you know, Facebook and Instagram are huge and dominate you know, Social media. And so if you could get your page up there I know Dr. Woo does a lot of this and really good at it. But you know, you can get patients, you can get other doctors to refer to you. I mean, the possibilities are really endless.

If you have happy patients, and they agreed to do a video for you, this is great because you can put this on YouTube, you can put it on your website. And obviously if you're a patient and you're looking up, you know, oh I have keratoconus and you find this video and you see other patients with keratoconus who are successful, are very happy with your services. This is you know, just a free way of getting patients to kind of trust you and trust your work. And so happy patients, testimonial videos, I think this is a great way to just gain patient trust even before they walk into your office.

So this is another point where I think we've covered a lot of material. And we were hoping to answer some questions.

Ed Bennett: I'll ask a few quick ones. And then I know you all will be finishing up. The first time that people are asking if it's going to be archived this this should be on our website. This webinar should be on our website within a couple of days. A couple people ask about online education. I would assume pertain to this topic relevant to this topic. And the first time I'll make is we have over 100 webinars on gpli.info, the scleral lens education society has a lot of great scleral webinars archived. We in our situation webinar in particular, that was very good on this topic was by Carmen Castellano, who owns cutting associates a couple years ago. I don't know of any webinar on this topic and compare it with what we're hearing tonight. But he did a nice job and give an overview, especially, contact lens practice. We don't know what tomorrow is going to bring in terms of the academy, maybe it might be online. If it is then take advantage of that because there'll be some great contact lens online Education for the Academy. Do Dr. Woo, Dr. Kramer, any other thoughts about online education that you'd recommend?

Elise Kramer: The scleral lens education society, you mentioned that but they have a lot of great webinars and I think now it's like webinar season. So there's just so much going on in the specialty lens realms, just get involved.

Stephanie Woo: Yeah, I think there's a lot of emails that I get like daily from different entities like women and optometry, review of optometry, review of cornea contact lenses that are having a lot of these kind of free webinars and even just podcasts.

Ed Bennett: Well, I have to mention we probably had about 380 attendees on this webinar, which is the largest number we've ever had for our monthly webinars. So congratulations to both of you. One question Andrew Fisher was asking any thoughts structure the costs for medical specialty lens fittings? And by that he means do you recommend a flat fitting fee or more of a procedural based specialty lens fitting fee?

Stephanie Woo: Depends on your billing structure. So a lot of vision and medical insurances, they define how you have to build it. So with vision you usually bill kind of as one lump sum, and that includes the fitting, the insertion, removal, training, the follow up care etc. Whereas with medical insurance, usually bill each visit individually. So it will depend on your contracts with those insurance companies.

Ed Bennett: And one more quick question before we finish up. A couple of questions, particularly probably to you, Stephanie, pertaining to high order aberrations. And one of the questions was, how would one order lens to correct for higher order aberrations? What data do you need to send to the lab?

Stephanie Woo: That's a great question. So it depends on what lab you're using, if they have that capability, because only a few of them, to my knowledge, have that capability as of now. The company that I'm working with, I actually have an aberrometer in my office that I have to get the data to put onto the lens. whereas others, you have to have a specific piece of equipment to be able to do it. And then yet others, they can use information from your topographer and kind of identify it that way. So I would say contact to your lab, whatever one you're using now and find out if they are doing that, and then how they need to get that information. And if they say, well, you have to have this piece of equipment, then that might be something that you would want to invest in.

Ed Bennett: And you aall might be able to contact either Dr. Kramer, Dr. Woo, if you have a specific question, you may well be able to email them. And in that framework, they'd be more likely to tell you what, here's a lab or some labs that that do, you know, certainly correct for high order aberrations. Okay, well allow you to finish up.

Elise Kramer: Yeah, and thanks for staying a little bit over time. And we're really excited to share this information. There's just so much information. We could probably speak on this for three to four hours, but I'll let Dr. Woo take it from here.

Stephanie Woo: Well, we just kind of wanted to make a quick, you know, reference to just some of these practical matters, like charting billing and coding and audits. And I guess, in respect of time, maybe we could just make a few quick comments Dr. Kramer and then move on to the slide about the labs and then we can finish. So I think it's just some pearls on that is make sure that your record keeping is perfect because you may get audited, and I have many friends that have been audited. This is specialty lenses are one of the biggest things to get audited in optometry. So very, very important to do that. And then Dr. Kramer, would you kind of give a couple pearls on billing?

Elise Kramer: Oh, sure. So basically, it's important to, you know, have, know what you're doing, obviously, understand how billing and coding works. There's many different ways to do this. There's webinars, there's, you know, articles about this and you know, every company has a different fee schedule. There's differences with medical insurance and vision plans as Dr. Woo was mentioning, and this also depends on government agencies, charities and things. So it's really important to be familiar with this. And as Dr. Woo mentioned, audits can and will happen. They're unavoidable. So most likely, as a contact lens specialist, this will happen to you at some point in your career. It's not that bad, if you're doing everything right, you should be fine. But basically keep your charts in check. Make sure that you're actually ordering lenses, that you keep invoices, that you write down everything that's going on, that you have proof that this happened and then you'll be fine.

Stephanie Woo: So I think we could maybe skip to the slide about the labs. Basically, we just wanted to give a shout out to the CMA labs because they have just been such a help and a partner during this crazy COVID thing happening right now. They have offered many different services like shipping directly to patients to help eliminate contact, they are doing extended warranties, a lot of them are doing four month warranties to six month warranties. And some of them are even doing a whole year. So they're just really going above and beyond to help address some of our concerns as eye doctors, and then just doing a few surveys with the labs kind of finding out more about what precautions they're taking. They are really going above and beyond to make sure that the quality of the product that you're getting is excellent. So the labs are just absolutely such an amazing partner in this whole thing. And of course, without them, these webinars wouldn't be possible. So we wanted to give a shout out to them because they've just been such a resource for us.

Elise Kramer: Yeah, and they're really the ones that are Keeping our patients, you know, okay during this time. Obviously, everyone's different. And this is an unprecedented time that we don't really know when it's gonna end and we've been just trying our best to manage our patients. So just a last few things, I think, just important to, you know, keep in touch with your patients, make sure you're sending out newsletters and, you know, helping those that you feel absolutely need to help right now, you know, and obviously, that's in your discretion. But the labs, as you mentioned, Dr. Woo, who have just been so amazing, and really coming through for our patients during this time.

Ed Bennett: I can ask a quick question or two and I'm trying to get I know we have so many and I apologize for those of you that we did not. It's really had some great questions. Here's a study that Craig brought this up. I think it's a good point to what about performing clinical studies is another way to differentiate you in your practice?

Stephanie Woo: Oh, I think that that's a great way. Sometimes it's hard to get involved. Sometimes you have to be picked because you kind of need to be a key opinion leader or maybe people need to know kind of what your practice is about. But that can absolutely be another way to kind of set yourself apart and be seen as one of the leaders in the industry. Dr. Kramer?

Elise Kramer: Yeah. And you can you can apply for a grant. There's a few organizations that provide grants and then you can team up with a group that you want to do research with if you have a specific interest in something and get going. I think if you're proactive in that, and you feel like you have the sample size in terms of the amount of patients or specialty patients, and I definitely encourage you to do it.

Ed Bennett: Okay, very good. Final question. You both have impressive websites. I would encourage everybody to google each of you and look at how you've done them. One of the questions was in creating your website, what topics, what information should be on the website? And in part to really promote you as especially kind of lens fitter?

Elise Kramer: Yeah, so I think the more information, the better. Obviously, you don't want to drown everyone in information, but to have a lot of content is necessary to make your website discoverable. So if you put there information that maybe other websites don't have. So about transplants, about keratoconus, about sclera lenses, you put your articles up there, you can do that. Because patients that are really suffering with conditions, they do a lot of research themselves. And they will stumble on your website, they will more likely stumble on your website if you're covering the topic they're looking for. So I remember, like, I think I mentioned graft versus host disease in one article I wrote, and that article was on my website, and there was a patient with graft versus host disease that was looking, desperately looking for a solution and they found my website that way. So I think the more information the better. What do you think Dr. Woo?

Stephanie Woo: Yeah, I think for me, I thought it was important to have a section that was dedicated to practitioners and have that be its own kind of separate entity because since this is kind of a referral basis, a lot of practitioners want to know more about you and what your qualifications are. So make sure to have like a biography on there. A quick and easy way to refer patients. And then on the patient side, just like you said, Dr. Kramer, having a lot of information, showing that you do specialize in a lot of these different eye diseases. This is something that you're doing every day. So having that type of information about the different types of equipment that you have, and the different eye diseases that you treat, I think just kind of having those pieces of information really, really helpful.

Ed Bennett: All right. Very good. We'll bring tonight's program to an end. You can see on the previous slide, you had the email addresses for Dr. Woo or Dr. Kramer. So if you do have a question that didn't get answered, or you think of something later on, reminder that this will be archived on the website in a matter of a couple of days if you'd like to watch it again, and it'll certainly be there for you.

I want to thank Dr. Stephanie Woo and Elise Kramer for an exceptional, contemporary and comprehensive presentation when that you'll never … the time that you to put into this had to be incredible. Thank you so much to the foremost experts in the United States on specially contact lenses. And I want to thank all of you for taking the time out of your busy schedule to attend. We all realize that you're dealing with something that we neither expected or truly deserved that together we're going to get through this.

Please come back join us Tuesday night may 19th, when our webinar will be managing ocular complications from custom contact lens and it will be presented by Dr. Roxana Potter. I will also add that we have a webinar that was open to students and residents and eye care professionals, and I think you will all benefit from it. It's gonna be this Monday afternoon at 2pm. And it's on the homepage now so you can find it there. This Monday afternoon at 2pm and titled specially GP lens fitting tools and techniques to be presented by the dynamic Dr. Tom Quinn.

With that said, Thank you everyone, for being with us tonight. Have a wonderful evening and we hope to see you again with the GPLI soon. Good night, everyone.