Incorporating Specialty Lenses into Practice
2020 was supposed to be the year of vision, and we approached it with great excitement, but never in our wildest dreams did we expect to face what we're experiencing now. And who knows what the future will bring? That said, one huge takeaway we have learned is the source of our income: contact lenses. In particular, we have learned to be proactive by approaching our contact lens patients who need lenses now or in the near future. If we don't, companies out there are willing and able to take over the contact lens business, especially for standard lenses.
Although rewarding, building a successful optometry practice is challenging. Many optometrists graduate with massive student loan debt and very little business knowledge or experience in a healthcare landscape that is constantly changing. Optometrists in private practice are faced with growing competition from e-commerce, optometry chains, and, more recently, online refractions. These issues will not be going away anytime soon. In fact, online refractions are likely to improve and expand. To be successful in this competitive environment, optometrists must find a niche that attracts patients to their practice.
That makes specialty contact lenses even more valuable to our practice. Patients who require specialty lenses typically come back to the practitioners who prescribe and fit them. And of course, the laboratories collaborate closely with practices to keep specialty lens patients satisfied.
Tailoring Your Practice
All optometrists share a common goal to help people but differ in their vision for achieving that goal. You need to decide where you want to go and then formulate a plan on how to get there. Instead of competing with online sales websites or giant optometry chains, why not offer something that is simply unavailable online, something that is not offered at every optometry practice? No two eyes are the same; each individual eye has its own unique shape and curvature, much like a fingerprint. Eyecare practitioners should eliminate the “one-size-fits-all” concept and specialize. Contact lenses, in particular, should be tailored to each individual patient’s needs, habits, and lifestyles. The addition of scleral lens fitting and care to an optometry practice offers a unique specialty niche that provides personalized and specialized eye care to a growing clientele.
Optometrists can use this model to build their practice and improve their patients’ lives. A specialty lens practice can vary widely; every practitioner will have his or her own way to build and conduct such a practice, but the most important focus should be on the contact lenses. For many, contact lenses are the primary focus, not spectacles, and some may not even have an optical dispensary. Of course, many practitioners do both. However, if you want to establish a specialty lens practice, it's invaluable that you have a wide-ranging experience. Scleral lenses have now become mainstream. Every optometrist seems to be fitting them nowadays. Fitting corneal gas-permeable, hybrid, and intralimbal lenses has almost become a lost art. You should know how to fit many different types of lenses. You should also have a multitude of fitting sets: a corneal GP set, an intralimbal set, a hybrid set, and a scleral set. You should also make use of innovative technology, including cutting-edge equipment that will help you practice at the highest level.
It's important to remember that we’re not just fitting contact lenses. We must also treat anterior segment eye disease. An essential aspect of specialty lens fitting is a commitment to managing the underlying disease that leads to the need for specialty lenses. Some optometrists forget this, but to develop a specialty lens practice, you need to remember the focus on anterior segment disease. For example, you may have patients who have had corneal scarring from LASIK or radial keratotomy (RK). For those patients, scleral lenses not only improve their visual acuity but also protect their eyes. Similarly, in patients with severe ocular surface disease or dry eye, scleral lenses protect their eyes from the outside environment and from the mechanical friction of the eyelids.
Attracting Patients and Building Referrals
Scleral lens and specialty contact lens practices have multiple avenues for attracting patients. Some are already patients of the practice while others may be referred by your current patients through word-of-mouth or through your marketing efforts. Most, however, will be referred to your practice by external optometrists or ophthalmologists. Scleral lenses can help build the practice, thanks to strong networks with colleagues, and good relationships with cornea specialists. Scleral lenses are an important vehicle to strengthen relationships between optometry and ophthalmology. In fact, owing to the severity of some of the conditions treated with scleral lenses, many patients are already under the care of a cornea specialist, who refers them to your office.
Many ophthalmologists are familiar with scleral lenses but do not have the time or resources to dedicate to them. They are more than happy to collaborate with an experienced scleral lens optometric practitioner. You should meet with other eyecare professionals to explain the indications and benefits of scleral lenses. Visiting their offices with marketing materials, literature, professional cards, and referral folders can be a powerful way to promote collaborative care for their patients. Other clinicians whose patients may benefit from scleral lenses include rheumatologists, oncologists, hematologists and pain management specialists.
Open communication is essential when sharing care. Communicate with the referring practitioner to explain the findings, including best corrected vision with scleral lenses, future recommendations, timeframe for follow-up appointments, and return of the patient to him or her. Correspondence should be sufficiently detailed, but concise and to the point. Often, a patient will see both the scleral lens practitioner and referring clinician for multiple visits. Thus, updates are essential to share information and optimize care. Open communication will also stimulate new referrals. Building strong professional relationships takes time, effort, and an ongoing commitment to excellence. Outside providers who refer to your practice rightfully expect to see surgical referrals coming their way in return.
How to Become an Expert
In the final year of school, optometry students find themselves facing important decisions: What kind of career should I pursue? In what setting? Should I specialize my practice? During school, you can request a fourth-year site that specializes in contact lenses, if that's not already a requirement. Then, if you are really passionate about it, a residency is one of the best things that you can do for your future career. That is particularly true if you wish to acquire clinical skills that go beyond the basics to improve your clinical judgment, ability to make appropriate diagnoses, decide on treatment, and manage complex contact lens cases.
The residency provides a bridge between education and practice that allows you to grow intellectually, technically, and professionally. When doing clinical rotations in the third and fourth years of optometry school, we always have someone to lean on. A residency will encourage you to take a more active role by participating in hands-on decision-making. Not only will it help you learn about different lens designs and modalities, but you will also get the opportunity to see patients with many different conditions, some with normal corneas, others with highly irregular corneas. The profession of optometry is evolving, with greater emphasis on specialty contact lenses. A residency can enhance your contact lens skills, prepare you for independent work as an optometrist and put you on the path for life-long learning.
Adding Scleral Lenses to Your Practice
Scleral lenses present challenges in design and fit. However, with online resources, webinars, workshops, and laboratory consultants, it is not difficult to become proficient in fitting these lenses. Once you become comfortable, you can focus on building your practice around this specialty. Consider joining the Scleral Lens Education Society. Membership is free and offers many resources, such as scleral lens indications, patient selection, induced complications, and lens care information. Members also get access to educational videos for both practitioner and patient, audio presentations, and peer-reviewed research. The Gas Permeable Lens Institute is another great resource for those interested in building a scleral lens practice. Their website answers frequently asked questions, whether basic or advanced, and provides practice tools for billing, coding, and insurance claims.
Attend Live Workshops When Possible
Many contact lens manufacturers organize free day-long workshops which usually include a lecture component (learning to fit and troubleshoot lenses) along with a hands-on portion. The hands-on portion is beneficial because you get to handle the lenses, see the fitting set, practice insertion and removal on patients, and also evaluate lenses. Practitioners can expect to leave the course feeling more confident with scleral lens fitting and incorporating it into practice. Many conferences throughout the year have a scleral lens track, which could be beneficial for practitioners wanting to gain more knowledge on this topic. Many conferences also offer hands on workshops as well.
Get Involved With Research and Studies
When you start fitting more lenses and gaining confidence, consider reaching out to your laboratory and offering to beta test some of their next products. Sometimes they will ask a handful of practitioners to fit a lens design they are experimenting. This can help improve your relationships with the labs and be exciting to be able to offer new technology to your patients. Additionally, labs, contact lens companies, and pharmaceutical companies may reach out to you for other studies, which can also help establish yourself as an expert.
Reach Out to Leaders in the Specialty Lens Community
Most of the key opinion leaders in the industry are very friendly, and they are happy to share their knowledge with you. For practitioners serious about expediting specialty lens integration, consider a business coach or consulting company for help that is custom tailored to your specific needs.
If specialty contact lenses are something you want to incorporate into your practice, you must fully invest. Do not be half in and half out, because that will be frustrating for you, and it will also be a disservice to your patients. Decide to commit, and then take the necessary steps.
Necessary Equipment
In order to have a successful scleral lens practice, specialized equipment is often necessary. Such equipment may include corneal topography, corneal tomography, profilometry, anterior segment OCT, anterior segment photography, specular microscopy, aberrometry, lens/device monitoring with a radiuscope, loupe and lensometer, as well as basic primary care optometry equipment. Although many of these items require a significant financial investment, a successful scleral lens practice is both financially and personally rewarding, with a strong interprofessional network and loyal patient base.
Laboratories have done an excellent job at creating fitting sets with specific instruction. So, if you are more of a novice, you can look at the particular instructions and it will tell you how to pick an initial lens and give you a starting point. The labs have all developed their own unique fitting sets and different fitting guides based on their specific product.
Corneal Topographer
A corneal topographer is critical to any specialty lens clinic. It doesn’t have to be the most expensive or the latest model, but it is important to have topographical data for several reasons. Topography can be used for disease management, which is incredibly important for conditions such as keratoconus, post-LASIK ectasia, corneal transplants, etc. Not only does the topography give you baseline information, but it allows you to monitor their eye for any changes. In other cases, like orthokeratology, topography is necessary to observe the progression of how their treatment is going. Topography also helps you diagnose different conditions and have different maps to help with diagnosis and management.
Profilometry
Profilometry is an excellent choice in equipment for a specialty lens practice. It is an instrument that's extremely efficient imaging scleral shape. This is also unique because most practices in eye care do not have this machine, and most ophthalmology practices do not have this type of device. This is such an amazing technology that will give you information that you otherwise wouldn't have be able to obtain. It can help you design contact lenses that are more comfortable and more precise. It can also give you information about sagittal height of the eye, which is just something that previously we had a very difficult time measuring. Profilometry has become such a huge part of our clinics and it's one of those pieces of equipment that once you have you can't live without. It may not be something you can afford immediately, but as you gain more income, this should definitely be on your list of equipment if you want to fit specialty lenses at the highest level.
Anterior Segment OCT
Anterior segment OCT greatly assists not only with ocular disease aspects but can also help with scleral lens fittings. Checking the clearance in the center, midperiphery, and limbus can help identify areas of excessive or minimal clearance. It can also be used to evaluate edges to observe compression or edge lift.
Anterior segment photography is very important, not only to manage the disease, but also be able to show it to patients as a visual. Being able to take photos of the eye and then show the patient so that they know what's going on the surface of their eye is very powerful.
Aberrometry
Aberrometry is an amazing technology if you are able to afford it in your clinic. Many patients have higher order aberrations, which results in decreased visual quality. Aberrometry allows the practitioner to identify the higher order aberrations and design a lens to correct some of these visual disturbances. This is the future of optics with specialty lenses—being able to correct for some of these aberrations that we've never been able to correct for is going to make a big difference to the patient’s vision.
Other essential pieces of equipment to a specialty lens clinic which are relatively inexpensive, including 7x7 maginication loupe, radiuscope, PD rulers, and HVID handheld rulers. Many of these you may already have from optometry school, so just dust them off and put them to good use.
Importance of Staff
When it comes to implementing specialty lenses into your practice, everyone has to be on the same page. That means your staff are telling patients that this is a new service you are offering now. Make sure that the staff are well educated on what you're providing, and get them used to some of these terms, such as keratoconus, hard contact lenses, gas permeable lenses, etc. There can be different roles that staff play in your specialty lens clinic. Technicians are amazing and are very important for a contact lens practice because they're going to be the ones help patients with application and removal, which is one of the biggest challenges for patients and contact lenses, especially novice wearers.
A contact lens coordinator could be someone who discusses price points with your patient, lens care and training, and possibly billing. Your staff have to be on the same wavelength as you, and the culture is very important. It's a team, and everyone wants the practice to succeed. So, the culture is really important. If your practice is innovative and cutting edge, your staff will be excited about that.
It's important to ensure your staff have access to resources. With the addition of new equipment or products, it is important to properly train and educate the staff. Representatives may come in for a lunch and teach or even conduct phone training. The values of having your staff feel important and informed is invaluable.
Building a Demand
It is extremely important is making sure that you are discoverable. Patients have to be able to search for keywords on the internet and find your clinic. Being visible on the internet and social media can help build your clientele. Designing an aesthetically pleasing website that is easy to navigate can also help convert patients. You want patients to search for certain words such as: “contact lenses” or “orthokeratology” or “scleral lenses” in a certain town to be able to find you at the top of the search page because no one goes to the third, fourth, fifth page of Google. If you are not familiar with marketing or SEO, hire someone to take care of this for you. There are companies who will do this much better and much faster than you can on your own.
You can increase your popularity just organically by being proactive on social media, such as Facebook or Instagram, just by creating a business page. Setting up a business page gives you a landing page to refer patients and doctors to, who want to learn more about your business. Create content about certain eye diseases or contact lens types within your website. This gives patients and practitioners confidences about the conditions you manage and the lenses you fit. Patients will appreciate reading up on their specific condition and realizing you are the best doctor to help with their needs.
Additionally, face-to-face marketing and building a relationship with other doctors is invaluable. If you are depending on referrals, the face to face interaction is huge. Meeting other practitioners in person can help build trust and getting to speak with you elevates that relationship.
Happy patients who agree to do a video testimonial for you is a great option because you can put this on social media pages and on your website. This is a free way of getting patients to trust you and trust your work before meeting you. Happy patients and testimonial videos are a great way to just gain patient trust by having them see your positive impact on other patients.
Implementing Specialty Lens Fits in Your Schedule
After deciding that you want to start offering specialty contact lenses into your practice, a common question is: How do I start? After discussing your new service with your staff, purchase the necessary equipment, supplies, and fitting sets. Once you have everything in place, it is time to schedule your first patient. For your first few patients, you will need to allot a large chunk of time to allow for the learning curve and developing a system that works for you and your office. One to two hours would be ideal for your first fitting. You can schedule a patient anytime you have a one- or two-hour gap, or you can block out certain times in your weekly schedule. For instance, you can schedule every Tuesday between 10am and 12pm as a new specialty lens fitting. This approach makes scheduling easier on the staff and gives you plenty of time to perform the fit. When those appointment slots start to fill up and get booked out, then you can add more slots to accommodate your growing schedule.
Billing and Coding
Billing medically necessary contact lenses will largely depend on the type of insurance used (vision vs. medical), lens fitting and material codes, and diagnosis and CPT code. Many vision and medical insurances have defined exactly how they want things billed. You must refer to your provider manual to find out their specific rules. With vision insurances, you usually bill one lump sum, which includes the lens fitting, the insertion, removal, training, the follow up care plus the supply of the contact lenses. Whereas with medical insurance, usually each visit is individually billed. It will depend on your contracts with those insurance companies. There are many webinars and articles online that can assist with billing and coding basics.
Audits
If you fit specialty contact lenses to any capacity, audits will happen to you at some point in your career. It's not a bad thing—the insurance companies want to make sure you are properly using medically necessary contact lenses and billing appropriately. If you are doing everything right, you should not have any issues. Things to be aware of:
Take topographies on all patients every year or more often
Keep OCT images and anterior segment images in patient files
Record manifest refraction and best corrected visual acuity with glasses
Record lens parameters and notes of evaluation of fit and follow up care
Keep excellent records of each encounter
Attach lab invoices to prove you ordered lenses
Ensure proper billing and coding techniques
Resources to Learn More
There are hundreds of free webinars and videos online, published by reputable companies such as the Gas Permeable Lens Institute and Scleral Lens Education Society. Visit their websites and YouTube channels for hours of archived lectures to help advance your learning. Other sources such as Women in Optometry, Review of Optometric Business, and many of the contact lens laboratories offer frequent webinars or online learning. Sign up for their emailing lists so you can receive emails on topics that might interest you.
Implementing specialty contact lenses into your practice can be very rewarding, but you must take the proper steps to ensure your success as well as your patients. Be sure to envelop yourself with the materials, equipment, and attitude before launching this new portion of your clinic. As the old saying from Alexander Graham Bell goes, “before anything else, preparation is the key to success.”
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