contact lens economics

Axe the Empirical Fit

BY WALTER D. WEST, OD, FAAO
February 2001

Until the availability of guaranteed fit policies from soft contact lens manufacturers and your local lens lab, most patients wearing lenses went through a contact lens evaluation and fitting. With rigid gas permeable lenses, corneal curvatures were

With rigid gas permeable lenses, corneal curvatures were measured, trial lenses were inserted and the practitioner evaluated the fit. Once this information was considered, either another trial lens was inserted and the evaluation process repeated, or the final lens was ordered. With soft spherical lenses, the same scenario occurred. With the advent of soft toric lenses, rotational stability became another variable to consider in the fitting and evaluation process.

Why Empirical Fitting Works

With the advent of disposable soft lenses, more trial lenses are available to practitioners than ever before. One would think that trial lens evaluations would be on the rise, but instead the keratometry and refraction mindset is alive and well. Even though most disposable lenses are easy to manage clinically, not every lens fits every patient the same way. Once again the way to give the patient the best possible fit and lens performance is to evaluate a lens on the eye and make your lens recommendations based on your evaluation, not by providing what usually works most of the time and hope it comes through again.

Soft toric lenses present rotational stability as another variable to be considered in fitting success. In the early days of toric lens fitting, trial lens evaluation at many times seemed a fruitless waste of time. The greatest variable in lens performance early on was poor repeatability in the manufacturing process. As the repeatability of toric lenses gradually improved, wider ranges of parameters made it difficult to have trial lenses available in those powers.

At this point many contact lens manufacturers began to promote empirical fitting rather than trial lens evaluation. Many practitioners gradually migrated from the lens evaluations of rotation, movement and centration that had previously been commonplace. Unfortunately, while the empirical approach to fitting soft toric lenses gained in popularity, practitioners seemed to lose sight of the advantages in using trial lens evaluations whenever possible.

Many practitioners indicate that they don't have time to do trial lens evaluation, others feel that it's not even necessary. Even though my contact lens practice is large, I continue to do trial lens evaluations because it helps me fit the patient right the first time. Patients seen in my office as new contact lens wearers are evaluated with corneal topography, slit lamp, tear assay and tear break-up time and trial lenses. Patients who have complaints with their current lenses and are being refit are evaluated in the same manner.

Give Trial Fitting A Try

To incorporate trial lens evaluation as a regular part of your contact lens evaluation, train your staff to assist you in gathering data such as corneal topography and measuring tear volume, tear break- up time and trial lens insertion and removal. Save your time for the evaluation of the fit and the lens design in addition to educating the patient.

Separate your fees for contact lens evaluation and fitting from your comprehensive examination fee, and ensure that the fee you charge is appropriate for the time you will spend as well as your expertise. For those practitioners who haven't been charging a fitting fee, I encourage you to do so. For those practitioners who have, I encourage you to give your patients what they are paying for.

It is time to stand out as one of the few who can truly fit contact lenses rather than one of the many who can sell them.

Dr. West practices in Brentwood, TN, and lectures nationally and internationally on contact lens and practice management topics.