contact lens economics
Match the Modality to Patient Perception of Convenience
BY WALTER D. WEST, OD, FAAO

As practitioners, we realize that different patients have different motivating factors in their selection of vision correction. Discerning which factors pertain to individual patients is the hallmark of an astute practitioner; offering all of the options in your practice signifies an astute businessman.

Patient Subgroups

Patients who select refractive sur-gery typically do not want to be bothered with any "appliance." Patients who do not want to assume the risk of refractive surgery must use "appliances," but this group of patients can be further divided into subgroups.

One subgroup is that group of patients for whom spectacles are sufficient. They have no interest in contact lenses.

Another subgroup is that which will accept the responsibility of wearing and caring for contact lenses. Obviously, there is today a multitude of options available to these patients. Each option has its place and its cheerleaders. For instance, many patients who experience the com fort and convenience of daily disposable lenses will never consider anything else. On the other hand, there are patients for whom the daily grind is the daily grind, whether it's removing a lens and throwing it away after one day or cleaning it and reusing it again for the next two weeks. It's simply the act of handling a lens daily that they find a nuisance. For these patients, continuous wear lenses are a consideration. Advances in continuous wear materials have recently brought a number of these patients into the fold.

A smaller but highly interested subgroup are patients who want the freedom from vision correction devices that LASIK offers but are unwilling to accept the surgical risk. These patients do not mind appliances, but they would like to go through their daily routine free from any concerns about them. This group makes ideal candidates for corneal reshaping, or corneal refractive therapy (CRT). In my practice, I use Paragon's CRT lens.

While some of us have been using CRT since it was first introduced several years ago, many more practitioners have become interested since the FDA's recent approval of CRT for overnight corneal reshaping.

Setting Fees

One tenet I have followed in my years in practice is that practitioners should charge professional fees commensurate with the time and level of expertise involved with fitting contact lenses; the more complicated the design, the higher the professional fee. Fees for materials should be market-appropriate. Gouging a patient on a material fee he can shop easily only alienates the patient. Conversely, patients tend to understand and more readily accept higher professional fees, particularly after having seen your professionalism and expertise demonstrated in the office.

With CRT lenses, even I had to undergo a slight paradigm shift. CRT is about therapy, not lenses. CRT is a program to reshape the cornea, resulting in clear, unaided daytime vision, free from appliances. Thus, our fee is solely for professional services, with virtually no material fee involved initially. (Lost or broken lenses are replaced at a nominal charge).

CRT is such a new concept to most of our patients that there is an investment of time on the front end in explaining the procedure and expected outcomes as well as alternative options. That is one component of the fee, just as a LASIK pre-op fee takes patient education and counseling into account. The actual fitting procedure is straightforward, thereby offering practitioners a very profitable procedure that is well accepted by patients and not time intensive in the clinic.

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