contact lens economics
Following Up on Follow Up
BY GARY GERBER, OD

How often do you see your contact lens patients for follow-up visits or progress evaluations? Every six months? Three months? Once a year? Does it depend on what type of lens they wear? What type of insurance  they have? Are your follow-up guidelines recorded somewhere at your front desk?

For many of us, writing "RTC" (return to clinic) or "RTO" (return to office) has become a knee-jerk scribble that has its roots in dated contact lens technology. Here's a more efficient, better way to monitor your contact lens patients.

See From Their Point of View

The ideal vision correction alternative for a patient is no correction at all. While successful refractive surgery may be the most convenient modality, no patient really wants to undergo it. Patients choose refractive surgery because they believe that for their lifestyle and level of risk taking, it's the best choice. The same holds true for patients who wear contact lenses.

No lens wearer wakes up in the morning and says, "What a great day! I'm so happy I have poor vision and I just can't wait to stick these pieces of plastic into my eyes!" These patients use contact lenses because they have no choice but to correct their vision, and for their lifestyle and level of risk taking, contact lenses make the most sense.

Keeping in mind that patients really don't want to wear lenses, we can extrapolate their desires to the next logical step -- they don't want to visit our offices either. But, again, they have no choice. Keep this "disdain" for your practice in mind as you formulate your follow-up philosophy for contact lens patients.

Time for a Change?

PMMA lenses set the stage for many practices that we still use to appoint our patients. Because these lenses have a high propensity for corneal insult, practitioners commonly saw these patients at least three to four times per year. Soft lenses slightly decreased the tension on this follow-up leash, but not by much.

With today's safer and healthier lenses (when was the last time you treated recalcitrant giant papillary conjunctivitis or saw corneal edema?), do we still need to maintain this excessively tight control on our patients?

Follow Patients, Not Lenses

We counsel our clients to not follow a lens per se, but to follow each patient. We instruct clients that if they have a system that pigeonholes, for example, "two-week disposable toric" patients into a particular follow-up scheme, then they should discard that system. Patients who wear these same lenses aren't all the same. Some are veteran wearers who have never had problems, and some present with pages of notes from their previous doctor. So why use the same follow-up program for all of these patients based solely on the type of lens they wear?

Following up patients based on their insurance not only demonstrates clinically poor judgment -- it's also illogical and unethical.

Instead, view each patient as a new case with individual needs and keep in mind that patients would certainly prefer no follow ups to any follow ups.

I'm not advocating prescribing and fitting lenses and never seeing your patients again. Rather, I'm suggesting that you trim the number of needed visits to the absolute, clinically necessary minimum. Untie this minimum from old historical trends that are based on archaic lenses and problems that no longer exist. I'm supporting a shift in thinking that will free up time for you to see more patients and will make your patients happier.

Nothing is magical about one week, one month, six months or one year. Break this mold and see patients when you must -- and not for one visit more.

Dr. Gerber is the president of the Power Practice ­ a company offering consulting, seminars and software solutions for optometrists. You can reach him at (800) 867-9303 or DrGerber@PowerPractice.com.