CL PRACTICE MANAGEMENT
Contact Lens Best Practices
This survey reveals the methods of contact lens practitioners who provide excellent patient care.
By Jennifer A. Barr

In a recent survey, Contact Lens Spectrum learned that contact lens specialists across the country experience similar situations, but employ a range of methods in managing them.

Nine of the industry's leading contact lens specialists, including members of both the American Academy of Optometry and the Contact Lens and Cornea Section of the American Optometric Association, participated in Contact Lens Spectrum's "Survey of Best Contact Lens Practices." Respondents included Doug Benoit, OD; Carmen F. Castellano OD; S. Barry Eiden, OD; Art Epstein, OD, Paul Klein, OD, FAAO; Timothy McMahon, OD; Glenda Secor, OD; David B. Seibel, OD; and Joe Shovlin, OD.

Here we'll share the practices, opinions and experiences of those practitioners, all of whom are highly respected within the contact lens industry. Our panel of experts, covering urban and suburban settings, private and group partnerships and university medical centers, agreed to share their contact lens fitting experiences, plus their practice management and referral strategies.

Lens Fitting Strategies

Our survey asked participating specialists about fitting toric soft contact lenses, front-surface aspheric soft lenses and GP lenses as well as about how they correct contact lens-wearing presbyopes.

Toric Soft Lenses The majority of doctors we surveyed fit nearly all soft lens patients who have 0.75D of astigmatism with toric lenses. Several mentioned that they automatically fit any patient who has 1.00D or more of astigmatism with toric contact lenses because of the resulting higher visual resolution. Yet, most doctors use the amount of sphere power to determine whether they fit a toric soft lens.

"The lower the sphere power, the less patients seem to tolerate uncorrected astigmatism," explains Dr. Castellano.

Front-Surface Aspheres Front-surface aspheric soft contact lenses raised varied responses from the expert panel. Three of nine in our survey most often fit patients who have low astigmatism with a front-surface aspheric soft lens.

When he's not fitting patients with silicone hydrogel contact lenses, Dr. Epstein finds that he fits most patients with a front-surface aspheric soft contact lens.

Dr. Eiden also includes incipient presbyopes in the category of patients he fits with front-surface aspheric soft contact lenses.

Fitting Presbyopic Patients More than half of the respondents fit contact lens-wearing presbyopic patients with bifocal/multifocal contact lenses. "Binocularity allows both eyes to work together, giving patients the best vision with the least compromise," says Dr. Secor. "It also helps establish me as an expert when difficult patients succeed."

Says Dr. Benoit, "I choose a bifocal/multifocal first to give patients the best, balanced vision I can." He finds that monovision may cause more problems with depth perception, and many of his patients can't tolerate it.

However, contact lens specialists participating in the survey use both monovision and bifocal/multifocal correction in their practices. Dr. Castellano fits patients with bifocal/multifocal correction, but his first choice is monovision. He explains that monovision not only has a high success rate, but practitioners can demonstrate it easily to patients and use it with any lens modality.

Silicone Hydrogels Our experts agreed that fitting patients with silicone hydrogel lenses is an outstanding option for continuous lens wear. It also improves late-day comfort and appears to be a safer option for contact lens wearers.

Some specialists, including Drs. Benoit, Epstein and Castellano, consider fitting silicone hydrogels the standard of care for contact lens patients.

Dr. Eiden agrees, "I currently consider silicone hydrogels to be the standard of contact lens care for any continuous and/or overnight wearing schedule or any other cases in which oxygen transmission values are critical for appropriate physiological response to lens wear." He continues, "We may find that silicone hydrogels will become the standard of care for traditional daily wear as well as time goes on, particularly if we discover evidence of improved physiological performance vs. traditional hydrogel materials."

Dr. Benoit believes the increased oxygen that the new silicone hydrogel polymers transmit to the cornea makes them the healthiest option available today. "Older polymers don't provide the same level of safety from corneal oxygen deprivation-related anomalies," he says.

GP Lenses The percentage of respondents whose patients wear GP lenses varied greatly. Some concluded that within their practice, they've fit only about five percent of patients with GP lenses. The majority reported that about 20 percent of their patients wear GPs, but that number jumped to as high as 35 percent for some practices.

"The advantages to fitting GP lenses include (often) superior visual performance, potential for myopia stabilization, superior performance in multifocal designs, ability to correct irregular astigmatism in cases of corneal diseases/injuries/post-surgical cases and, finally, corneal reshaping," says Dr. Eiden.

Dr. Castellano adds, "GP patients tend to be more loyal."

Practice Management Strategies

Annual Dispensing Philosophies Whatever lens type they're dispensing, the majority of our survey participants encourage annual contact lens dispensing and agree that it helps make the contact lens wearing process easier for patients.

"It's a matter of convenience," says Dr. Eiden. "Patients who order annual supplies don't need to contact the office to order lenses every three to six months and they run out of lenses less frequently."

Dr. Benoit agreed that annually dispensing disposable contact lenses allows patients the convenience of making only one trip to the office, most often during their annual exam. He added that patients in his office usually receive a rebate to reduce their costs. "Most patients appreciate our consideration of their time and monetary outlay," he says.

Convenience aside and with health benefits in mind, Dr. Secor agrees: "Annual dispensing improves compliance, reduces potential problems and helps maximize vision with new, clean lenses and healthy eyes."

To Bundle or Not to Bundle Fees Doctors can present their contact lens services and materials fees either bundled or separately. Our surveyed experts shared advantages to each method.

"We bundle our initial fitting fees so that we may de-emphasize product and put the emphasis on service," says Dr. Castellano. "Patients pay us for our service and expertise -- the lenses are simply a tool."

Conversely, Dr. Secor finds that offering contact lens services and materials fees separately allows the patient to compare fees and realize that her prices are the same, or often less costly, than alternative delivery channels. This offers justification for professional fees to cover services, Dr. Secor says.

Dr. Benoit separates his professional service fees from his material fees because it doesn't bother him if some patients choose to get replacement contact lenses from an outside source. "Patients will still need to pay for my professional services in the future to renew their prescription. This is where I generate my income."

Today's advanced technology, specifically online shopping, adds an additional level of competition to the sales strategy. Our respondents have set their material fees equal to or more than those found on the Internet, for example at 1-800 Contacts.

Dr. Benoit explained that the price difference between his fees and the competition's is the reason he separates his professional and material fees. "This allows patients to compare contact lens prices for replacement purchases," he said. He added that most patients easily see that his lens prices are the same or, in his case, even lower than alternative sources, so they don't go elsewhere.

Similarly, and even more so than material fees, our experts contend that their service fees overall are higher than their local competitors'.

Dr. Castellano explains, "We spend time and energy educating patients on the benefits of regular follow-up care and we try to go the extra mile to exceed patient expectations. You get what you pay for."

Promotion Within the Practice To promote contact lenses within a practice, several of our contact lens specialists share that newsletters, on-hold messages and office displays all contribute to the success of contact lens endorsement in their offices. Others mention e-mail or providing lectures as successful ways to promote contact lenses to patients. Dr. Benoit and Dr. Klein discuss contact lenses with every appropriate patient. Dr. Epstein says that contact lens promotion within his office is so successful because contact lenses are essentially what his practice focuses on. Table 1 summarizes these methods.

Garnering Referrals

Working with MDs Our respondents shared their best practices for promoting referrals from ophthalmologists. In some cases, they've partnered with area ophthalmologists and have arranged two-way referrals with cataract surgeons and retinal specialists. Some return patients to the ophthalmologist for primary care to increase traffic in their offices. Others rely on traditional advertising and public relations methods, including mass mailing, while promoting referrals from ophthalmologists.

Directly sending referral letters and following up with reports can help optometrists gain respect from ophthalmologists, resulting in more referrals. Some suggest maintaining a strong reputation and, as Dr. Secor says, "Demonstrating a high level of expertise in specialty or difficult patient situations promotes referrals from ophthalmologists."

Be a Leader Our respondents promote referrals from optometrists in similar ways to that from ophthalmologists, such as mass mailing, sending referral letters and demonstrating expertise in a specialty or difficult patient situation. Some differences include offering presentations on general contact lens topics and networking at local meetings.

Regional and national industry involvement has helped Dr. Castellano promote referrals from optometrists, including from out-of-town doctors whose patients might relocate to his area. "Professional involvement allows you to network and, as a leader, makes you more recognized as an expert," he says.

Dr. Shovlin said that some of his referrals are patients that other doctors don't want to fit with contact lenses.

In contrast, Dr. Klein doesn't promote contact lens referrals from optometrists because "the average optometrist who gets a tough case tells the patient that he can't wear contact lenses."

Maximizing Patient Perception While earning respect and demonstrating expertise is pertinent to promoting your practice and gaining referrals from partners in the eyecare industry, it may also help patients perceive you as a contact lens expert.

Says Dr. Benoit, "To achieve ultimate patient perception, I assess each case and then discuss options that are best for that patient, educating him on why I chose that option from a health and visual performance standpoint."

Dr. Eiden finds that presenting new technologies and educating patients about new developments in contact lenses enhances his image in patients' minds as an expert in the contact lens field.

Experts Agree

The panel of experts cites communication, both with fellow professionals and with patients, as the key to becoming a successful contact lens practitioner. You can heighten your reputation as a contact lens expert with positive word-of-mouth referrals.