The Business of Contact Lenses

Reducing Chair Time to Maximize Profitability

By Clarke D. Newman, OD, FAAO

When trying to maximize the profits associated with contact lens practice, you have to do everything you can to reduce the chair time it takes to make patients happy. We have talked about many ways to do this in my past columns, such as maintaining full diagnostic lens sets and knowing how to use them, etc.

Well, I have several other mind vitamins that might help.

Listen to Your Patients

First, I have 12 Eyecare Commandments that I give to my externs on day one. Eyecare Commandment One is, "Obey the chief complaint." Each of my Commandments has corollaries. This Commandment has two. First, "Don't fix anything that ain't broke." The most embarrassingly aligned GP lens that a patient can wear for 15 hours, with clarity, every day without irritation, is a triumph. Don't try to be a hero by messing with it. You have nowhere to go but down.

The second corollary is, "Don't fail to fix things that are broken." A perfectly aligned lens that a patient can't see out of, or can't wear without discomfort, needs fixin'. The number-one reason that causes chair time to get out of control is not listening to what patients ask you to fix. Don't resist changing a lens because you think it is okay when the patient is complaining.

A bit of wisdom when listening to a Chief Complaint is to "wait for it." When a patient rattles off 10 complaints, it is usually the last thing they say that is really the main problem. You'd think that they would start with it, but that is not human nature.

Standardize Lens Prescribing

The next thing that helps reduce chair time is to standardize the steps of evaluating a lens. One way to do that is to compound your own sodium fluorescein. There are two things that change a fluorescein pattern—solution concentration and different solution components. You won't find a dye strip of any kind in my office. I have my compounding pharmacist (you have a compounding pharmacist, don't you? No? Get one.) compound 10cc of 0.75% fluorescein, compounded in sterile technique using 0.9% sterile saline buffered to physiologic pH and placed in a 10cc syringe. On the end I have him place a 0.22μm Millex Leur-Loc micropore filter. I do the same thing with 0.5% lissamine green.

That way, I get the exact same fluorescence every time I instill fluorescein. By standardizing my fluorescein, I always know what the pattern is telling me. I know this sounds trivial, but I keep the syringe and my Wratten #12 filter in my pocket, and I can instill a drop of fluorescein on an eye and accurately evaluate the pattern before you can tear open a strip. When you fit a lot of GP lenses each day, it adds up. Plus, you make better alignment decisions, which reduces remakes—a major drain on profitability.

The next thing I do to reduce remakes is to reduce bad decision-making by checking centration, lag, and rotation of all lenses when the patient's head is not unnaturally situated in a slit lamp chin rest. Use a Burton Lamp with the white light on, or a +20D condensing lens and a good pen light or transilluminator. It is quick and accurate.

Endeavoring to standardize and to reduce errors saves chair time. So take a hard look around, because time is money. CLS

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Dr. Newman has been in private practice in Dallas, Texas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine and refractive surgery. He is also a consultant or advisor to B&L. You can reach him at cdnewman@mindspring.com.