When you are an optometry student, you have many career choices to consider once you graduate: working in private practice, corporate practice, group practice, industry, hospital setting, military, Indian health services, and more. There are many questions to consider, such as:

• Should I do a residency, or would I feel comfortable practicing right out of school without one?
• In what type of setting do I envision myself working?
• In what location do I see myself working?
• Would I be willing to join the military?
• Would I consider moving somewhere rural to help pay off my student loans?
• How am I going to pay off my student loans?
• Where do I see myself in five years?

The list of questions goes on and on. As you approach the end of your schooling, it starts to set in that you are going to be a real-life adult on your own, and the decisions that you make now will affect your future.

With the rising amount of student loan debt, early career choices can help or hurt you. A hot topic of discussion on many optometry social media forums has to do with student loans: how to repay them and in what manner to repay them (do you try to put extra money toward your loan to reduce the principal, or do you pay the minimum and invest/save more for the future?). Many eyecare practitioners have different opinions; some have been successful in paying off their loans in just a few years, while others are making the minimum payment and saving more of their hard-earned money for their house, children, lifestyle, etc.

It was during my cornea and contact lens residency that I pondered these life questions and started to make some decisions that would affect my life forever.

STARTING FROM SCRATCH

After weighing the pros and cons of my options, I decided to move back to my hometown. My childhood optometrist Dr. Stuart Adams offered me a job, which I was grateful to accept. Dr. Adams founded Havasu Eye Center in Lake Havasu, AZ, in 1990. Havasu Eye Center’s patient base was mostly comprehensive eye exams, glasses, soft contact lenses, and ocular disease management when I joined the practice in 2012. I had an interest in fitting specialty contact lenses, but that was not a service that the practice had ever offered. Equally challenging was that Lake Havasu is a rural community that had a population of 52,844 in 2013. My initial concern was, “How many specialty contact lens patients could there possibly be in a town of only 53,000 people?” Another potential issue was the low socioeconomic status of Lake Havasu, with the median household income being well below the national average. Would patients even be able to afford specialty lens services and products?

If I really wanted to incorporate specialty lenses into a practice that had essentially no specialty lens patients, what could I do, and how could I do it?

OFFER SPECIALTY LENSES TO ANY PATIENT WHO MAY BE A GOOD CANDIDATE

Specialty contact lens patients can be some of the most rewarding patients in your practice. Imagine a patient who has had keratoconus for years and could not see well until being fit with a specialty lens. Think of a patient who has an irregular corneal surface due to a prior trauma that you fit with a specialty lens who can now drive a car. Or a mother who can now see her child’s face. These are the types of patients whose lives you can change with specialty lenses.

I am passionate about specialty contact lenses, and I was excited to offer this new service to patients in my hometown. I offered specialty contact lenses to every patient whom I thought may be a good candidate. Many specialty contact lens patients were discovered at the time of their comprehensive examination, including:

• Post-radial keratotomy (RK) patients complaining of fluctuating vision
• Keratoconus patients
• Patients who had corneal scarring from trauma or herpes simplex
• Patients suffering from extreme dry eye who have tried various artificial tears, gels, and medicated eye drops
• Corneal transplant patients looking to improve their vision
• Normal cornea patients who were unhappy with the vision or comfort of soft toric contact lenses
• Patients who have high astigmatism
• Presbyopic patients looking for the best possible vision at distance and near
• Other patients who have irregular astigmatism seeking the best possible vision

When I first started, most of my specialty lens patients were actually those whom I evaluated for their comprehensive eye examination. I didn’t have a large referral base at first, so most of my specialty lens patients were existing patients of the practice. My partner was a huge help in referring me any complicated contact lens fits or irregular corneas. In the beginning, I would explain to patients almost all of their treatment options (along with the associated pricing), but that became too overwhelming. Now, I usually narrow it down to the top two treatment options that I feel are best for a particular patient based on his or her condition, lifestyle, etc. If patients want to know every single treatment option available to them, I am happy to explain all options, but I have found that making a strong recommendation for one or two specific treatments has streamlined the process.

Patient Example A 63-year-old white male presented to the clinic for his annual eye examination. He had a history of radial keratotomy surgery in 1991 OD and OS. He explained that his vision was great for many years, but over the past decade, he needed glasses to see clearly at distance and near. He currently wore progressive lenses of +1.25D sphere OD and OS with a +2.50D add. With his current glasses, he could achieve 20/20 vision. Manifest refraction did not yield very different results.

At the conclusion of the examination, I mentioned that if he wanted to wear his glasses less often, there are specialty contact lenses that might allow him to see clearly at distance and near and could also help with fluctuating vision, which many post-RK patients experience. My patient said, “That would be great! I always assumed I could never wear contact lenses again, due to my surgery. It would be wonderful to get out of these glasses if I could.” We fit him with a scleral multifocal, and he sees 20/20 at both distance and near without reading glasses. He is thrilled with the reduced dependency on glasses, and he has successfully worn the lenses for more than four years.

Most practitioners would never offer a different form of vision correction to this type of patient because his vision was good with his current glasses and he had no real eye complaints. When you start recommending specialty lenses to any patient who might be a good candidate, you will be surprised at how many patients opt to try them.

TAKE THE INITIATIVE

To successfully incorporate specialty contact lenses into your practice and build your specialty lens population, you need to mentally prepare yourself: you need to acknowledge that it starts with you. Your mindset is the most important part of the journey to succeeding with specialty contact lenses (or any part of your life for that matter). If you want to grow your specialty lens population, ask yourself why. Is it because you want to help more patients? Is it because you want to offer a unique service to set yourself apart from other practitioners? Is it because you want to generate another stream of revenue to your practice? You must love what you do and be passionate about it to truly be successful. Whatever your reason is, always keep that in the back of your mind.

Knowledge is power, but knowledge means nothing without action. You could read every book about specialty lenses, but until you actually apply what you know, it means nothing. Incorporating a new skill into your practice is exciting and scary at the same time. There will be times of fear and times of failure. View adversity as opportunity. If something negative occurs, rather than beating yourself up about it, take a look and say, “What could I learn from that situation? What can I do better next time?” No one ever succeeded without failing many times prior. People who avoid failure also avoid success.

Getting Started If you start fitting specialty lenses in a practice that currently does not fit them, my advice would be to block out an entire hour (or more) for your first fittings. In the beginning, your technicians will likely not have the knowledge or experience to assist you, so you will be doing almost everything yourself. When I started fitting specialty lenses in my practice, I had a technician in the room to assist me, but I performed the lens preparation, application, evaluation, special diagnostic imaging, lens removal, and lens disinfection. I also performed application and removal training myself because none of the staff knew how to do this. After some time, I was able to teach my technicians almost the entire process except for lens evaluation, which created a more efficient patient flow for our specialty lens patients. Now, I simply select the diagnostic lens that I want the technician to apply to a patient’s eye, and the technician is able to complete the entire fitting process minus lens evaluation and over-refraction. The technicians are also now fully trained in application/removal and lens care, so they are able to work with patients and teach them appropriate techniques. This has allowed us to serve more patients per day.

Inform the Community When I first joined my practice, we placed a small advertisement in the local newspaper. Several patients who had keratoconus, corneal transplants, and even high amounts of regular astigmatism contacted our office to learn more. A small, inexpensive advertisement could generate some foot traffic that will pay for the advertisement and more.

Take Cost Concerns Out of the Equation As eye-care practitioners, we often feel nervous presenting to patients what we perceive to be a high cost of service. Get this idea out of your head immediately, and charge what your services are worth. Specialty lens fitting is an extra skill; it takes more time and involves greater decision-making to manage these patients, so be sure to appropriately bill for your services. Always treat patients as if they were your own family member. This is my feeling toward all patients who walk through my door, no matter what they look like, who they are, or what their financial status is.

If I feel that a patient could possibly benefit from a specialty contact lens, I will always offer it to him or her. The price is the last thing that we discuss. If patients really want something, they will find a way to do it. We have many patients at very low income levels who you might think would never opt for such a large expense, but many patients will do anything it takes to achieve good vision. Never judge patients, and always present the option to them. If they say no, at least you did your duty of presenting all potential treatment options. And consider that this year may not be the year for them, but next year, they may come back asking for those special contact lenses because they remembered that there was another option. Many practitioners say, “Patients will never pay for the high cost of specialty lenses.” I live in a low socioeconomic area, and if cost was the deciding factor, I would have hardly any specialty lens patients. If you believe in something and are passionate about it, you will succeed.

Surround Yourself with Great People I attribute much of my success with specialty contact lenses to my educators. If you are still a student reading this, be sure to reach out to the contact lens faculty for advice on specialty contact lenses. My contact lens residency was also a huge factor in my success with specialty lenses.

My business partner supported me from day one, and he helped me grow the specialty lens portion of our practice by referring me patients and discussing lens options with his current patients. Our staff were also motivated, eager to learn, and excited about a new service that could be offered to our patients. They had positive attitudes, learned extremely fast, and probably now know more about specialty lenses than many practitioners do. Friends and family supported my vision of a specialty lens practice, too, and their encouragement helped me push myself to my maximum potential.

Build Professional Relationships Many practitioners have absolutely no desire to fit specialty contact lenses. Many consider the process timely, costly, and frustrating. So, there are many practitioners who would be happy to refer patients to you because they simply do not wish to fit these patients. When they find someone who specializes in these complicated lens fits, they send those patients in your direction. We have a great relationship with other optometrists and ophthalmologists in the area who refer their complicated contact lens fits and irregular cornea patients to us. We always send the referring practitioner a letter after the consultation explaining our treatment plan, and we always send the patient back to the referring practitioner for any other eyecare services and products (comprehensive examinations, eye emergencies, glasses, sunglasses, etc.). This keeps the relationships that we have built with these other eyecare practitioners strong and trustworthy.

Build Your Reputation Attend lectures, webinars, and workshops in specialty lenses. Not many practitioners fit specialty lenses, especially compared to those patients who need them. By fitting specialty lenses, you will create a name for yourself. The specialty lens community of fitters is actually quite small, and you can quickly develop connections and network with a variety of fitters throughout the nation (or world!).

Contact lens manufacturers can be an advocate for you. Sometimes practitioners need an expert who can help with a specialty lens fit, but they don’t know of a specific expert in their area; they sometimes reach out to their manufacturers for help in locating a specialty lens fitter in that state.

IF YOU BUILD IT, THEY WILL COME

Before reading this article, you may have thought:

• The market is too saturated with eyecare practitioners in my area.
• No patients will pay for specialty contact lenses.
• It will take too long for me to learn how to fit specialty lenses.
• I don’t know where to begin.
• It is too expensive to learn how to fit these lenses.
• No one will refer specialty patients to me.

It is easy to become a victim, complain, and think negative thoughts. But you need to choose to grow your practice and help it succeed. Have you ever heard the saying, “If there’s a will, there’s a way?” This is 100% true when it comes to incorporating specialty lenses into any practice. If you have the desire and the passion to succeed, it is absolutely possible. When you change your mindset and take enormous action, success will follow.

By recommending specialty contact lenses to each patient whom I thought may benefit, I quickly grew my specialty contact lens patient base from essentially zero in 2012 to more than 1,000 patients in a matter of four years. I refused to accept anything except massive success. My experience shows that even in a small community of about 53,000 people, there are definitely patients who need specialty contact lenses.

I believe that anyone who is passionate about specialty contact lenses and can confidently recommend this unique service can succeed. If you explain all of the options to patients and keep their best interest at heart, you will be pleasantly surprised at how many patients opt for specialty lenses. The people with whom you surround yourself are also critical to achieving success. My partner, fellow colleagues, inspirational mentors, incredible staff, and fantastic patients were all integral to growing the specialty lens portion of my practice.

Specialty lenses help set you apart from average practitioners and can become a lucrative part of your practice. It’s time for you to decide that you can make a difference in patients’ lives. Get fired up about specialty lenses, and think about how many patients you’ll be able to help and how it can benefit your practice. CLS