The year 2020 will forever be remembered as more than symbolic for perfect vision. The surreal circumstances that encompass our daily lives today as a result of the novel coronavirus and its resulting COVID-19 respiratory disease are neither desired nor deserved. However, they are a fact of life, and we therefore need to work together to make it through these challenging times. It’s during times such as these when we realize who our true friends are. Fortunately, with regard to providing care to our specialty contact lens patients—who frequently are individuals who cannot survive visually without their contact lens correction—our true friends are often the independent contact lens laboratories that manufacture GP, hybrid, and custom soft lenses. 
 
This article is a companion to another feature in Contact Lens Spectrum titled “Weathering the COVID-19 Storm,” and it presents information derived from several sources:
 
1) An online forum of 17 key opinion leaders in specialty contact lenses, who are acknowledged at the conclusion of this article. 
 
2) Two separate surveys sent by the authors to independent contact lens laboratories. The first sought information on how labs are currently working with eyecare providers (ECPs) during this pandemic, knowing that ECPs are primarily seeing only urgent cases at this time and so income is significantly reduced to both ECPs and laboratories. The second asked what changes the labs have made to ensure sterility and to minimize the risk that COVID-19 can be spread to employees, contact lens materials, ECPs and their staff, and ultimately to patients. 
 

EXTENDED WARRANTIES

For patients who—for good reason—have been recently fit into specialty contact lenses, both the patients and the ECPs may feel a high degree of anxiety about the lens warranties that are provided by the laboratories to the respective ECPs; these warranties are then typically transferred to the patients. 
 
Laboratories are making it clear to ECPs that they understand this dilemma for recently fitted patients and are extending their warranties to reassure both ECPs and patients. This extension can range up to an additional two to four months, with consideration to extend this time period further depending upon when a practice reopens for routine eye care. All key opinion leaders were very complimentary of how their laboratories were working with them to help them through this unanticipated and uncertain period of time.
 

COMMUNICATION

It is evident that the laboratories are in regular communication with their ECPs to address their needs and concerns while finding ways to provide value beyond products. For some ECPs, contact lenses represent their primary—if not only—source of revenue. But practices are receiving cash flow sufficient to make it through this pandemic in part because of assistance that they are receiving from their laboratory via regular communication, often helping ECPs on a case-by-case basis with regard to patients who need special-design lenses to function visually. A representative laboratory sent a mailing to all of its customers with information on how ECPs can reach the laboratory (e.g., online, email, phone, and virtual contact information); the mailing also contained information pertaining to free direct-to-patient shipping, processing of return credits, and extended product warranties. 
 
In addition, as many ECPs are working remotely, the laboratories are providing information on patients who are currently in need of lenses or on those who may need lenses in the near future. This is invaluable for helping ECPs “hit the ground running” when routine eye care resumes and for optimizing patient retention.

DIRECT SHIPPING LENSES TO PATIENTS

When ECPs desire lenses to be directly shipped to patients (e.g., for successful GP wearers who lose a lens or a similar scenario), the laboratories have been very willing to do so. This is an exceptional benefit to both ECPs and to patients, and it ultimately is an important factor in patient retention. However, follow these guidelines when laboratories ship directly to patients:
 
1) Have laboratories provide only the minimal amount of information—as mandated by the U.S. Food and Drug Administration—to patients (e.g., lens material, basic parameters) and not labels, logos, stickers, invoices, or patient names/other identification information.
 
2) Use the ECPs’ return address if possible. That said, a concern expressed by some laboratories—which is also relevant to packages sent from laboratories to ECPs—is that sometimes these packages are returned because the ECPs’ office was not open to receive deliveries. Therefore, it is important for all offices to have some mechanism (e.g., a sign on the door, whom to contact, etc.) to inform the delivery service of where to deliver the packages. Many laboratories are also offering shipping to ECP home addresses temporarily if they have limited their time at the office.
 
3) Include a small card or insert that concisely reminds patients of the importance of such factors as handwashing, lens cleaning and disinfection, avoiding tap water, and not wearing their lenses if they are ill. It could also mention (notably for GP wearers) that directly delivering lenses to their house is not a customary procedure, but the need for social distancing is a special circumstance that allows it.

MAINTAINING A STERILE ENVIRONMENT IN THE LABORATORY

All of the responding laboratories were clear that they are committed to providing a safe work environment for their employees and that they are ultimately doing everything possible to greatly minimize the risk of COVID-19 spread to ECPs, their office employees, and their patients. There are variations from laboratory to laboratory, but procedures and strategies should follow Centers for Disease Control and Prevention (CDC) and Occupational Health and Safety Administration (OSHA) guidances (see "Additional Resources" box) and may include: 
 
1) Continually disinfecting the office by frequently wiping down all of the counters, door handles, and other surfaces. Several laboratories have implemented new sanitation systems or protocols and have regular communication about COVID-19 with their employees.
 
2) Decreasing the number of staff in the laboratory at one time so that social distancing guidelines are maintained, but the labs are able to maintain their available hours of operation. In some cases, staff are working part-time (e.g., two to two-and-a-half days on and two to two-and-a-half days off) and also are working remotely from their homes when possible.
 
3) Assigning only one staff member—essentially serving in the role of quality control—to handle incoming and outgoing packages to minimize the risk of contamination.
 
4) Requiring staff to frequently wash/sanitize their hands.
 
5) Requiring staff to wear proper attire such as personal protective gear, cloth face masks, hairnets, and clothing covers depending on their job requirements and proximity to others.
 
6) Requiring staff members to take their temperature when they report to work.
 
7) Keeping used lenses out of the laboratory. The great majority of the laboratories indicated that they are not allowing used lenses sent from ECPs (e.g., with the purpose of exchange, modification, etc.) to be received. If lenses are received, they are typically disinfected according to the adopted guidelines from the American Academy of Optometry, the American Optometric Association, the Contact Lens Manufacturers Association, and the GP Lens Institute (available at https://www.gpli.info/wp-content/uploads/2020/03/2020-01-15-in-office-disinfecting-of-diagnostic-lenses.pdf). The laboratories that are allowing lenses into the facility have taken great measures to ensure the lowest risk of contamination.

KEEPING THE LAB OPERATIONAL TO PROVIDE PROMPT SERVICE

Obviously, the laboratories depend upon the income generated from ECP orders to survive, and their business has therefore been significantly reduced. That said, even with a reduced staff, they have typically not greatly reduced their hours of operation—if at all—to be fully operational and to ensure that all urgent patients will have their lenses manufactured and shipped on time.
 

TRIAGING PATIENTS WHO CONTACT THE LAB DIRECTLY

Some patients go directly to the laboratory desiring new lenses. In some cases, these patients have an understandably high level of anxiety because their quality of life greatly depends upon contact lens wear (e.g., those who have keratoconus and other irregular cornea conditions or severe ocular surface disease). The laboratories efficiently refer these patients to their prescribing ECP to address their questions and concerns. This does, however, make it incumbent for ECPs to be available for their patients’ calls.
 

OTHER LABORATORY BENEFITS
Understanding the significant amount of practice income loss during this period, laboratories are working with ECPs to reduce their current expenditures. This can include providing flexible payment options as well as reduced shipping rates of lenses to ECPs, patients, or both. 
 
The bottom line is that nothing is more important than for ECPs to communicate directly with their patients that they will be scheduling in-office appointments when routine care has been re-established. That said, a very important component to patient retention is our contact lens laboratories working in synergy with ECPs to take care of those patients who are very much dependent upon special-design contact lenses to be able to function visually during this challenging period of time. This bond between ECPs and their laboratories strengthens the ECP-to-patient relationship, as opposed to some other entities in which the emphasis is on lens brand-to-patient. And that relationship between ECPs and their patients is integral to the ultimate survival and regrowth of contact lens practice.  CLS

Acknowledgements: Roxanne Achong-Coan, OD; Josh Adams (Valley Contax); Jill Anastor (Art Optical); Tom Arnold, OD; Melissa Barnett, OD; James Beeler (Universal Contact Lenses); Lori Bell (Carter Contact Lens); Cindy Belliveau (Visionary); Jeff Birk (Essilor Custom Contact Lens Specialists); David Bland (Euclid Systems); Manoel Carvalho (BostonSight); Clark Chang, OD; Brian Chou, OD; Daniel Deligio, OD; Karen DeLoss, OD; Greg DeNaeyer, OD; Melanie Frogozo, OD; Robert Grohe, OD; Susan Gromacki, OD, MS; Derrell James (X-Cel Specialty Contacts); Elise Kramer, OD; Heidi Miller, OD; Troy Miller (AccuLens); Daren Nygren (Custom Craft Lens Service of Nevada); Keith Parker (Advanced Vision Technologies); Thomas Quinn, OD, MS; Susan Resnick, OD; Monica Sanders (Visionary Optics); Jeffrey Sonsino, OD; and Jan Svochak (Tru-Form Optics). 
 

Dr. Bennett is professor emeritus at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. He is also clinical features editor for Contact Lens Spectrum. You can reach him at ebennett@umsl.edu.

Dr. Woo owns the Contact Lens Institute of Nevada, a clinic dedicated entirely to custom contact lenses. She is past president of the Scleral Lens Education Society. She is a consultant or advisor to Alcon, Blanchard, Bio-Tissue, B+L, Essilor, and X-Cel.