EDITED BY CHAD ROSEN, OD, MBA

LEARNING METHOD AND MEDIUM

This educational activity consists of a written article and 20 study questions. The participant should, in order, read the Activity Description listed at the beginning of this activity, read the material, and answer all questions in the post test.

To receive credit for this activity, please follow the instructions provided below in the section titled “To Obtain CE Credit.” This educational activity should take a maximum of 2 hours to complete.

CONTENT SOURCE

This continuing education (CE) activity captures key statistics and insights from contributing faculty.

ACTIVITY DESCRIPTION

The goal of this article is to educate eyecare professionals in adding scleral lenses to their practice and tips for practice management once added.

TARGET AUDIENCE

This educational activity is intended for optometrists, contact lens specialists, and other eyecare professionals.

ACCREDITATION DESIGNATION STATEMENT

This course is COPE approved for 2 hours of CE credit and NCLE General Knowledge approved for 2 hours of CE credit.

COPE Course ID: 68770-PM
NCLE Course ID: CWCLS005

DISCLOSURES

Elise Kramer, OD, has received honorarium from Contamac, Gas Permeable Lens Institute, Scleral Lens Education Society, Spectrum International, X-Cel Specialty Contacts, and Visionary Optics.

Stephanie Woo, OD, has received honorarium from ABB Optical Group, Alcon, Art Optical, Bausch + Lomb, Biotissue, Blanchard Contact Lenses, Contamac, Essilor Contacts, GPLI, Katena, Ophthalogix, Scleral Lens Education Society, Shire, Specialeyes, STAPLE program, Synergeyes, Triad Ophthalmics, Visonary Optics, and X-Cel Specialty Contacts.

Chad Rosen, OD, MBA, editor of the continuing education series, reports no conflicts of interest.

DISCLOSURE ATTESTATION

The contributing faculty members have attested to the following:

1. That the relationships/affiliations noted will not bias or otherwise influence their involvement in this activity;
2. That practice recommendations given relevant to the companies with whom they have relationships/affiliations will be supported by the best available evidence or, absent evidence, will be consistent with generally accepted medical practice;
3. That all reasonable clinical alternatives will be discussed when making recommendations.

TO OBTAIN CE CREDIT

To obtain COPE CE credit for this activity, read the material in its entirety and consult referenced sources as necessary. We offer instant certificate processing for COPE credit. Please take the post test and evaluation online by using your OE tracker number and logging in to clspectrumce.com .

Upon passing the test, you will immediately receive a printable PDF version of your course certificate for COPE credit. On the last day of the month, all course results will be forwarded to ARBO with your OE tracker number, and your records will be updated. You must score 70% or higher to receive credit for this activity. Please make sure you take the online post test on a device that has printing capabilities.

To obtain NCLE credit, a score of 80% or higher is required. Passing scores will be forwarded to ABO-NCLE at the end of each month.

NO-FEE CONTINUING EDUCATION

There are no fees for participating in and receiving credit for this activity.

DISCLAIMER

The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Illinois College of Optometry or Contact Lens Spectrum. This CE activity is copyrighted to PentaVision LLC ©2020. All rights reserved.

This continuing education activity is supported by unrestricted grants from ABB Optical Group, Blanchard Contact Lenses, BostonSight, Menicon, and X-Cel Specialty Contacts.

RELEASE DATE: OCTOBER 1, 2020
EXPIRATION DATE: JULY 20, 2023

2020 was supposed to be the year of vision, and we approached it with great excitement; but never in our wildest dreams did we expect to face what we’re experiencing now. And who knows what the future will bring? That said, one huge takeaway that we have learned is that contact lenses are a significant source of income. In particular, we have learned to be proactive by approaching our contact lens patients who need lenses now or in the near future. If we don’t, companies out there are willing and able to take over the contact lens business, especially for standard lenses.

Although rewarding, building a successful eyecare practice is challenging. Many practitioners graduate with massive student loan debt and very little business knowledge or experience in a healthcare landscape that is constantly changing. Those in private practice are faced with growing competition from e-commerce, eyecare chains, and, more recently, online refractions. These issues will not be going away anytime soon. In fact, online refractions are likely to improve and expand. To be successful in this competitive environment, practitioners must find a niche that attracts patients to their practice.

That makes specialty contact lenses even more valuable to our practice. Patients who require specialty lenses typically return to the practitioners who prescribe and fit them. And of course, the laboratories collaborate closely with practices to keep specialty lens patients satisfied.

TAILORING YOUR PRACTICE

All eyecare practitioners share a common goal to help people, but they differ in their vision for achieving that goal. You need to decide where you want to go and then formulate a plan on how to get there. Instead of competing with online sales websites or giant eyecare chains, why not offer something that is simply unavailable online, something that is not offered at every eyecare practice? No two eyes are the same; each individual eye has its own unique shape and curvature, much like a fingerprint. Practitioners should eliminate the “one-size-fits-all” concept and specialize. Contact lenses, in particular, should be tailored to each patient’s needs, habits, and lifestyle. The addition of scleral lens fitting and care to an eyecare practice offers a unique specialty niche that provides personalized and specialized eye care to a growing clientele.

Practitioners can use this model to build their practice and improve their patients’ lives. A specialty lens practice can vary widely; every practitioner will have his or her own way to build and conduct such a practice, but the most important focus should be on the contact lenses. For many, contact lenses—not spectacles—are the primary focus, and some may not even have an optical dispensary. Of course, many practitioners do both. However, if you want to establish a specialty lens practice, it’s invaluable that you have a wide-ranging experience. Scleral lenses are becoming more mainstream. More practitioners are fitting them nowadays. Fitting corneal GP, hybrid, and intralimbal lenses has almost become a lost art. Practitioners should know how to fit many different types of lenses. You should also have a multitude of fitting sets: a corneal GP set, an intralimbal set, a hybrid set, and a scleral set. Also, make use of innovative technology, including cutting-edge equipment that will help you practice at the highest level.

It’s important to remember that we’re not just fitting contact lenses. We must also treat anterior segment eye disease. An essential aspect of specialty lens fitting is a commitment to managing the underlying disease that leads to the need for specialty lenses. Some practitioners forget this, but to develop a specialty lens practice, you need to remember to focus on anterior segment disease.

For example, you may have patients who have had corneal scarring from laser-assisted in situ keratomileusis (LASIK) or radial keratotomy. For those patients, scleral lenses not only improve their visual acuity, they also protect their eyes. Similarly, in patients who have severe ocular surface disease or dry eye, scleral lenses protect their eyes from the outside environment and from the mechanical friction of the eyelids.

ATTRACTING PATIENTS AND BUILDING REFERRALS

Scleral and specialty contact lens practices have multiple avenues for attracting patients. Some are already patients of the practice, while others may be referred by current patients through word-of-mouth or through marketing efforts. Most, however, will be referred to your practice by external eyecare practitioners. Scleral lenses can help build the practice, thanks to strong networks among colleagues and good relationships with cornea specialists. In fact, owing to the severity of some of the conditions treated with scleral lenses, many patients are already under the care of a cornea specialist, who refers them to your office.

Scleral lenses are an important vehicle to strengthen relationships among eyecare professionals. Many ophthalmologists are familiar with scleral lenses, but do not have the time or the resources to dedicate to them. They are more than happy to collaborate with an experienced scleral lens practitioner. Meet with other eyecare professionals to explain the indications and benefits of scleral lenses. Visiting their offices with marketing materials, literature, professional cards, and referral folders can be a powerful way to promote collaborative care for their patients. Other clinicians whose patients may benefit from scleral lenses include rheumatologists, oncologists, hematologists, and pain management specialists.

Open communication is essential when sharing care. Communicate with the referring practitioner to explain the findings, including best-corrected vision with scleral lenses, future recommendations, timeframe for follow-up appointments, and return of the patient to him or her. Correspondence should be sufficiently detailed, but concise and to the point. Often, a patient will see both the scleral lens practitioner and referring clinician for multiple visits. Thus, updates are essential to share information and optimize care.

Open communication will also stimulate new referrals. Building strong professional relationships takes time, effort, and an ongoing commitment to excellence. Outside providers who refer to your practice rightfully expect to see surgical referrals coming their way in return.

HOW TO BECOME AN EXPERT

In the final phase of schooling or training, students find themselves facing important decisions: What kind of career should I pursue? In what setting? Should I specialize my practice? In the case of optometry school, students can request a fourth-year site that specializes in contact lenses, if that’s not already a requirement. After that, for optometry school graduates who are passionate about contact lenses, a residency is one of the best things that they can do for their future career. That is particularly true if they wish to acquire clinical skills that go beyond the basics to improve their clinical judgment and their ability to make appropriate diagnoses, decide on treatment, and manage complex contact lens cases.

A residency provides a bridge between education and practice that allows residents to grow intellectually, technically, and professionally. When doing clinical rotations in the third and fourth years of optometry school, students always have someone to lean on.

A residency will encourage young practitioners to take an active role by participating in hands-on decision-making. Not only will residents learn about different lens designs and modalities, they will also have the opportunity to see patients who have many different conditions as well as both normal and irregular corneas. A residency can enhance contact lens skills, prepare residents for independent work as an eyecare practitioner, and put them on the path for life-long learning.

ADDING SCLERAL LENSES TO YOUR PRACTICE

Scleral lenses present challenges in design and fit. However, with online resources, webinars, workshops, and laboratory consultants, it is not difficult to become proficient in fitting these lenses. Once practitioners become comfortable, they can focus on building their practice around this specialty.

Join Associations Scleral Lens Education Society. Membership is free and offers many resources, such as information on scleral lens indications, patient selection, induced complications, and lens care. Members also have access to educational videos for both practitioner and patient, audio presentations, and peer-reviewed research. The Gas Permeable Lens Institute is another great resource for those interested in building a scleral lens practice. Its website answers frequently asked questions, whether basic or advanced, and provides practice tools for billing, coding, and insurance claims.

Attend Live Workshops When Possible Many contact lens manufacturers organize free day-long work-shops that usually include a lecture component (learning to fit and troubleshoot lenses) along with a hands-on portion. The hands-on portion is beneficial because practitioners get to handle the lenses, see the fitting set, practice application and removal on patients, and also evaluate lenses. Practitioners can expect to leave the course feeling more confident with scleral lens fitting and with incorporating it into practice. Many conferences throughout the year have a scleral lens track, which could be beneficial for practitioners wanting to gain more knowledge on this topic. Many conferences also offer hands-on workshops as well.

Get Involved With Research and Studies When you start fitting more lenses and gaining confidence, consider reaching out to your laboratory and offering to beta test some of the lab’s next products. Sometimes labs will ask a handful of practitioners to fit a lens design with which they are experimenting. This can help improve your relationships with the labs while providing the opportunity to offer new technology to patients. Additionally, labs, contact lens companies, and pharmaceutical companies may reach out to you for other studies, which can also help establish you as an expert.

Reach Out to Leaders in the Specialty Lens Community Most of the key opinion leaders in the industry are very friendly, and they are happy to share their knowledge. For practitioners serious about expediting specialty lens integration, consider a business coach or consulting company for help that is tailored to your specific needs.

If specialty contact lenses are something that you want to incorporate into your practice, you must fully invest. Don’t be half in and half out, because that will be frustrating for you, and it will also be a disservice to your patients. Decide to commit, and then take the necessary steps.

NECESSARY EQUIPMENT

To have a successful scleral lens practice, specialized equipment is often necessary. Such equipment may include corneal topography, corneal tomography, profilometry, anterior segment optical coherence tomography (OCT), anterior segment photography, specular microscopy, aberrometry, lens/device monitoring with a radiuscope, loupe, lensometer, and basic eyecare equipment. Although many of these items require a significant financial investment, a successful scleral lens practice is both financially and personally rewarding, with a strong interprofessional network and a loyal patient base.

Fitting Sets Laboratories have done an excellent job of creating fitting sets with specific instructions. So, if you are more of a novice, the particular instructions will explain how to pick an initial lens to give you a starting point. The labs have all developed their own unique fitting sets and different fitting guides based on their specific products.

Corneal Topographer A corneal topographer is critical to any specialty lens clinic. It doesn’t have to be the most expensive or the latest model, but it is important to have topographical data for several reasons. Topography can be used for disease management, which is incredibly important for conditions such as keratoconus, post-LASIK ectasia, corneal transplants, etc. Not only does the topography provide baseline information, it allows practitioners to monitor their patients’ eyes for any changes. In other cases, such as orthokeratology, topography is necessary to observe the progression of how a patient’s treatment is going. Topography also helps with diagnosing different conditions; the different maps help with diagnosis and management.

Profilometry Profilometry is an excellent choice in equipment for a specialty lens practice. It is extremely efficient at imaging scleral shape. It can differentiate your practice, because most eyecare practices do not have this type of device. It is an amazing technology that provides information that you otherwise wouldn't have been able to obtain. It can help practitioners design contact lenses that are more comfortable and more precise. It can also provide information about sagittal height of the eye, which is something that was previously very difficult to measure. Profilometry has become a huge part of our clinics, and it’s one of those pieces of equipment that once you have it, you can’t live without it. It may not be something that you can afford immediately, but as you gain more income, this should definitely be on your list of equipment if you want to fit specialty lenses at the highest level.

Anterior Segment OCT Anterior segment OCT greatly assists not only with ocular disease aspects, but also with scleral lens fittings. Checking the vault in the center, midperiphery, and limbus can help identify areas of excessive or minimal clearance. It can also be used to evaluate edges to observe compression or edge lift.

Anterior Segment Photography Anterior segment photography is very important, not only to manage disease but also to provide a visual to patients. Being able to show patients a photo so that they know what’s happening on the surface of their eye is very powerful.

Aberrometry Aberrometry is an amazing technology if you are able to afford it in your clinic. Many patients have higher-order aberrations, which result in decreased visual quality. Aberrometry allows practitioners to identify the higher-order aberrations and design a lens to correct some of these visual disturbances. This is the future of specialty lenses—being able to correct some of these aberrations that we’ve never been able to correct before is going to make a big difference in patients’ vision.

Other pieces of equipment that are essential to a specialty lens clinic and that are relatively inexpensive include 7x7 magnification loupes, radiuscopes, PD rulers, and horizontal visible iris diameter (HVID) handheld rulers. Many of these you may already have from your schooling or training, so just dust them off and put them to good use.

IMPORTANCE OF STAFF

When it comes to implementing specialty lenses into practice, everyone has to be on the same page. This means that your staff is telling patients that specialty lenses are a new service you now offer. Make sure that staff is well educated on what you’re providing, and get them used to terminology such as keratoconus, rigid contact lenses, GP lenses, etc. Staff can play different roles in a specialty lens clinic. Technicians are amazing and are very important for a contact lens practice because they are the ones who help patients with application and removal, which is one of the biggest contact lens challenges for patients, especially for novice wearers.

A contact lens coordinator could be someone who discusses price points, lens care and training, and possibly billing with patients. Your staff has to be on the same wavelength as you, and the office culture is very important. It’s a team, and everyone wants the practice to succeed. If your practice is innovative and cutting edge, your staff will be excited about working there.

It’s important to ensure that staff members have access to resources. With the addition of new equipment or products, it is important to properly train and educate the staff. Representatives may come in for a lunch-and-teach session or even conduct phone training. Staff members who feel informed and important are invaluable to a practice.

BUILDING A DEMAND

It is extremely important to make sure that your practice is discoverable. Patients searching for keywords on the internet need to be able to find your clinic. Being visible on the internet and on social media can help build your clientele. You want patients in your town who search for terms such as “contact lenses,” “orthokeratology,” or “scleral lenses” to be able to find you at the top of the browser search page, because no one goes to the third, fourth, fifth page, etc. Designing an aesthetically pleasing website that is easy to navigate can also help convert patients. If you are not familiar with web design, marketing, or search engine optimization, hire someone to take care of this for you. There are companies that will do this much better and much faster than you can do on your own.

You can increase your popularity organically by being proactive on social media outlets such as Facebook or Instagram, and by building a business page on your website. A business page is a landing page to which you can refer patients and practitioners who want to learn more about your business. Create content about certain eye diseases or contact lens types within your website. This gives patients and practitioners confidence about the conditions that you manage and the lenses that you fit. Patients will appreciate reading up on their specific condition and realizing that you are the best clinician to help with their needs.

Additionally, face-to-face marketing and building a relationship with other practitioners is invaluable. If you are depending on referrals, the face-to-face interaction is huge. Meeting other practitioners in person can help build trust, and having an opportunity to speak with you elevates that relationship.

Video testimonials from happy patients who agree to do them are a great option because you can put them on social media pages and on your website. This is a free way of getting patients to trust you and to trust your work before meeting you. Happy patients and testimonial videos allow prospective patients to see your positive impact on other patients.

IMPLEMENTING SPECIALTY LENS FITS INTO YOUR SCHEDULE

After deciding that you want to start offering specialty contact lenses in your practice, a common question is: How do I start? After discussing your new service with your staff, purchase the necessary equipment, supplies, and fitting sets. Once you have everything in place, it is time to schedule your first patient. For the first few patients, you will need to allot a significant amount of time to allow for the learning curve and for developing a system that works for you and your office.

One to two hours would be ideal for your first fitting. You can schedule a patient for any time that you have a one- or two-hour gap, or you can block out certain times in your weekly schedule. For instance, you can schedule every Tuesday between 10am and noon as a new specialty lens fitting. This approach makes scheduling easier on the staff and gives you plenty of time to perform the fit. When those appointment slots start to fill up and get booked out, then you can add more slots to accommodate your growing schedule.

BILLING AND CODING

Billing medically necessary contact lenses will largely depend on the type of insurance used (vision versus medical), lens fitting and material codes, and diagnosis and CPT code. Many vision and medical insurance companies have defined exactly how they want things billed. You must refer to your provider manual to find out their specific rules.

With vision insurances, you usually bill one lump sum, which includes the lens fitting, the application and removal training, the follow-up care, and the supply of the contact lenses. With medical insurance, usually each visit is individually billed. It will depend on your contracts with those insurance companies. There are many webinars and articles online that can assist with billing and coding basics.

AUDITS

If you fit specialty contact lenses to any capacity, audits will happen to you at some point in your career. It’s not a bad thing—the insurance companies want to make sure that you are properly using medically necessary contact lenses and billing them appropriately. If you are doing everything right, you should not have any issues. Things to keep in mind:

• Take topographies of all patients every year or more
• Keep OCT images and anterior segment images in patient files
• Record manifest refraction and best-corrected visual acuity with glasses
• Record lens parameters and notes of fitting evaluations and follow-up care
• Keep excellent records of each encounter
• Attach lab invoices to prove that you ordered lenses
• Ensure proper billing and coding techniques

RESOURCES TO LEARN MORE

There are hundreds of free webinars and videos online, published by reputable organizations such as the Gas Permeable Lens Institute and the Scleral Lens Education Society. Visit their websites and YouTube channels to see hours of archived lectures to help advance your learning. Other eyecare organizations and many of the contact lens laboratories offer frequent webinars or online learning. Sign up for their emailing lists so you can receive emails on topics that might interest you.

Implementing specialty contact lenses into your practice can be very rewarding, but you must take the proper steps to ensure your success as well as your patients’. Be sure to arm yourself with the necessary materials, equipment, and attitude before launching this new portion of your clinic.

As the old saying from Alexander Graham Bell goes, “before anything else, preparation is the key to success.” CLS