Eyecare practitioners are all trying to make their practices thrive to benefit everyone involved—patients, the team of coworkers, and the practice overall. Raising the bar to the next level can be a challenge. Sometimes education needs to occur, or an implementation of change and, at times, a financial investment. Change is difficult and it usually involves effort, struggle, and the challenge of those around us dragging their feet.

When reflecting on specialty contact lens practice over the last few years, there have been specific areas where we realized we could grow. Doing this reflection on an annual basis is a good way to stay current, push the boundaries, and provide better patient care. Whether in a longstanding specialty contact lens practice or looking to expand into more specialty areas, try these tips to make your practice thrive.

TIP 1
CONSIDER SPECIALTY CONTACT LENS FITTING FOR STANDARD PRESCRIPTIONS.

Historically, every patient with a cylindrical power who desired a soft contact lens needed a very specialized product. The fitting process required vialed trial lenses that might take 30 minutes to settle. The lenses were available in various diameters, base curve radii, and cylinder powers in a limited number of axes. Once the best lens was discovered, a new trial/final lens order was placed with the optimum diameter and base curve for the patient. Careful work was performed with the slide rule for cross-cylinder calculations to find the most ideal lens spherical and cylindrical power located at the most ideal axis.

Those who are aware of the “good old days” realize the amazing innovations that have occurred and how remarkable it was when frequent replacement contact lenses came onto the scene. These single diameter and base curve lenses are available in complete fitting sets that reside in the office. A practitioner can fit a patient, and if the power is incorrect, the practitioner simply changes to a new lens immediately. Without knowing why a lens is not successful, practitioners just attempt something else. What an innovation!

Today, most soft lenses stabilize very quickly, are made of highly breathable materials, and allow patients excellent comfort. Rare is the case in which a patient cannot be fit into a ready replacement lens or a daily disposable lens.

Let’s review how most unhappy contact lens fits occur. A patient presents wearing a soft lens and reports dissatisfaction about the lens-wearing experience. The practitioner might look at the lens that the patient is wearing and refit them into their “go-to” lens of choice. If this is unsuccessful, the practitioner goes to their second go-to lens. The process appears to be somewhat trial and error for many offices.

Over the past three years, our practice has altered the trial-and-error process for standard contact lens fits by implementing the findings of a study by Eef van der Worp and colleagues that looked at sagittal depth of standard soft lenses.¹ Their work resulted in a grid that shows how each lens type fits into what a patient might have for their predicted sagittal depth.

We were surprised to see that our go-to lenses were often in the middle of the graphs, which may explain why they became our go-to lenses. When a patient comes into the office and has a larger cornea or deeper sagittal depth, practitioners can look to the graph and select a lens on the right-hand side. When a patient comes into the office with a shallower sagittal depth or smaller cornea, eyecare providers can gravitate to the left-hand side of the chart. When a referred patient presents with a list of lenses that they have attempted, it should no longer be surprising to see that these lenses do not align well with the sagittal depth extreme that the patient exhibits.

If, for some reason, the patient is unsuccessful with the extreme ends of standard lenses, practitioners can order a custom soft lens with an altered base curve/diameter to create a more appropriate sagittal depth. This has been one of the greatest innovations observed in “standard” soft lens practice—that is, “fitting” lenses rather than performing the trial-and-error approach.

Another observation is the gravitation back to GP materials for more of our standard contact lens patients, at least in my own practice. Revisiting the GP design and material category is highly recommended. GP lenses are becoming thinner and more wettable—the latter due to the introduction of better materials and surface treatments—making them increasingly comfortable.² Whether it pertains to a toric or multifocal patient, consider giving GP lenses another opportunity.

Colleagues often recommend scleral lenses exclusively for “custom” patients. For years, many utilized scleral lenses for patients who had extreme cases of keratoconus, were post-graft, or had irregular corneas. Over the last few years, however, the growth of “specialty” practices is occurring due to fitting more “standard” patients. At first, it was toric patients who had high amounts of astigmatism, but now that extends to scleral lenses for low/moderate cylinder patients and toric presbyopes.

The presbyopic patient is an incredible opportunity for a customized approach due to a high level of motivation. Soft, GP, and scleral multifocal contact lenses are great options for anyone entering presbyopia. In our practice, referred patients have previously failed in these lenses when their referring provider was not confident in fitting them and when those patients were not properly educated on expectations. Rather than explaining to patients that multifocal contact lens wear may mean having to “compromise” either distance or near vision, try to think of it more as “balancing” the vision to a point where they can achieve everything needed in day-to-day life.

Aspheric GP and scleral lenses are additional options for patients who have comfort issues with soft lenses—and don’t hesitate to fit translating GPs! If patients want to have clear vision at distance and near, the practitioner can provide this to them via this option. Also, don’t assume that patients will not be interested in multifocal contact lenses if they have never worn glasses or contact lenses before; they may even be the most interested patients, as they will be motivated to stay out of glasses.

Dry eye patients are also great candidates for scleral lenses. Not only can scleral lenses provide more comfort to the patient, but they can also act as a reservoir for autologous serum drops or preservative-free artificial tears (off-label). Scleral lenses can exacerbate lid wiper epitheliopathy (Figure 2) if the patient has increased friction on the lens surface, so close monitoring of these patients is crucial.³

In addition, ensure that dry eye patients have adequate meibum flow when fitting them. We have observed that concomitant thermal pulsation treatments may be the optimum method for patients who have more advanced dry eye due to meibomian gland dysfunction (MGD) prior to fitting them with scleral lenses. Also, long-term warm compress usage is recommended to help keep the glands flowing.

TIP 2
DON’T RUSH THE CONSULT.

Time in the clinic always appears to be limited, but giving patients those few extra minutes to completely answer all questions is well worth it. Many patients no longer have relationships with their physicians. Instead, these patients were becoming more accustomed to a 10-minute visit in which the provider attempted to solve the problem about which they were most concerned.

Specialty care should be just that—special. Having sufficient time to spend with each patient to hear what challenges he or she is facing can establish a strong bond that can last a lifetime. Making the choice to move forward with specialty lenses is not a small decision, so it is important for patients (and sometimes parents) to feel confident and hopeful with their decision to move forward with your recommendations and prescriptions.

Especially with myopia management, it is important to take the time to educate the patients’ parents on the goals and how specialty lenses can help us reach those goals. It is also important to ask the patients what their goals are and focus on how those will be achieved. Setting proper expectations will result in more positive outcomes for all areas of specialty practice.

TIP 3
REKINDLE AN INTEREST IN LEARNING.

The contact lens world is full of experts who are willing to share their knowledge, and companies are constantly creating new products. In today’s world of easy electronic data sharing, this has never been more apparent.

Social media and podcasts are incredible media to learn from others involved with specialty contact lenses and also represent fantastic venues for sharing real-world experiences. Facebook groups have increased in number with specific groups that share knowledge, ask questions, and post case reports.

While these resources require a careful eye to ensure that evidence-based practices are considered, a careful practitioner can quickly discover colleagues who are equally invested. Social media posts and podcasts by experts in the field have encouraged us to look into additional products and resources when we encounter patients with similar issues.

Another resource for expanding knowledge is specialty meetings, which have become extremely popular in eye care over the last several years. Meetings continue to innovate and focus on specialized topics. It is incredible to be surrounded by like-minded people also wanting to advance their knowledge. While these meetings provide great education, we find that some of the best education occurs between the lectures and in the exhibit halls. Plan to devote additional time before and after classes to get acquainted with colleagues to network with and learn from.

Finally, practitioners who continually seek education on what’s new will find an increased passion for specialty contact lenses. Innovations in the field are occurring every day. It seems that new technology and lenses are being introduced each month. Look to expand on, at minimum, two new innovations a year. To continue to innovate, ask the question, “What could make the practice more efficient, provide better patient care, or improve patients’ health?”

New innovations can often be a burden for an office, especially in the first few months of introduction. Develop a standard operating procedure (SOP) for how to incorporate new technologies into the office. This SOP will address why the new technology is needed, how it will make the patients’ lives better, how it will affect each position in the office (front desk, optician, technician, optometrist), how much it will cost, and how it will be presented to the patient. The SOP will establish what will occur in the months, weeks, and days leading up to the launch of the innovation: how meetings with the team need to be forecasted to bring everyone up to date and how trial runs with the new technology will occur.

Having a plan for how the practice is going to integrate all future innovations brings everyone up to date on what to expect and helps the innovation to be better accepted and implemented more effectively once it is launched. Falling into complacency is a sure way to plateau the business, so continue to find enjoyment in innovating and learning something new.

TIP 4
SELL THE MYOPIA MANAGEMENT OUTCOME RATHER THAN THE REFRACTIVE OUTCOME.

It is easy for parents to focus on the 20/20 line when their child comes into the office (as that usually is the goal for patients who visit the eyecare practitioner). During the consultation (without rushing), explain to the parents why it is important to reduce the progression of their child’s myopia.

Take a two-pronged approach to this. First, share the benefits of lowering myopia that have been observed. It improves quality of life, allows performance of more activities without visual correction, allows for thinner glasses, and potentially results in better surgical outcomes in the future.

Second, share how this lowers the risk of comorbid diseases. A higher prescription is associated with a greater risk of disease.⁴ This stretching has shown to increase the risk of disease as a person ages. Eyecare practitioners should make it clear that the goal is to see that the patient’s prescription is increasing less and that eye length is stable.

In the case of orthokeratology contact lenses, explain that the child may not need glasses during the day and 20/20 vision may be achieved, but that this is not the primary objective. Tell patients and parents that there is an expectation for vision to be somewhere between 20/25 and 20/30 with orthokeratology or soft multifocal contact lenses. The majority of patients do achieve 20/20 uncorrected vision and that is certainly a celebrated outcome. However, some patients have slightly decentered treatment zones, larger pupils, or uncorrected cylinder and, therefore, their vision may not be perfect despite their myopia management treatment.

Focusing on eye health and quality of life moving forward should be the primary topic of conversation when talking to patients and parents about myopia management modalities. At follow-up visits, patients and their parents should get excited about the stability of the prescription, rather than focusing on visual acuity. This alteration in our practice has increased our success rate for our myopia management program over the last four years more than any other innovation.

TIP 5
MAKE MYOPIA MANAGEMENT PATIENTS AND PARENTS THE PRACTICE’S AMBASSADORS.

Frequently, we have new myopia consultations at which parents ask about myopia management, as their friend’s child is participating in it. Children who are current orthokeratology wearers tell their friends at school that they don’t need to wear glasses during the day because they wear contact lenses to bed every night. Patients and their parents will sell myopia management when well educated and happy with the services they received.

One practice promotion idea is to buy small prizes for children to win if they show that they or their parents have posted on social media about your practice. Practitioners can even make T-shirts that promote the practice and give prizes when kids wear the shirts into the office.

One of the absolute best ways to promote your business is to simply ask parents to share practice experiences with friends, family, and coworkers. When they understand that you are helping their child have a better life, they won’t be able to keep from sharing their experience of your practice.

TIP 6
MAKE THE TEAM SPECIALTY LENS CONNOISSEURS…BUT ALSO SET BOUNDARIES.

Having a team and technicians who are comfortable with application and removal training, educating patients on contact lens handling and hygiene, and knowing the different brands and types of contact lenses in your office, and are friendly to patients, are game changers when it comes to improving the success of specialty lens practice. A well-educated team helps the clinic run smoothly, gives patients better care, and keeps the team confident.

Also, the staff members answering phone calls represent the first impression of the office. Patients may be disappointed if the staff person on the phone is unable to answer questions or does not know where to direct questions.

Our office encourages the team to learn as much as possible about eye care and the eyes and make sure they know which questions they can answer and which should be referred to the practitioners. Confident responses to patients build confidence in the practice.

TIP 7
KNOW YOUR BILLING.

This is by no means a comprehensive article on billing, but there are some important aspects of contact lens billing that are important to know when using patients’ insurance for contact lenses. Many insurance companies will pay for “medically necessary” contact lenses, and each insurance company has a list of codes that can be billed for them.

Many patients have vision care plans and there are some obvious diagnoses that are on the plans’ lists, such as keratoconus, aphakia, high ametropia, and corneal transplants. There are also many diagnoses that could be surprising, such as dry eye, irregular astigmatism, nystagmus, band keratopathy, peripheral opacity of cornea, recurrent erosion of cornea, and many more. Having lists from the most common insurance companies readily available makes it easier to use these codes when fitting new patients with specialty lenses.

CONCLUSION

The tips outlined in this article are only a starting point for what practitioners can do to increase the success of the specialty contact lens practice. The definitive goal should always be to look for ways to improve and grow. Whether it be equipment, services, staff, or practitioners, always be on the lookout for ways to avoid stagnancy. Explore ways to continue to enjoy practicing, because when work is both challenging and enjoyable, patients will benefit from coming to the practice. CLS

REFERENCES

1. van der Worp E, Lampa M, Kinoshita B, Fujimoto MJ, Coldrick BJ, Caroline P. Variation in sag values in daily disposable, reusable and toric soft contact lenses. Cont Lens Anterior Eye. 2021 Dec;44:101386.
2. Mickles C, Harthan J, Barnett M. Assessment of a Novel Lens Surface Treatment for Scleral Lens Wearers With Dry Eye. Eye Contact Lens. 2021 May;47:308-313.
3. Korb DR, Greiner JV, Herman JP, et al. Lid-wiper epitheliopathy and dry-eye symptoms in contact lens wearers. CLAO J. 2002 Oct;28:211-216.
4. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019 Jun;96:463-465.