Optometric Management Tip # 318   -   Wednesday, March 05, 2008
Delegation in Contact Lens Practice: The Finer Points

Last week I made a case for increasing the delegation of your contact lens procedures in order to improve the profit margin of that service. In this tip, I'll provide some ideas for how to adapt your practice to make it happen. Change can be difficult and most practices have a lot of management inertia, which tends to keep things going the same way they did in the past. Let's get specific about what you need to do to take action.

Exam rooms

Here is a review of what you need in your facility.


You probably have most of the equipment you need but if not, take steps now to invest in your practice. There is no better investment. Talk with your instrument dealer and attend a major eye care conference to test and compare brands.


The primary reason why most practitioners can't become more efficient in contact lens fitting is because their staff is too small. I'm pretty sure most doctors feel they can't afford to hire more staff, so they continue to do many tasks themselves, which could be delegated. When you convert the doctor's hourly pay rate compared to that of an optometric assistant, it seems like a false economy to me. The technicians in my practice work in contact lenses, general eye care, and optical dispensing. When I hire an additional employee, our whole practice gets a lift in efficiency and productivity. I've never noticed the increase in payroll cost. Here are some more key points:


Let's not make contact lens fitting any harder than it needs to be. Don't make it more complicated then it needs to be in an attempt to impress the patient or justify your fees. Patients are more impressed if the process is simple and fast. Contrary to optometric thinking which tends to equate the value of a service with doctor time spent... patients will actually pay a higher fee if they can get done quicker and with fewer visits! That's real value to most people today!

Wipe the slate clean on your contact lens fitting paradigm. What do you really need to do to successfully fit the patient? Don't schedule another visit for a special exam if you don't really need to. Do the exam, fitting and dispensing all at the first visit. Reduce the additional visits for lens dispensing and follow-ups if possible. Of course every case is different and you should always do what you need to do to provide excellent eye health care, but don't follow a process just because you've always done it that way in the past or because you were taught that way in school.

Make changes to your appointment schedule, your exam forms, patient handouts and any other office tool or process that promotes the old approach to contact lens fitting. Design your practice to reflect the new streamlined approach.

The contact lens fitting

After I complete a comprehensive eye exam and talk to the patient for a few minutes, I pretty much know what contact lens to prescribe. The decision on the type and brand of lens is determined as I talk to the patient (more on this below). I've already examined the eye with a slit lamp. I already made note of the corneal curvature. I already know what lens power is needed. My job at this point is to confirm the fitting characteristics with the slit lamp and verify the lens power via over-refraction. It only takes a few minutes and it would be a waste of time to make the patient come back for another visit, in my opinion. We're on a roll; let's not stop now! My technician gets everything ready and I just come back into the exam room for those tests, approve the fit and leave.

I view the “talking to the patient” part before the fitting as a very important aspect of the contact lens procedure and I won't fully delegate that. There are many great options available to us in contact lens materials, designs and modalities and I want to explore the patient's wants and needs and make a recommendation. I don't like to just list all the options and ask the patient to choose; I prefer to select the best option for the specific patient and advise him. I welcome input from the patient in this process, of course. I want the patient to obtain the lenses that suit him the best. I like to sit and talk face to face with the patient after the exam is completed, but I've also gathered a great deal of information during the course of the exam. I've already asked questions, mentioned lens options and observed the reaction. The calm discussion after the exam makes the patient feel like I have all the time in the world for him, even though I spend very little actual time in the exam and fitting process.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management