Optometric Management Tip # 33   -   Wednesday, September 04, 2002
Who inserts diagnostic contacts in your office?

Reinventing and streamlining your fitting process

Many optometrists complain that profitability in contact lens practice is not what it used to be. Indeed, market pressures and new forms of competition have caused some price erosion on lens products and even our professional fees may not be able to keep pace with this loss of revenue.

An alternative to raising the price of goods and services is to increase efficiency. I find this is an important factor that ODs often overlook! There are many ways to do this in a contact lens practice, and it begins by starting with a clean slate and not just performing contact lens procedures the same way you learned in optometry school. Contact lenses have changed dramatically, but chances are the way you fit them hasnít.

One good example in this self-analysis of your practice involves the task of diagnostic (trial) contact lens insertion and removal. Now Iím not talking about who instructs new patients on insertion techniques, but rather who actually places the first trial lens on the cornea during a fitting evaluation. Itís usually the doctor, because no technicians would be available in the exam area at the moment needed, and even if they were, the chances of he or she having the skill to perform this task on a new, slightly nervous patient are slim. Yet, I believe this is the kind of thing that is absolutely necessary to restore profitability to contact lens fitting in this day and age.

We simply canít perform the numerous menial tasks in contact lens fitting ourselves, because it is too expensive for the doctor to do it. In my practice, after a routine eye exam, the doctor tells a technician the parameters of the lens he wishes to see on the eye, and he moves on to see another patient. During that time, the tech has retrieved the lens, talked to the patient about the lens application process, washed her hands, opened the blister pack, inspected and rinsed the lens, inserted it on the patient, often removing it - re-rinsing - reinserting for comfort, and then waits a few minutes. You know the drill. The time-savings for the doctor in that process alone is significant, but our tech goes on to measure visual acuity with the trial lenses in place, and perform an over-refraction via the auto-refractor. She also discusses contact lens fees and follow-up visits, and may discuss lens care if there is time before the doctor shows up again.

When the doctor does return, his evaluation is very quick and lenses are prescribed and dispensed. Patient instructions are completed by the tech and a follow-up appointment is made. This approach is not only more profitable due to the reduced doctor time spent, but it is actually more impressive to the patient! I find that patients are more impressed with efficiency and the saving of their own time than they are with over-complicated procedures and re-appoints for more tests.

By the way, just because a service is fast does not mean it cannot carry a high fee. It can and it should. Ask yourself: do patients want an eye exam (or CL fitting) to take a long time? You actually can charge a premium because you are fast!

Sure, you will have many practical dilemmas that stand in the way of delegating contact lens fitting tasks, which means you will have to reinvent your fitting process. But that could be precisely what is needed!


Best wishes for continued success,

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