Optometric Management Tip # 399   -   Wednesday, September 30, 2009
Delegating Contact Lens Follow-ups

Some readers will think this is a radical idea; others will say I've been doing it for years. I was speaking to a colleague/client recently and she described how her usual office routine for contact lens follow-up visits is to have her clinical technicians see the patient. All those office visits are scheduled with a technician on the appointment schedule, freeing the doctor to do more revenue producing exams.


As one who believes strongly in the practice building power of delegation, I think the idea has merit. I'm always looking at new ways to delegate without reducing the quality of care. Can that be done with contact lens care?

As I see other health professions moving more and more to delegation, with respiratory therapists prescribing drug regimens, nurse practitioners doing physical exams and pharmacists giving injections, I realize that we must continually challenge our old ways of thinking. We also must look for ways to make health care more efficient and more cost effective.

Keep an open mind

I think we all know that ophthalmic technicians can be trained to perform slit lamp exams and over-refractions. We know of some practices that use techs in this way, yet most optometrists have not seriously thought about adopting the process in their own offices. Many would say they want and need to know the ultimate success of each case. It helps refine the doctor's knowledge of various lenses when they are seen on follow-up. Good points, but I'm not sure you would lose that if you delegated contact lens follow-ups, providing that you had the right office protocol and kept some data.

Consider this procedure:

In this scenario, the doctor would still see all the complications and problems associated with contact lens fittings. Data could be kept that provides a success rate for each brand of contact lens so the doctor retains an overall sense for what lenses are working best and the percentage of cases having problems.

Since most follow-up visits are completely normal and without complication, this approach should save a significant amount of doctor time and allow everyone in the practice to work at his or her highest level. The doctor would have to be flexible enough to work in an occasional contact lens problem on top of his schedule, but the examination and disposition of those cases should not be too time-consuming given the high level of technician assistance.

Always follow your state law when determining what you delegate in your office.

Best wishes for continued success,

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