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If we objectively look at the contact lens fitting process in most optometric practices, there is probably room
for improvement. Let's start with a clean slate and erase any old notions we learned in optometry school or that
have been in place since your practice was first started. Times have changed - especially in the contact lens
Let's look at our contact lens clinical procedures from the patient's point of view. Most optometrists would
like to make a good impression on the patient during the fitting process. I agree with that goal; perception is
important. It builds patient loyalty and promotes word-of-mouth referrals. But I disagree with the approach
that most ODs think is impressive.
Complex and drawn-out vs. simple and fast?
The typical way most optometrists try to improve the patient's perception of the contact lens fitting process is
to make it more complicated. On the surface, it seems logical that if we perform lots of additional tests,
patients will think the fitting procedure is scientifically advanced, and requires a great deal of professional
time and judgment. This reasoning may even extend as a rationale for justifying a higher professional fee. But,
how ODs think is not necessarily how patients think. I've found that taking the opposite approach is even more
impressive to patients.
From the patient's point of view, additional office visits are an inconvenience. Having tests performed is boring
at best. Waiting for lenses to be ordered (and reordered) and returning to pick them up is not pleasant. The
patient just wants to wear contact lenses and they want to leave all the other stuff to a competent professional.
It's progressively disappointing as they learn that reaching their goal is time consuming and difficult. They
aren't impressed by the complexity; they're put off by it. Some candidates even drop out.
Patients are actually more impressed if a contact lens fitting and dispensing can be done on the same day as
their initial comprehensive eye exam and they leave with their boxes of lenses. The good news is you can still
charge the same high professional fees that you would have charged when you took longer to deliver the service.
Patients may even be willing to pay more for the convenience of fast service.
Can it be done?
Can you prescribe and dispense contacts on the same day as an eye exam, even if you only have a 15-minute
appointment slot and you didn't know the patient wanted contact lenses? Sure, if you delegate some of the
exam and fitting to qualified technicians. I've done it for years. Patients are very impressed and very happy.
They begin wearing contacts at the height of enthusiasm and they pay their entire bill for services and materials
that day. Do you wonder if patients think contact lens fitting must be very simple and they are being
ripped-off? They don't. They think my office must be incredibly good to cut through all the red tape and
Please understand that I'm not advocating cutting corners in the fitting process. I know contact lenses are
medical devices and we have a responsibility to do the job right. I'm only suggesting that you not add any more
steps than those you truly need and that you look at ways to eliminate waste and redundancy. There probably are
some areas that can be tightened up, and take comfort in knowing that as you do this - you're actually impressing
patients more! We have no room for waste in today's market.
How to do it
I think we all agree that most of the data you need to fit contact lenses is in your comprehensive eye exam. I
simply tell my technician what brand of lenses I would like to prescribe and I move on to my next patient. The
tech performs corneal topography, if it wasn't completed as a pretest (current contact wearers have it done as a
yearly routine), and then inserts trial lenses in the correct powers. All technicians in my practice can insert
trial lenses, even on a patient who has never worn contacts before.
The technician takes visual acuity with the contact lenses and performs a spherical over-refraction. I stop back
in the exam room to check the fit of the lenses with the slit lamp and review the case, and we are done! I move
on again and the tech reviews insertion and removal and lens care, although many contact lens patients have worn
lenses before. We stock our most frequently prescribed lens brands, so we typically deliver a full supply of
lenses at the fitting. The technician writes up all charges and assists the patient to the front desk. A
one-week follow-up appointment is scheduled if this was a new fit.
Benefits of streamlining
This technique greatly decreases chair time, since we don't have to have the patient come back for a diagnostic
fitting exam or a separate dispensing visit. For most cases, we only need one follow-up visit to complete the
fitting, and then we'll see the patient back annually for ongoing eye care.
There are two good reasons to reinvent the contact lens fitting operations in your practice:
- Improve contact lens profitability through efficiency
- Impress patients to enhance loyalty and word-of-mouth referrals
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
A Proud Supporter of
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Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.
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