Article Date: 8/1/2007

An Introduction to Specialty Contact Lenses
contacts

An Introduction to Specialty Contact Lenses

Benefit your practice and millions of patients.

BY MICHAEL A. WARD, M.M.SC., F.A.A.O. Atlanta, Ga.

Has there ever been a greater time to fit patients with specialty contact lenses? Consider the following:

► In the United States, there are about 100 million presbyopes and four million baby boomers become presbyopic each year, thus creating a tremendous opportunity to fit multifocal lenses.

► Over half of patients who could benefit from toric lens correction are actually fit with toric lenses.

► Advances in lens design for stability and ease-of-fit and in manufacturing capabilities for reproducibility have made specialty lens fitting uncomplicated and provide dependable results.

Some optometrists hesitate to recommend and/or fit specialty contact lenses due to unfamiliarity. This article is meant to be a catalyst for specialty contact lens fitting by providing an introduction to specialty contact lenses, including modalities, applications, training and tips for patient care and practice management.

Why specialty lenses?

Contact lenses are ubiquitous in our society. Over half the young people who require vision correction wear contact lenses. These happy patients will refer friends and family.

Many presbyopes would benefit from multifocal lenses, yet monovision is still the predominant form of presbyopic contact lens correction by a factor of 4:1.

When you gain a reputation for fitting specialty contact lenses, you differentiate your practice from others. Also, patients often assume that if you're good at fitting contact lenses, then you're good at everything else you do. So specialty contact lenses can significantly benefit your entire practice.

Defining a "specialty"

The majority of specialty lenses, if we wish to use a broad definition, would be soft toric and soft multifocals. Another level of specialty lens fitting is rigid gas permeable (GP) contact lens fitting. GP bifocal and multifocals provide the excellent optical correction. A rigid, spherical anterior refractive surface of a GP lens, allowing tears to create an optical bridge between the contact lens and cornea, provides the ultimate in optical correction. This is why GP lenses are the mainstay of keratoconus, post refractive surgery and post penetrating keratoplasty management.

It amazes me that there are those who still consider soft toric lenses as a specialty. The reality is that today's soft torics are stable with excellent optics and the results are consistently reproducible, which is very important. It is as easy to fit a soft toric lens as it is a sphere and you can provide the patient with better definition, acuity and contrast sensitivity by correcting even the small 0.75D residual cylinders. In short, soft toric lenses should be considered a standard, not a specialty.

In terms of chair time, fitting a soft toric is very close to fitting a soft spherical lens. After you obtain the refraction (corneal curvature measurements are primarily for the medical record), place the lens on the eye and assess the orientation, movement and centration. The lens orientation is within 5° of expected approximately 90% of the time, and the initial lens is the final lens nine out of 10 times – about the same as fitting soft spheres. Generally the dispensed lens is the final lens, but the first follow-up visit is the most common time to make refinements to the power or lens fit.

Chair time and fees

Rigid lenses and soft multifocals may take more chair time, so you need to charge accordingly. Lens fitting always requires assessing motivation and setting proper expectations; explain how you can achieve the patient's visual goals. For soft multifocal lens fitting, I recommend charging a set fitting fee, which includes the first follow-up visit. If the patient desires refinements beyond the first follow-up visit, additional office visit charges are appropriate. That way, you've established a self-controlling system that compensates you for your time and expertise.

We need to get away from the perception that we're offering a commodity. Fitting contact lenses is a professional service that the doctor provides. We must charge accordingly.

The staff's role

As with any specialty, staff are critical. The front desk staff answers the phone, greets the patient, explains the proper fee structure and sets initial patient expectations. It is helpful for the doctor to train technicians to handle many of the procedures involved in contact lens fitting, including keratometry, initial lens selection, and explaining proper lens handling and care techniques. The investment in training will pay back your practice in efficiency, patient satisfaction and specialty practice growth.

Where to Find Training
In addition to manufacturers, a number of organizations support specialty contact lens practices. A sampling is listed below.
American Academy of Optometry (aaopt.org) offers education for both optometrists and technicians.
American Optometric Association (aao.org) provides the profession with a variety of resources for education and training of both optometrists and staff.
Contact Lens Society of America (clsa.info) offers annual hands-on clinical training at basic and advanced levels for all practitioners, limited to about 50 participants.
Rigid Gas Permeable Lens Institute (rgpli.org) offers an online forum to practitioners, which is moderated by a specialist in a different field of contact lenses.
The Vision Care Institute of Johnson & Johnson (thevisioncareinstitute.com) offers specialty contact lens and practice management training to third and fourth-year optometry students, recent graduates, ophthalmology residents, opticians and technicians.
Vision Expo (visionexpo.com) offers "Contact Lens Boot Camp," which presents the basics of contact lens fitting.

Getting started

Each lens type requires different fitting techniques. For all contact lens types, I recommend that you choose on or two workhorse lenses. Designate a primary lens that will work with 90% of your patients and when it doesn't work, know which lens to go to next. Become very familiar with these. Get to know their nuances.

Many forms of marketing are effective, but nothing is more important than word of mouth, where patients tell their friends. Everyday patients generate referrals with a conversation typical to this:

"I'm having trouble with my contact lenses."

"Oh, I see Dr. Jones and I have no problems at all."

The last word

For all the success we've had with contact lenses, there will still be those practitioners who will convince themselves to avoid specialty lenses due to fear of competition. To them, I offer the words of Neal Bailey, O.D., Ph.D.: "There's always room at the top." It doesn't matter how many discounters compete next door to you. By providing the best quality that you can for your patients, you will grow your practice. OM

Mr. Ward is Director, Contact Lens Service, for Emory University. He has managed difficult contact lens cases for more than 20 years. Send e-mail to mward@emory.edu.


Optometric Management, Issue: August 2007