Article Date: 6/1/2010

CL Strategies For The Health Of Your Practice
contact lenses

CL Strategies For The Health Of Your Practice

Grow your practice by following the 4Rs: Retention, referrals, repurchase and reduced chair time.

BY RICHARD WALLINGFORD, JR., O.D., Jacksonville, Fla.

Even in a tough economic climate, it's possible to grow both your revenues and your patient base. Some strategies are surprisingly simple; others may require investments in new technology and ongoing education. Here, optometrists with thriving practices offer four core strategies for boosting your practice's financial health through contact lenses.

1 RETENTION: Keep the patients you have.

One of the best ways to keep your contact lens patients returning regularly is simply to make the next appointment for them. In addition to pre-appointing at checkout, practices with high retention rates are also diligent about reminder postcards, e-mails and personal calls.

"When I say, ‘I'll see you in a year,’ I like to attach a very specific reason to make it something more than a routine appointment," explains Jacksonville, Fla., optometrist Jon Scott Walker, O.D. "I make it clear that I want to see them again to monitor prescription changes or a developing cataract, or to ensure that they continue safe and healthy contact lens wear." Dr. Walker believes this "special reason" gives patients more of an incentive to return because it's personal.

Dr. Walker believes that preappointing helps to reinforce contact lens compliance. He says he knows that patients should be nearly out of lenses when he sees them again. If they aren't, or if they delay an appointment, that's a sign they're stretching out the wearing schedule, he says.

Many eyecare practitioners agree that compliance is a key factor in retaining patients. Patients who follow lens cleaning regimens and replacement schedules tend to have healthier eyes and clearer vision than those patients who don't. And patients with clear vision and healthy eyes tend to be among the most loyal patients.

In addition to pre-appointment and education, other tools may help improve compliance, such as LensAlert cases that provide electronic reminders of when it's time to change lenses and the Acuminder In-Office service (, which allows you to sign-up patients, for regular electronic reminders via e-mail, text message or Facebook on when it's time to change their lenses.

Recent studies provide a clearer picture of non-compliance. One reported that 52% of those who wear two-week replacement contact lenses say they are non-complaint with replacement schedules, vs. 28% of monthly replacement wearers.1

Another study showed that longer replacement schedules lead to longer periods of overwear. That is, while overwear is common in both groups, 23% of monthly wearers stretched their lenses out to eight weeks of wear or more, compared with 4% of two-week wearers.2

"Some practitioners try to accommodate a noncompliant pattern by switching to a longer replacement frequency, but you run the risk of actually exacerbating the overwear," says Dr. Walker. "Instead, I try to educate the patient about what I see that they don't — papillary changes, edema and neovascularization." He says his approach reinforces the compliance message and highlights the medical reasons patients need to return for follow-up visits.

It certainly takes more than pre-appointing to keep patients in your practice. "Becoming comfortable with fitting multifocals is essential," says Dr. Walker. "Otherwise, you are guaranteeing that your patients will ‘age out’ of contact lenses."

Recent research shows that nine out of 10 (89%) contact lens wearers want to remain in contact lenses.3 Dr. Walker cautions against reserving multifocal lenses as a last resort for patients who just haven't been satisfied with anything else."

A better strategy is to start fitting your emerging presbyopes in very comfortable multifocal lenses with low adds," he says. "They will hardly notice the transition to presbyopia."

Optometrist Millicent Knight of Evanston, Ill., says you can also retain contact lens patients by seeking continuing education opportunities for both yourself and your staff.

"Patients have a lot of options for learning about eye care and new lens technologies online," she says. "You will certainly lose them if you and your staff aren't at least as aware as they are of new products. And in many cases, patients are misinformed [by] what they read on the Internet, so if you take the opportunity to re-educate them, you will build a sense of loyalty to your practice."

2 REFERRALS: Keep new patients coming in the door.

Staying at the top of your game is a great way to generate referrals, says Washington, D.C. optometrist Michael P. Rosenblatt.

"We take pride in being able to offer the latest products and diagnostic tools, and in being able to fix problems that no one else can," he says.

From challenging keratoconic eyes to astigmats who have been told they can't wear contacts or presbyopes struggling to see the computer, he says he finds that patients who have specific problems are often the most enthusiastic sources of referrals.

Dr. Knight agrees.

"Presbyopic women are a huge referral source," she says. "In that age group, many women are dealing with dry eye and a host of other age-related symptoms. They often feel like no one is really listening to them," she says. "If you can send that patient away happy — even if that means putting her in a one-day lens she can wear part-time for sports and special occasions — you are very likely to hear from her friends."

In addition to friends, women also seek recommendations from their primary care providers, often OB/GYN specialists, so Dr. Knight recommends that you share your expertise and services with a wide range of local clinicians, not just the obvious ophthalmic practices and internists.

In addition, Dr. Knight says she relies on the personal touch to boost referrals. At the end of the day, she says writes a personal thank you note to any new patient seen that day and to the person who referred that person. The referring patient gets a courtesy gift certificate to use at his or her next visit, she says.

"Little perks can make a big difference," agrees Dr. Rosenblatt. "We give patients free movie passes for referring others," he says. He says his downtown practice also gets referrals from local hotel concierges trying to help their business travelers or vacationers with lost contact lenses or ocular problems.

3 REPURCHASE: One patient, many options.

With so many options for discounted contact lenses, why should patients buy from your practice?

"For the same reason they buy bagged salad," says optometrist Wilson W. Movic, of Bloomington, Ill. "We make it easy for them."

Package pricing, manufacturer rebates and keeping lenses in stock for quick replacement of a torn lens, for example, all make buying directly from the practice attractive, he says.

But there's no substitute for staying competitive on pricing. Across the board, practitioners with high capture rates all say they regularly monitor online pricing and at least come close to matching prices for their mostprescribed lenses. To make up for any online cost differential, they say they focus on patient care and customer service.

Most also strongly encourage annual supply purchases.

"In our discussions with patients, the assumption is that they will purchase a year's supply," says Dr. Rosenblatt. "We structure our pricing so that it doesn't even make sense financially for patients to choose anything other than an annual supply."

He says his staff receives training on how to talk about the costs and benefits of annual supplies and buying from the practice.

"If you avoid those conversations or are uncomfortable with them, you won't capture nearly as many of your patients," he says.

Providing patients with the latest technology also encourages repurchasing and keeps patients coming back to you to see what is new, says Dr. Movic.

"Lens technology keeps getting better and we want to use that to our patients' advantage," says Dr. Movic. "At every visit, we ask patients how many hours they wear their lenses per day vs. how many hours of comfortable wear they get. If the difference is two hours or more, we sample a different lens."

He says his practice is highly computerized, allowing him to market multifocal lenses to emerging and early presbyopes and colored disposable lenses to teenagers during prom season.

When a company releases a large value pack of lenses or offers a particularly good rebate, Dr. Movic says he notifies patients. In fact, he says generous rebates have helped his patients overcome price barriers to his favorite modality — one-day lenses.

"It's a great modality for convenience, compliance and ocular health," he says.

Ideally, he says he'd like to fit as many patients as he can with contact lenses, even though the conventional wisdom is that spectacle wearers are more profitable.

"I see my contact lens patients more often, and have a better rapport with them than with the patient who only comes in once every few years for a new pair of glasses," Dr. Movic says. "Contact lens patients are more profitable for the practice because they make more visits and purchases over the long-term."

4 REDUCE CHAIR TIME: Make every minute count

With so many new contact lens options, how do you satisfy patients without eating up too much chair time?

The first step, says Dr. Walker, is training your staff. Not only does this ensure that they gather the data you need to make decisions quickly, but it empowers them to have more proactive discussions with patients.

"An educated staff can start talking about new technologies on the phone and during the pretest," says Dr. Walker. "By the time the patient gets to my exam room, he or she is already excited about possible options."

Next, educate yourself about the design, advantages and limitations of new lenses, says Dr. Walker.

"Lack of familiarity with the products is what ends up wasting the clinician's time, " he says. "If you are new to fitting torics or multifocals, follow the fitting guides closely because they provide a stepwise plan of action."

In addition to product knowledge, you need to have a linear progression and a stopping point. Otherwise, you can find yourself going in different directions that take up a lot of chair time — and may still not result in a workable solution for your patient, he says.

Once you get used to a new product, Dr. Walker maintains, the chair time to fit it is not much different than for a standard spherical lens. "And you will really see the benefits in patient loyalty, referrals, and profits," he says.

Fitting astigmats used to require at least 15 minutes of settling time, but new lenses, which settle faster, can reduce the amount of chair time.

Many optometrists may be concerned that pediatric fits represent another category that increases chair time, yet in the Contact Lenses in Pediatrics (CLIP) study, doctors reported that chair time for fitting and follow-up visits for eight- to 12-year-olds was about the same as that of new teenage wearers.4

Dr. Knight says her experience reflects this.

"For me, fitting children is no different than fitting adults. Younger kids may take a little more of my technician's time for insertion-and-removal training, but that staff-time investment is well worth the cost," she says. "Proper training at an early age sets the stage for a lifetime of compliance and healthy wear habits."

Ultimately, it may help to consider chair time not only in terms of efficiency and time reduction, but also in terms of value to the patient.

"A former associate of mine who practiced until the age of 80 taught me an important lesson," Dr. Knight says. "At the end of the month, his profit was often higher than mine — even though he was seeing half as many patients. I finally realized that was because he took the time to really listen to each patient and go the extra mile to address all their eye care needs," she says.

Those patients might walk away with one-day contact lenses for tennis, special glasses for golf and another pair for everyday use.

"In my practice, I try to combine that level of patient care and attention with maybe a little more attention to efficiency," she says. OM

1. Dumbleton K, Richter D, Woods C, et al. Compliance with contact lens replacement in Canada and the United States. Optom Vis Sci 2010;87:131-9.
2. Hickson Curran SB, Chou P, Gardere J. Longer prescribed replacement intervals leads to more stretching of frequent replacement lenses. Presentation at American Academy of Optometry annual meeting, November, 2009, Orlando.
3. Data on file, Vistakon.
4. Walline JJ, Jones LA, Rah MJ, et al; CLIP Study Group. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci 2007;84(9):896-902.

Dr. Wallingford is Director Professional Affairs, Professional Development Group, Vistakon. He is responsible for leading professional affairs activities with associations and independent eye care practitioners and directs the company's promotional grant approvals process. Contact Dr. Wallingford at

Optometric Management, Issue: June 2010