By Christopher Wolfe, OD | For Optometrists and Their Teams

Are You Intentionally Designing Your Contact Lens Practice?

Answering those questions tells me much more about a contact lens practice than simply knowing which lenses are on the shelf.

Start With the Patient, Not the Product

Our practice fits essentially every major contact lens modality.

For irregular corneas, I primarily utilize scleral lenses, although there are certainly patients for whom a corneal GP is appropriate. For a regular cornea where we simply need to achieve better correction than a soft lens can provide, a corneal GP may be my preference.

We utilize orthokeratology and other contact lens options for myopia management. We use custom soft lenses when patients require them. For more traditional refractive correction, we fit toric and multifocal designs in both daily disposable and reusable modalities.

But the point isn't that every practice needs a long menu of contact lens options.

What patient population am I currently unable to serve as well as I would like?

From there, I evaluate whether a product or technology allows me to better serve that population.

Sometimes a new product enters the market and applies to a significant portion of our patients. Sometimes it solves a very specific problem for a relatively small group. Either can have value.

If the technology is uniquely better for a particular patient scenario, I want to have access to it.

If it isn't meaningfully different from technology I already have available, then other considerations become more important. Cost to the patient, acquisition cost to the practice, manufacturer support, education, ease of access, and the company's approach to the doctor-patient relationship can reasonably influence which product we choose.

But those factors come after the clinical question.

How We Actually Choose Manufacturers

It is easy to speak in generalities about wanting an “industry partner,” but I think it is more useful to explain what that looks like in a real practice.

For our routine soft contact lens patients, I primarily work with CooperVision and Alcon.

That does not mean I have decided to be a “Cooper practice” or an “Alcon practice.” It means that, generally speaking, I believe those companies offer some of the best technologies for the patients I see. And when two options are clinically equivalent, I have found that they often also provide very competitive economics for both the patient and the practice.

We use their products across spherical daily disposable, toric, multifocal, and reusable categories.

How do I decide between them?

There usually isn't one single factor. I look at the patient's prescription and parameter availability. I consider material and comfort. I think about optics, multifocal design, handling, cost, rebates, and my own experience with how a particular lens performs in a certain type of patient.

You want enough familiarity with a group of products that you can quickly identify what is most likely to work, while still being willing to go outside that core group when the patient requires something different.

Clinical Distinction Comes First

There are absolutely times when I use products outside of those primary manufacturers.

One example is NaturalVue in myopia management.

I still have some patients in NaturalVue multifocal lenses because that technology was available before MySight and filled an important need at the time. These are patients who have been stable, successful, and happy in the lens.

Could I move them to something newer? Probably.

Should I?

Not necessarily.

If the patient is clinically doing well, the lens remains appropriate, and the patient is happy with the vision, material, and overall experience, I do not believe in changing a successful system simply because another product later entered the market.

That illustrates another part of the decision-making process: continuity and patient preference matter too.

Clinical need comes first. Clinical distinction comes next. Then individual patient performance and preference matter. Only after those things are addressed do economics and vendor relationships become meaningful tie-breakers.

Specialty Lenses Require a Slightly Different Kind of Partnership

The same overall philosophy applies in specialty contact lenses, but the value of the manufacturer or laboratory relationship can become even more obvious.

For orthokeratology, I primarily use Paragon designs, while I also use Euclid when I need a more customized option.

For scleral lenses, I typically use the Jupiter design from Essilor.

Why Jupiter?

A large part of the answer is simple: it is what I learned on.

Over time, I became comfortable with the design and comfortable making the modifications required to solve different clinical problems. I understand how the lens behaves. I understand how to change it. And so far, I have not had a significant number of patients whose needs required me to abandon that design for something else.

There is value in that familiarity.

Sometimes we assume the best specialty lens is automatically the newest design with the longest list of features. I do not think that is always true.

There is substantial clinical value in becoming highly proficient with a design and understanding how to manipulate it to solve problems.

For corneal GP lenses, I typically work with Art Optical.

One of the reasons is their consultation support. Historically, they have been helpful when we need to troubleshoot a difficult case.

With a specialty lens laboratory, you are not always just purchasing a piece of plastic.

Sometimes you are also purchasing access to people with a tremendous amount of experience who can help you solve a problem.

Complexity Isn't the Problem

One reason practices sometimes avoid certain contact lens modalities is that they look complicated.

They require more chair time. There may be more follow-up. The doctor may need additional education. Staff need to learn new processes. Specialty technology may need to be purchased.

Those are legitimate considerations, but I don't believe they're reasons not to offer a service that benefits patients.

They're reasons to build the service correctly.

When I introduce a new service, I estimate how much doctor time it will require and compare that with the revenue per OD hour that I currently generate individually and that our practice generates collectively. Then we build a fee structure around the resources we expect the service to require.

Importantly, I tend to estimate conservatively.

When I began fitting scleral lenses around 2010, for example, I structured the service assuming I might need five 15-minute follow-up visits. The fee needed to make sense even if every patient required all five visits.

Today, after years of experience, I almost never need five follow-ups. Frequently I need one, and sometimes I don't need an additional follow-up at all.

That increased efficiency doesn't mean the service has become less valuable.

Quite the opposite.

The expertise developed over those years allows me to produce the desired outcome more efficiently. The result is an increase in revenue per OD hour as proficiency increases.

This is consistent with how I think about building any clinical pillar within an optometric practice: determine the clinical protocol, understand the resources required, establish appropriate fees, train the team, and create a repeatable process.

The economics should be designed on the front end so that they don't interfere with the clinical decision on the back end.

Stop Trying to Beat Commoditization With More Commoditization

This brings me to what I believe is one of the biggest problems in contact lens practice.

Contact lenses have become increasingly commoditized.

Patients can search for the price of a box of contact lenses before they've made it from the exam room to the optical. Understandably, many optometrists don't like that.

But our response can be peculiar.

We dislike the commoditization of contact lenses, and then we battle it by leaning even harder into the commodity.

We focus on the price of the box.

We worry about where the patient will buy it.

We structure profitability around product sales.

Then we look at the additional time, technology, education, and expertise required to prescribe more sophisticated contact lenses and wonder whether all that effort is worthwhile, because we're still evaluating the opportunity primarily through the value of the commodity.

I think we need to separate two things:

Those are not the same thing.

Determining which lens technology provides the best vision, comfort, ocular health, and quality of life for a particular patient requires professional expertise.

That expertise has value even if the patient ultimately purchases the box somewhere else.

Our practice has intentionally built its contact lens model so that we can be financially agnostic about where patients purchase their lenses. We are compensated for the professional services we provide.

That doesn't mean we don't want patients purchasing lenses through us. We do.

We believe it is often better for the patient. We actively compare our pricing with other sources, and after rebates and annual-supply benefits, we can frequently compete with or beat online retailers. We also support our patients in ways a commodity seller may not, for example, providing trial lenses when necessary so they aren't running out.

Contact lens sales are helpful and important to our business.

But the professional contact lens service doesn't depend upon them.

That's an important distinction.

Prescribe the Technology That Produces the Best Experience

Our preference for daily disposable lenses is another example.

We utilize monthly lenses when appropriate, but when a daily disposable option meets the patient's needs, I frequently prefer it.

Why?

Because I believe it creates a better patient experience.

Starting with a fresh lens each day reduces the buildup that occurs on a lens over time and the frictional issues that can accompany those deposits. It can reduce irritation and inflammation and reduce risks associated with microorganisms, overwear, and corneal infiltrative events.

In other words, I'm not choosing a daily disposable because I calculated that selling 360 lenses is better than selling 12.

I'm choosing it because I believe it's the better technology for that particular patient.

Interestingly, making the clinically better decision can also produce a better business outcome.

A comfortable patient who sees well and experiences fewer contact lens problems is a successful contact lens patient. Success has value, even if some of that value shows up as the patient needing fewer unnecessary problem visits because we got it right the first time.

What I Want From an Industry Partner

When I think about the companies I want to work with, the first thing I want is meaningful innovation.

Are they developing technologies that allow us to serve patients we couldn't serve previously? Can their products improve quality of vision or quality of life? Can they expand patient access?

Second, can patients actually obtain the technology?

A great product that is economically inaccessible isn't particularly helpful. Cost to both the patient and the practice matters.

Third, I value companies that support professional education. Better education allows us to become better clinicians and ultimately provide better patient care.

And finally, I believe industry partners should keep the doctor-patient relationship at the forefront rather than attempting to circumvent it.

Again, none of those considerations should cause me to withhold a uniquely beneficial technology from a patient. If a product offers a clinical advantage I cannot obtain elsewhere, that distinction matters most.

But when products are clinically equivalent, those factors absolutely influence which companies I choose to work with.

Diagnose Your Contact Lens Practice

If an optometrist tells me, “My contact lens system is broken,” I'm not sure there is one universal place I would tell them to start.

Instead, I would diagnose the practice much like we diagnose a patient.

I believe optometrists should practice to the fullest extent of their knowledge, education, and training. Contact lenses are an excellent example of why.

We have enormous expertise in understanding the eye, the ocular surface, optics, refractive needs, disease, and the interaction between all of those things and a piece of technology that sits directly on the patient's eye.

There is tremendous value in that expertise.