Dr. Zachary Holland shares how ECPs can increase their revenue by five times per patient with myopia management.
By Zachary Holland, OD, FSLS
Oftentimes, one change can make a profound difference. In my practice, I found that intentionally scheduling time for consults during comprehensive exams has greatly improved my patient’s appreciation of our services, and, consequently, our profitability.
Rethinking Myopia Management Consults
I used to subscribe to the fairly popular process of bringing back the family on a separate day for a myopia management consultation but have rethought that approach. In a standard 30-minute comprehensive exam, I have found that if the parent doesn’t understand enough of why their child’s myopia needs to be treated, the default response to too much information and mild confusion is “that sounds expensive.” I call this premature disinterest. To combat this, I make sure I have corneal topography and axial length to really drive the “why” of myopia control and proactively answer two common questions from parents. Will some appointments end early due to lack of myopia management candidacy? Of course, but some will not and those are the appointments that you want to capitalize on and get to reap the revenue of multiyear treatment plans.
I try to set up all my processes to minimize no-shows, while maximizing long-term efficiency and patient buy-in for that prized same-day conversion. So instead of losing that patient or family, I protect my time and increase my conversion rate by planning ahead for these myopia candidates. MiSight® 1 day has been a game changer. MiSight® 1 day soft lenses are specifically designed for myopia control and are FDA approved* to slow the progression of myopia in children (aged 8-12 at initiation of treatment).‡2 Don’t get me wrong, I thoroughly enjoy ortho-k. But life is easier for me, my staff, and the families when my ratio of MiSight® 1 day to ortho-k follow ups is at least 1 to 3. Think about it: MiSight® 1 day takes me no extra chair time to fit than single vision daily disposable soft contact lenses.†1,2
As a parent myself, I’m too busy to take time off work and pull my kids from school during the day to come back for multiple appointments on short notice. We know that the sooner a child starts myopia management, the better the final outcome in saving every diopter possible.3
How Do I Make This Change?
You are going to have to totally reprogram both your brain and how you prepare for a day of scheduled patients to maximize revenue per patient. You’ll still need adult primary care to educate the parents to bring in their children starting at age 3, or younger with InfantSEE, depending on your comfort level.4 If your school district has early release days, leverage that to capture as many children as possible. And maybe plan for another half day as well.
Can Any of Us Afford Not to Do This?
Two common complaints of practice owners are staff as it relates to hiring and retaining, and stagnantly low vision care plan reimbursements. When I 5x my revenue per patient with myopia management, I can sleep better at night and bolster my monthly practice cash flow. I’m a proponent of prioritizing time and resources around the most prevalent ocular diseases: myopia and dry eye.
So, during the comprehensive exam, you make them aware of a problem that they didn’t know they needed a solution for, candidly, a more expensive solution. Don’t apologize. That’s when you need to create value and make it about our responsibility to not only provide clear vision for their child but help protect their vision from getting worse as they grow.
To paraphrase financial guru Ramit Sethi, why are we focusing on $5 latte costs when we should be creating $100,000 to $1,000,000 opportunities. Care less about the $20 co-pay or $90 deductible payment. We want to consistently see new patients that generate well over $1,000 per comprehensive exam. Generally, once patients are on a myopia control, dry eye or specialty lens program, it’s a rinse and repeat situation next year. So, expanding revenue isn’t a linear, but exponential, growth curve.
What Does Good Look Like?
In our practice, we’ve been able to increase our revenue per exam from the normal $35-450 to north of $1,200 – that’s where the 5x comes from. My revenue per exam has exceeded $1,800 in recent months on a fully booked schedule with a waitlist of patients.
With many things, health related or not, out of sight, out of mind. So, while planting the seed is a good idea in theory, patients forget most of what we say. Then they don’t come back. Whether you have the same day conversion or not, make sure the problem and solution of myopia has an emotional connection and that the parents go home with compelling information in hand. Sending information digitally is supportive but less tangible than visual diagrams of longer eyes on paper that should resurface at home with the spouse or partner.
Stop settling for two myopia management patients a month. You see more than two adults a month with children aged 5 to 15. I guarantee there’s far more children with myopia in every community than 24 per doctor.5 In 2022, glasses sales represented 4 percent of my gross revenue collected in my $2,000,000 single-OD practice. Many of you can enjoy the same success. Every parent deserves to know the best outcome for their child – just start.
Dr. Zac Holland is the owner of the Cornea and Contact Lens Institute of Minnesota, a practice dedicated to over 500 specialty contact lens fittings per year. He actively participates in multiple surgical, drug and device FDA clinical trials along with frequently lecturing as a KOL and is published regularly on the topics of myopia control, scleral lenses, keratoconus management, corneal crosslinking and practice management. Dr Holland is an adjunct faculty member at multiple optometry schools and hosts 10-12 fourth year optometry students where they learn hands-on specialty lens fitting, anterior segment disease management and specialty lens practice logistics. He was granted Scleral Lens Fellowship in 2017, CooperVision's Best Practices award in 2023 and Minnesota's Young Optometrist of the Year in 2024.
* Indications for Use: MiSight® 1 day (omafilcon A) soft (hydrophilic) contact lenses for daily wear are indicated for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes, who at the initiation of treatment are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with ≤ 0.75 diopters of astigmatism. The lens is to be discarded after each removal.
† Initial CL BVP selection and observation of fit follows same fitting protocol for single vision CLs; fit success rate same with MiSight® 1 day and Proclear® 1 day.
‡ Compared to a single vision 1 day lens over a 3-year period.
References:
1. CVI data on file 2018.
2. Chamberlain P, et al. A 3-year Randomized Clinical Trial of MiSight® Lenses for Myopia Control. Optom Vis Sci. 2019; 96(8)556-567.
3. K. Zadnik, G.L. Mitchell, L.A. Jones, D.O. Mutti; Factors Associated with Rapid Myopia Progression in School-aged Children. Invest. Ophthalmol. Vis. Sci. 2004;45(13):2306.
4. Comprehensive Pediatric Eye and Vision Examination. AOA Evidence-Based Optometry Guideline Development Group. Approved by the AOA Board of Trustees February 12, 2017.
5. Fortin P, Kwan J. The Myopia Management Opportunity in the United States Using the 2020 Census. ARVO 2022, Denver, CO.
