By Cindy Shan, OD, FAAO
So, you have a great gig at an optometry practice, but you want to add in some specialty contact lens fitting? Perhaps you are tired of referring out specialty contact lens fits and want to expand beyond comprehensive eye exams. Although it may appear easier to start this type of specialty when you own your practice, there are many benefits to creating something within an already established practice. It can be a strategic win for everyone involved: you, the host practice, and most importantly, the patients. Creating a specialty service means patients will no longer have to navigate going to a different office and setting up new appointments, not to mention the fact that your practice owner will now have a new stream of revenue.
Below is a comprehensive, practical guide to planning, launching, and growing your specialty service within a larger private practice.
Understand Your Interests
Learn about specialty contact lens fitting. What type of lenses are you interested in fitting? Scleral lenses? Orthokeratology? Custom soft lenses? All of the above? In these cases, investigate and determine your target patient demographic or patient cases. Below is a list of example cases that may interest you.
Keratoconus and pellucid marginal degeneration
- Post-LASIK/PRK/RK ectasia
- Post-transplant corneas
- Severe dry eye and ocular surface disease (sclerals as PROSE-alternative solutions)
- Irregular astigmatism
- Aphakia
- High ametropia
- Myopia control
Prosthetic lenses
How to Propose the Idea to Your Boss
The clinic owner’s acceptance of your ideas may be the easiest or hardest part of this process. Although some owners will be thrilled at the idea of bringing in a new specialty, some may hesitate to invest in new equipment, adjust the patient schedule, or train the staff on new techniques.
In any of these scenarios, it will be critical to answer some questions for upper management.
1. What are you proposing and why is it beneficial?
Once you have decided on what type of specialty contact lenses you would like to add to your practice, you can answer the question of what you want to offer patients and why it is helpful.
Keeps complex care in-house
- Generates high-value services
- Enhances the clinic’s reputation as a comprehensive and medically advanced care center
- Creates a competitive advantage in the community
Increases patient satisfaction and loyalty
2. What financial details need to be determined ahead of time?
It will be important to showcase the financial benefit of a specialty contact lens practice. Specialty lenses are a premium service and are charged accordingly. This may include custom fitting fees, lens costs, regular follow ups and replacements. Generate an estimate and be open to discussing the numbers.
3. What is needed to outfit your specialty service?
Investment in new equipment is often one major concern for practices. This may be due to cost or space in the clinic. It is important to note that not every shiny new piece of equipment is needed to begin fitting specialty contact lenses. It is possible to start with the basics: an autorefractor. Of course, this will require more time utilizing our slit lamp techniques but remember that optometrists have been fitting these lenses long before anterior segment OCTs and topographers existed. Of course, they are helpful tools but not necessary to get started. What is non-negotiable is a fitting set. Start off with one or two companies so you can have consistency with parameters used and their consultation team. This will help build your confidence and decrease confusion with the clinic’s financial team as it will simplify invoicing.
If getting new equipment is an option, there are a variety of devices on the market. These range in price and size, and some may combine features with another device creating an “all-in-one” (i.e. topography and axial length). It may be beneficial to have a written agreement on when new equipment can be considered if revenue achieves a certain level and value can be proven (i.e. less chair time, improved results etc.).
4. What impact will a specialty service have on scheduling and clinic flow?
The clinic flow is another important discussion during this process. For example, how many exam lanes will be required? Will the contact lens technicians need to be trained on how to teach application and removal or assist in the fitting process? How much time is required for the specialty fitting exams? Although some may find it easier to roll this out slowly, others may find a condensed training weekend is more beneficial. Regardless, it will likely start off slow with the number of patient cases. Below are some examples of schedule timing.
30–60 min for initial consults
- 45–60 min for fitting evaluations
- Specific days blocked or integrate into your usual schedule
Follow-ups as needed
5. How will you market this new service?
While your own patients will be educated on these new services, ideally, you’ll attract new patients to your practice and increase your patient base. Good signage and education amongst other doctors in the practice and surrounding area is an easy way to start. This can include other optometrists and ophthalmologists. Many specialty practice owners and associates will be familiar with the cold calls and visits to nearby practices when they first started out. Having easy resources available (i.e. referral pad/forms) for other doctors to refer to you is key. Educational seminars or a quick summary sheet of what you offer, why it’s helpful, and when to refer will provide guidance. Providing co-management letters and consultation reports will reinforce these relationships.
Additionally, if the goal is to have nearby optometrists refer to you, they may want to ensure that they don’t lose their patients in the process. Have a system in your office to prevent accidental absorption of patients and share this process with referring optometrists. This will improve relationships amongst colleagues. Updating the clinic website will also be key to direct patients looking for fitters online.
Looking at your target demographic will also be helpful. For example, if you are planning to start a myopia management clinic, connecting with mommy groups or visiting schools would be a great place to start. Pediatricians and family doctors are also excellent referral networks.
Next Steps for Success
Launching a specialty contact lens clinic inside an existing private practice is one of the most powerful ways to build a subspecialty career with minimal financial risk and maximum clinical impact. Your first few months may start off slow but with solid operational systems, focused staff training, and a strong referral network, your specialty contact lens service can quickly become an amazing way to help your patients thrive.
Dr. Cindy Shan pursued her education at the University of British Columbia and the University of Waterloo. She completed her cornea and contact lens residency at Northeastern State University in Oklahoma. A distinguished Valedictorian of her optometry class, Dr. Shan is a proud Fellow of the American Academy of Optometry. She has contributed to various organizations, including the Canadian Association of Optometrists, the American Optometric Association, and the British Columbia Association of Optometrists. Dr. Shan’s commitment to education extends to lecturing at the Contact Lens Society of America and the Oklahoma Association of Optometric Physicians Vision Summit.
