At Vision Expo East, Drs. Patricia Fulmer and Steven Turpin sat down to discuss how optometrists can get started with specialty contact lens services in their practices.
Where would you start if you’re a practice that wants to get into fitting specialty contacts?
There are plenty of manufacturers out that that are looking to support practitioners interested into expanding into the specialty contacts space. “There are certainly some [kits] that you can buy,” says Turpin, “but I would recommend that you just talk to a bunch and figure out who you can get one from to at least try out.”
He also suggests fitting some people — like your staff — for practice, but also to get buy-in from the entire practice.
How do you have the cost discussion with your patients?
“The majority of the time, I don’t have to have that conversation,” Turpin says, because sclerals and other specialty lenses are becoming more and more a medically necessary treatment that’s covered by insurance. Still, it’s important to let the patient know that scleral lenses are not just more expensive than regular lenses, but also take a greater time investment.
However, Turpin adds, sclerals are usually a last resort for patients. This means they’re often willing to put more time and money into managing their lenses.
Do you rely on topographies and testing, or the fit set?
“Testing is getting a lot better,” says Turpin. “With sclerals, it’s a little hard from the topography because you’re not actually interacting with that surface. But what the topography tells you is, are you going to have any success with a corneal fitted lens?”
In Turpin’s experience, looking at the difference in the elevation of the cornea is key to answering that question. “If the elevation of the cornea in one spot is, like, 350 microns different than the elevation in another spot, don’t even worry about throwing a corneal lens on there or anything like that. You’ve got to go to the scleral, because it’s just not going to stay where you want it to stay.”
After that, he goes to diagnostic fitting; but he says, there are so many cool resources out there for fitting when it comes to shape that can help you get the perfect fit every time.
Have you ever failed in a fit?
“Oh, absolutely,” laughs Turpin. He usually starts off simple, and if that works, great! But if not, then you go through the fitting cycle. “But there are plenty of times where we haven’t made the difference that the patient wanted, for a number of different reasons, and you have to have that conversation.” With sclerals, it’s a high burden of care, and unless it’s working, it’s not an easy lifestyle change for patients to make.
How do you calculate fitting fees and costs?
“As far as fitting fees go, sometimes it’s a little bit hard, especially with insurance,” says Turpin. “You’re biling a 92310 for a regular fit. You can only use a modifier so much for that.” It’s the material side where you have to concentrate on billing. Fortunately, Turpin jokes, “1800 Contacts isn’t selling sclerals online, so you pretty much have a 100 percent capture rate on the material!”
It’s up to you to set a good price for specialty contacts, and there are also resources out there to help you figure out how to adjust your prices for specialty lens fittings based on what you charge for regular exams. As you get more experience, you can modify your fees.
Any tips on marketing your services?
“Meet everyone who can make referrals to you!” recommends Turpin. When it comes to myopia control and the opportunities offered by specialty contacts for that, there are many opportunities for outreach, whether it’s to schools or other ODs.
After all, there are even more ODs who aren’t interested in offering specialty contacts, and they are perfect sources of referrals. One method for opening these lines of communication is to mail your local colleagues with an explanation or proposal of the services you offer and how it can benefit them and their patients.
“The cool thing about the specialty lenses,” Turpin says, “is that you get these, all kinds of different aspects of optometry blended into one. You get to make that difference, you get to be involved in the industry, and you get to see patients and build awesome relationships with it. So it’s all of those things that make it really special for me.”