It is the optometrist’s skill and expertise that allow a patient to succeed with contact lens wear, not the result of any name-brand contact lens. Therefore, the emphasis should be placed on the service provided by the practitioner and not the material. The practitioner needs to stay informed about all technologic advances in the contact lens industry for lens materials, lens designs, and care systems to be updated frequently. To stay aware of the growing options, doctors can subscribe to various contact lens publications, such as Contact Lens Spectrum, Review of Cornea and Contact Lenses, Eye and Contact Lens, and EyeWitness, as well as the weekly e-mail newsletter CL Today.

Continuing education (CE) is another source of contemporary information. Some of the aforementioned journals offer CE credit if doctors read featured articles and then answer and
submit questions based on the reading. Also, CE hours can be obtained by attending local, regional, or national conferences.

In addition, all optometrists have the opportunity to become involved in the Contact Lens and Cornea Section of the American Optometric Association (AOA) and the Cornea and Contact Lens Section of the American Academy of Optometry (AAO). Membership in the AOA Contact Lens and Cornea Section provides several benefits: free continuing education at the AOA’s Optometry’s Meeting, manufacturers’ discount coupons, and a monthly e-newsletter supplying late-breaking clinical alerts. The Contact Lens and Cornea Section also affords optometrists the opportunity to work as liaisons with third-party programs, allowing optometrists to receive fair reimbursement for their clinical efforts.³,⁴,⁵ For application and dues information, visit the AOA website (http://www.aoa.org). Optometrists can apply to be considered for fellowship in the American Academy of Optometry. Besides completing an application for candidacy, optometrists must also achieve 50 points by meeting several written requirements. After the written work is reviewed, candidates will be eligible for an oral examination held at the annual meeting. Successful completion of all stages grants the optometrist recognition as a Fellow. After achieving fellowship, one can also strive for the highly regarded status of Diplomate in the Cornea and Contact Lens Section, which requires completion of additional case studies as well as written, slide, oral, and practical examinations. Numerous symposia and educational position papers are available through membership in this Section.⁶,⁷ For membership information, visit http://www.aaopt.org or write to the following address:

Membership Department

American Academy of Optometry

6110 Executive Boulevard, Suite 506

Rockville, MD 20852 USA

Finally, it is the doctor’s responsibility to share his or her wealth of knowledge with the staff and patients. The optometrist should delegate and monitor tasks given to staff, ensuring that their knowledge level is adequate. Patient education is one of the most important factors in increasing patient compliance. The doctor should provide the tools necessary for the patient to succeed.

The best tool to educate your patients is to have an educated staff. Typically, a patient’s original impression of a practice is not formed by direct communication with the optometrist, but rather by contact with a staff member. Therefore, staff personnel should be capable of answering patients’ initial questions, providing sound advice, and making informed recommendations regarding general contact lens product information, care regimens, and basic ocular health. A well-educated staff member is then able to be a bridge between the patient and doctor, providing the best-quality care and instruction to the patient. Staff members can learn via several means: meetings, textbooks, journal articles, the Internet, workshops, and seminars.

Personnel can be educated by mandatory meetings scheduled on a regular basis (i.e., monthly, bimonthly). The primary focus of the meetings is to enhance communication and education, keeping staff members updated on recent contact lens issues. Some examples of topic ideas are new contact lens designs/materials, contact lens-related ocular diseases/conditions, lens wear complications, patient compliance, and proper lens care. To further review these subjects, the optometrist can provide the staff with textbooks, journal articles, and material from reputable online sources.

A few examples of textbooks available for use are the Self-Study Course for Paraoptometric Certification, 3rd ed., produced by the AOA (http://www.aoa.org) and Stein et al’s The Ophthalmic Assistant, 8th ed., available at http://www.elsevier.com. Online sources include the following:

Another method through which staff members can gain valuable information is by utilizing the knowledge available from pharmaceutical, lens care, and contact lens representatives. These representatives are experts of their particular product and are willing to share this information with practices. Some practitioners find it suitable to schedule seminars during lunch hour, for representatives often will provide refreshments.

In addition, companies may offer CDs/DVDs and printed information to be distributed to staff for further training. The American Optometric Association offers educational modules such as the “ABCs of Optical Dispensing,” “Anatomy and Physiology,” “Practice Management 101,” etc. The modules are in a very easy-to-use PowerPoint format with accompanying audio. This information is available on the AOA website (http://www.aoa.org) under the Paraoptometric section.

Finally, staff can also attend state, regional, and national conferences. These conferences not only offer continuing education courses for optometrists, but also provide seminars for paraoptometric staff as well. A wide range of courses, from introductory to advanced, are provided to develop staff communication skills and general contact lens knowledge. An example of the array of courses provided at the 2008 Heart of America Contact Lens Society Conference begins with a fundamental course “The Essentials of Optometric Care: Facts, Terms and Anatomy” and extends to a more complex “Contemporary Contact Lens Correction for Presbyopia.”⁸ Workshops on technical skills are available as well as instruction on proper billing and coding. Enrollment fees for paraoptometrics are reduced and are typically paid for by the employing optometrist.

Setting fees for contact lenses falls into two areas, the professional service fee and the materials fee. Some practitioners will present a global fee that includes both the service and materials in a lump sum. Others will charge separate fees for each visit. A common approach to fees is to offer a service fee for the examination, fitting, and follow-up care and the fee for the products that includes the cost of the contact lenses. Some practitioners set their professional fees by staying within the “normal” range for a given area.

An option developed by the consulting firm The Williams Group recommends developing the retail fee in total. This fee is based on the amount of chair time with the patient in addition to the cost of the product. The basic formula for setting the fee is: Chair cost/hour × Clinic time + Material cost × % Mark-up needed = Your retail fee. First, your chair cost per hour should be determined. To accomplish this, the clinic/professional overhead per month should be determined. With knowledge of the office monthly gross income, operating costs are usually about 35% to 40% of this amount. The professional overhead is generally about 70% of the operating expenses and does not include the doctor’s salary or cost of goods. Then, the professional overhead is divided by the number of practitioner hours per month. This will result in the dollar amount per hour. Table 22.1 provides an example of chair time determination.

The amount of time a specific contact lens-related examination requires is then used to determine the professional service fee. This should include the time involved for the initial examination, diagnostic fitting, dispensing, 2-week follow-up, 1-month follow-up, and any
unexpected return visits. The complexity of a situation may greatly increase the amount of chair time with a patient and should be considered in the final determination of professional service fees. Some examples are provided in Table 22.2.

Each office should initiate their usual time-per-patient type. Following this example, the professional fees for a 3-month period varies depending on the type of service needed. The profit-goal percentage determined in the office forecasting may also be added to the fee. Once this initial fee determination is completed, many practitioners will develop a fee system that groups services. A sample grouping is in Table 22.3. The practitioner can insert his or her specific fees in each section.

The next step is to determine the cost of the product, the contact lenses. It is customary to mark up the cost of the product to pay for administrative costs involved in obtaining the lenses. A standard mark-up usually ranges from 20% to 30%. Lenses can be purchased directly from the manufacturer or through a buying group. Buying groups may offer a lower per unit cost but can charge an administrative fee (often approximately 5%). It is essential to be competitive in the material cost assessed to the patient. Some practitioners will determine the fees assessed by practitioners in the area via online or other alternative distributor sites and establish a fee
similar to the average of the competition. A fee calculator for gas-permeable presbyopic patients is available as part of the “Rx for Success” program available at http://www.gpli.info.