Optimizing Efficiency and Profitability With Scleral Lenses

I am part of one of the largest OD/MD eye care groups in Louisiana, Williamson Eye Center, which has seven offices. We were fitting very few scleral lenses when I joined the practice, but I was certified to fit them and enjoy doing it. So, I built our scleral lens business from scratch. Our physicians see a high volume of patients with keratoconus and those who have received radial keratotomy. I first approached the MDs within Williamson and asked them for scleral referrals. Eventually, a few local cornea surgeons sent me some complicated cases, and when scleral lenses solved those patients’ problems, those referring physicians told colleagues of theirs outside of our region. In fact, I am the only fellow of the Scleral Lens Society in multiple surrounding states, and thus I have treated patients who have driven as much as 8 hours to see me. This service also attracts referrals from commercial practices that lack the time, technology, and billing capabilities to fit scleral lenses. Ours has become a very synergistic referral network, and I have developed a passion for fitting these lenses because of the positive impact they can have on patients’ lives.

Profitability and Affordability

Fitting scleral lenses at a high volume can be very profitable for a practice. To support this volume, I built a team that includes three technicians, a scribe to record all patient interactions, and a dedicated billing expert. We also have a certified optician in our optical who performs most of the scleral lens insertions and removals. (Anecdotally, I have noticed that male patients learn faster how to place and remove a scleral lens from a male optician versus a female optician. I think this is because women who wear makeup are more comfortable touching their eyes, and they don’t remember what it’s like to feel unfamiliar with such maneuvers.)

Delegation helps us handle the volume, which I estimate at 30 to 40 scleral lens patients per week. Every person on the team is cross-trained to handle multiple responsibilities, and our technicians are all proficient in the imaging and diagnostic tasks. Each team member enjoys taking part in a solution that patients can’t get elsewhere, and some of them even wear these lenses themselves. Although we fit these lenses every day of the week, we dedicate Wednesdays and Fridays to fitting sclerals exclusively.

Patient Education and Cost

In my conversation with patients, I am very upfront about the cost of scleral lenses, which, depending on their insurance coverage, will be between $1,500 and $2,000 each time they need new lenses (every 1 to 3 years). We do not negotiate this price, although we do offer two financing plans if patients need assistance (CareCredit and Alphaeon Credit). My conversation with scleral lens patients is free of any pressure. Most of the candidates I see have either been referred by their ophthalmologist and are already aware of the benefit of these lenses, or they have conducted their own research and decided they want to try them.

I give each scleral lens candidate a packet of educational material that I compiled over several years, which I call the Fine Print. This folder includes, among other things, instructions for how to care for scleral lenses, a flyer from the GP Lens Institute, and a list of my answers to every valid question a patient has ever asked me about scleral lenses. Each candidate takes home a copy of this folder, and I’ve received positive feedback about this resource.

Examinations & Practice Flow

Whether patients are referred to our team from inside Williamson or not, they receive a full examination that includes ocular testing and Pentacam (Oculus, Inc.) corneal measurements. Then I will refract the patient, and once I confirm that his or her glasses prescription won’t work, we send the findings to his or her insurance carrier to request authorization for scleral lenses.

I am the one who performs patients’ scleral lens fittings, with help from one of our team members. I have a dedicated room that holds my scleral lens fitting sets. I select a size and view its fit through the slit lamp, then my assistant will perform the diagnostic measurements. These include an autorefraction, Pentacam measurements, and anterior-segment OCT scans. The technician or I will perform the overrefraction, and then I will complete the rest of the fitting.

To this day, I still order every single scleral lens personally, because mistakes take a lot of time to correct. This is something I cannot delegate. When the patient returns for the initial lens trial, it usually takes me 1 to 2 lenses to get the perfect fit.

It is rare that a patient is dissatisfied with a scleral lens, but it has happened. One particular patient comes to mind: a 17-year-old male who could not place them comfortably in his eyes after three 2-hour training visits at our office. His mother asked us to schedule a fourth fitting visit, and we refused. We did not refund this patient because the lenses were billed through insurance and we had provided the training sessions as a service, but he did not wear the lenses again.

Conclusion

Personally, I find scleral lenses to be one of the most fulfilling aspects of my career. To this day, I get just as excited when someone achieves their best vision with these amazing lenses as I did with my first patient, and I think the joy it brings to me is obvious to those I treat. As word about the benefits of scleral lenses spreads and recipients and candidates find each other via message boards, social media, or just simple happenstance, I believe our specialty lens clinic will continue to grow exponentially.

As with all things, technology will continue to play a huge role in the development and implementation of specialty lenses and all other aspects of optometric health care. For example, I am excited to see how the development of higher-order–aberration lenses progresses in the coming years.

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