So You Want to Start Fitting Medically Necessary Contact Lenses?

Adding medically necessary contact lenses to your practice is a rewarding decision, but one that requires careful planning, dedication, and hard work. Before even considering starting this journey, you must already be passionate about this subspecialty, otherwise it will not be a success.

So, what exactly is a medically necessary contact lens? There is no universal definition, but the category includes soft, spherical, and toric lenses, as well as hybrid, rigid gas permeable, and scleral lenses. These lenses are typically used to provide a quality of vision that is better than the patient’s experience with glasses or to treat some type of ocular surface disease. Every insurance company has its own criteria for coverage of medically necessary contact lenses (see Insurance Plan Coverage of Medically Necessary Contact Lenses). It is important to download the manual for each type of health insurance that you accept or plan to accept and have this information readily accessible.

FAMILIARIZE YOURSELF

Before you dive in, be sure to educate yourself on all available contact lens modalities (ie, soft, rigid gas permeable, hybrid, and scleral) rather than building your expertise in only one modality. This way, you can give patients the best recommendations based on their diagnosis and financial situation.

Completing a contact lens residency can give you the opportunity to work and network with educators, students, and researchers in the contact lens space. It will also expose you to many different specialty lens patient cases, including some difficult cases, in a short span of time because of the availability of contact lens diagnostic sets and the technology that is used to aid in lens fitting.

If you are unable to undertake a residency, you can still select a site to practice with an experienced doctor who is willing to mentor you in specialty contact lenses. National meetings such as the American Academy of Optometry, the American Optometric Association, the Global Specialty Lens Symposium, and Vision by Design from the American Academy of Orthokeratology and Myopia Control are excellent places to learn more about specialty lenses. Online education and resources are also available via the Gas Permeable Lens Institute, Woo University, and Scleral Lens Education Society, to name a few options.

Once you have achieved many successful lens fittings, you can then share your cases by writing articles for professional publications. This way, you can become the mentor and give local talks to raise awareness of your services, and, as you gain experience, you can even participate in continuing education meetings. This can be a great practice-builder because many individuals who are researching their ocular conditions may read some of these published articles and seek you out as their eye care provider as a result.

GET YOUR TEAM ON BOARD

Staff education is another critical component to mastering medically necessary contact lenses. From the call center to the technicians, to the opticians, to the billing department employees—every team member must be able to identify potential patients who may benefit from these lenses and schedule the appropriate length of time needed for the appointment. Past medical records will help you to efficiently fit contact lenses, as there will be a history of what has and has not been successful.

Regular weekly or monthly meetings are an opportunity to teach staff about the differences between lenses, the data required from instrumentation to achieve a successful fit, the disinfection solutions needed to clean the lenses, the techniques for insertion and removal of different lenses, the saline solutions required to fill the bowl of the lenses before insertion, and the artificial tears that are approved for use with the different contact lenses.

ADD TECHNOLOGY

The technology used to aid in contact lens fitting is expensive, but worth the investment. Such technology is used to diagnose ocular disease, evaluate its severity, and check for its progression.

For example, pachymetry measures the thickness of the cornea and should be performed in patients who have progressive corneal diseases such as keratoconus and corneal degenerations. Corneal topography is used to evaluate the shape and height of the cornea, while scleral topography is used to evaluate the shape of the surrounding conjunctiva close to the limbal area. Anterior segment OCT measures the apical clearance of the lens and displays the landing of the lens on the conjunctiva. Specular microscopy can be performed to measure cell count in patients who have had corneal transplants and those with Fuchs dystrophy.

DO YOUR RESEARCH

Selecting one or two labs to work with and speaking with contact lens lab consultants who are familiar with the different lens designs that the manufacturer uses will help you acquire knowledge about these specific lens designs. When choosing a lens manufacturer, it is critical that you consider the questions below:

• What is the cost of the lens?
• How many lens exchanges are allowed at no charge, and what is the cost of additional lenses if there are no more exchanges left?
• What is the timeframe for achieving a successful fit before there are any additional charges?
• What are the shipping charges to the practice?
• Does the lens for a new order include a starter kit and accessories, such as tools for lens insertion and removal, mirrors, and/or sample saline to fill the bowl of the lens before insertion?
• How long does it take for the lens to be manufactured and shipped to the practice?
• What are the warranty policies for broken lenses and non-wetting lenses?
• What is the cost of a loaner fit set, and what is the timeframe on the loaner kit?
• Do lenses that do not work need to be returned to the manufacturer?

DON’T FORGET ABOUT MARKETING

Once your practice begins to offer medically necessary contact lenses, it would behoove you to establish a budget to increase awareness in the community about this new service. There are two types of marketing, external and internal, and you may choose to employ elements of each.

External Marketing

This type of marketing includes websites, podcasts, community service meetings, and social media (ie, Facebook, Instagram, TikTok).

Internal Marketing

This form of marketing includes website blogs, email, text messages, newsletters, reviews, and on-hold messages.

Referrals for medically necessary lenses can be obtained from teachers, ophthalmologists, optometrists, and other health care providers. Follow-up letters should be sent to anyone who provides a referral to update them on the patient’s medical history. These letters will help to build trust with your referees as you continue to successfully fit these patients with medically necessary contact lenses, ultimately spreading awareness of your services.

THE FINISHING TOUCHES

When a patient decides to try medically necessary contact lenses, any costs associated with treatment, lens care products, and the lenses themselves should be calculated and thoroughly explained to them. Have the patient sign a contract, which should include the following details:

• The patient’s medical condition and prognosis
• Insurance coverage for medical and vision and the copay amount
• How to handle extra tests during the examination that are not covered by insurance
• Out-of-pocket expenses (eg, patients may have to purchase supplies for the lenses at the dispense or replacement materials if a starter kit is provided)
• Cost of disinfection systems and solutions needed to wear and maintain the lenses
• Explanation of warranty policy if the lenses become lost or broken
• The importance of keeping scheduled appointments to complete the fit
• Cancellation fees, if applicable

WORTH THE REWARD

Choosing to offer a medically necessary contact lens service requires education, organization, and preparation, as it is a considerable financial investment. However, in my opinion, it is the most rewarding feeling to help patients for whom wearing these lenses is the only way for them to function normally. In fact, patients fit with medically necessary lenses are often very appreciative and many become lifelong loyal patients who, in turn, refer other patients to your practice in the future.