By Vittorio Mena OD, MS
Feb. 24, 2021
Planning for a practice that will be able to maintain profitability long-term requires the pursuit of growth opportunities. Here are three areas our practice has invested in, which are spurring growth and generating revenues.
Prescribing & Selling Soft CLs for Myopia Control
I started prescribing contact lenses for myopia management in January of 2019. There is no initial cost in acquiring a fit set. Once you have obtained a fit set it is easier to have a discussion with the parent, and then have an opportunity to put these lenses on the child. I currently have two fit sets: the first is NaturalVue® Multifocal 1 Day Contact Lenses from Visioneering Technologies Inc. (VTI) and the second is the more recent FDA-approved MiSight 1 day from CooperVision. The youngest child I have prescribed contact lenses for myopia management was five years old. On average, I recommend myopia management to at least five children a day in my office.
To dive fully into myopia management, consider purchasing an optical biometer to measure the axial length, which costs $3,000-$15,000 in price. The optical biometers on the market include IOLMaster 700, Lenstar LS 900, Aladdin HW 3.0, Nidek AL-Scan, Pentacam AXL and ARGOS. I advise consulting with your local ophthalmologist, if you do not own an optical biometer, and have patients scanned in their offices since most, if not all ophthalmologists, will have one. This will create a network of referrals for both myopia management and cataract surgery between your office and theirs.
In the exam room, when I spot a child with myopia, I find out when they got their first pair of glasses and if anyone in their immediate family wears glasses. If no one in the family wears glasses, this is the child’s first eye exam and there is a mild prescription, I have a conversation with the parent about potentially slowing down the progression. I hand them a form that I created explaining what myopia is, outlining the risks from low-to-moderate to high myopia and the interventions that currently exist to slow progression.
Set a global myopia management fee for your services, expertise and the cost of the lenses. Time is your most valuable asset, so think about how much your chair time is worth. You can charge a patient as little as $1,000 for fitting in MiSight lenses and make a profit of $250. However, if you were to charge $2,500, then your profit would be $1,750. On average, the cost to the patient for MiSight lenses is $1,250-$2,500 depending on your geographic area and your expertise level. Profitability is slightly higher with NaturalVue since the cost of the lens is less to the practice.
Myopia management is not covered by insurance plans, so whatever you charge will be an out-of-pocket expense for the patient. Another benefit to my practice is that the NaturalVue and MiSight lenses can only be sold in doctors’ offices. That means there is no chance of losing a sale of these lenses to an online retailer.
Profit: Of the five patients per week that I recommend myopia management via contact lenses, 1-2 pursue contact lenses and most of the others elect either atropine .05% eye drops or bifocal glasses. When patients come back for the follow-up visits some elect to switch from drops to contact lenses. The parents of the children who elect the contact lenses often talk to other parents about it, referring those other families to our practice. The services I am providing combined with friends and family referrals translates into a minimum of an additional $100,000 annually.
Prescribing & Selling Scleral Lenses
I have been prescribing scleral contact lenses since October 2014. To acquire a scleral fit set you have to become certified. Once you pass the certification training, you can acquire a fit set, which usually costs $350-$750. I currently use Valley Contax and Zenlens. Fitting scleral lenses is rewarding to both the patient and practitioner. It is a huge game changer to get a patient from seeing 20/400 best corrected to, ultimately, 20/20 for the first time ever after everything else they have tried in the past has failed.
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The usefulness of these lenses is tremendous, from helping corneal irregularities to improving visual correction and promoting healing to the ocular surface from dry eye. All you need is a fit set, fluorescein strips, a Wratten filter and a slit lamp. However, for an easier time with the fitting process, to help you better check on clearance and landing zones, consider purchasing an anterior segment OCT, which costs $20,000-$40,000.
On average, one scleral lens will cost a practice $100-$250. I have seen prices as low as $800 being charged to a patient for scleral lens fitting and purchase to $10,000. The average fee for patients to be fitted for and purchase scleral lenses appears to be $1,500-$3,000. Once again, my recommendation is to set a global fee for both your scleral lens services, expertise and cost of the lenses. There are vision insurance plans that cover medically necessary contact lenses (scleral lenses are sometimes called a scleral shell) for the patient. Since, as we all know, it can be challenging getting reimbursed from insurance companies, especially for complex services, have the patient pay upfront and then guide them in getting reimbursed from their insurance company.
In addition to promoting scleral lens services on your practice website and social media pages, you could shoot videos to post to YouTube (with the patient’s consent in a signed HIPAA marketing agreement) that show the patient comfortably wearing and benefiting from these lenses. Patients will admire and respect you once you are able to provide them the relief and vision they have been missing for many years. That will result in a patient who sticks with you for decades and refers many friends and family members.
Seek out MDs, such as corneal specialists and diabetic specialists, to let them know you offer scleral lens services for patients with compromised vision, and that you can restore vision for most of these patients.
Profit: Most patients usually will not know many other friends or relatives with irregular corneal issues, however they will still rave about you as the practitioner that helped them, and they will still refer their friends and family to the office. I see an average of 24 patients a year for scleral lenses, which generates about $25,000-$50,000 annually.
Selling Eye Vitamins
I began selling eye vitamins in May 2015. As a sports performance vision optometrist, I prescribed EyePromiseVizual Edge PRO to support the brain in relation to its interaction with the visual system during the competition of sports. However, in the past few months I have started prescribing a supplement called VIZION EDGE, which contains a high amount of zeaxanthin and lutein, as well as meso-zeaxanthin.
These vitamins typically come in a case of 24. In the first month of prescribing these vitamins, a total of five cases of VIZION EDGE were purchased for the practice with four cases sold in just four weeks! Soon we will start selling the eye vitamins on our website, so patients can order online from us instead of having to drive to our office.
There are 30 soft gels in each VIZION EDGE bottle, which last patients one month as they take it once a day. The cost to the practice on each bottle is $13-$15. The profit to the practice per bottle is around $15. EyePromise Vizual Edge PRO comes in a case of 10 and the cost to the practice is $450. Profit on each patient is about $30-$35 per box.
I educate patients on the importance of supplementation in the exam room, explaining that the typical American diet does not provide the key nutrients we need for our bodies, including our eyes. I tell them it will take 3-6 months to see noticeable changes to their vision after starting the vitamins, however the vitamin will start working within a month of use.
In addition to the profitability of the vitamin sales, the other added benefit of talking about supplementation is that it naturally leads into a conversation about protecting eyes from the sun. The same eye conditions, such as cataracts and macular degeneration, that can be made less likely with nutritional help from vitamins, can also be made less likely by wearing sunglasses. This often results in the prescription and sale of both vitamins and sunglasses, adding up to a win for both patients and practice.
Profit: On average I sell about three bottles a day and the office is open six days a week. That means I go through one case of vitamins in about a week and a half. $45 a day x 6 days a week = $270 per week. On average, that is an additional $14,000 per year to the practice selling just three bottles a day.