By Melissa Barnett, OD, FAAO, FSLS, FBCLA
and Edgar Davila-Garcia, OD, FSLS, FIACLE, NCLE-AC
Nov. 18, 2020
Scleral lenses provide patients, who have struggled to find vision and/or comfort solutions, a way to vastly improve their lives. Scleral lenses tie patients to your practice for life. Those patients, who refer friends and family, help you to grow your practice. Here are key steps to make scleral lenses work for both patients and practices.
Become an Expert
The first step when deciding to make scleral lenses a part of your practice is to educate yourself. Here are several valuable resources:
“Scleral Lens Issues and Complications: Their Recognition, Etiology and Management” by Daddi Fadel
“The Clinical Guide for Scleral Lens Success” by Melissa Barnett and Daddi Fadel. A practical guide to scleral lens fitting available in hardback, this guide is available in English, Italian, Spanish, Russian and Portuguese.
“Contemporary Scleral Lenses: Theory and Application” is available in hardback, paperback and pdf. It also is available HERE.
“A Guide to Scleral Lens Fitting,” Version 2.0 updated in 2015 by Eef van der Worp from the Pacific University web site.
“Scleral Lens Fit Scales” is a guide to estimate central clearance. This guide is available in English and Spanish.
In addition to reading up on current developments in scleral lenses, specialty contact lens meetings enable practitioners to stay informed with the latest developments in scleral lens and contact lens technology and network with like-minded practitioners. Here are key meetings:
The Global Specialty Lens Symposium (GSLS)
International Congress of Scleral Contacts (ICSC), a meeting solely dedicated to scleral lenses.
British Contact Lens Association (BCLA)
Cornea & Contact Lens Society of Australia (CCLSA)
Nederlands Contactlens Congres (NCC)
Bill Appropriately
Specialty lens billing and coding can be challenging, however there are great resources to ensure success. Set fees appropriately for both the fitting and materials. Take into account chair time, staff time and doctor time when determining the rates. Here are two resources to help with scleral lens billing:
The GP Lens Institute (GPLI) has a billing and coding module with the expertise of Clarke Newman, OD, that is available HERE.
The Scleral Lens Education Society (SLS) teaches contact lens practitioners the science and art of prescribing scleral lenses, and has a multitude of information. Membership in the SLS is free of charge and comes with multiple benefits. The SLS web site includes guidelines and instructional videos for scleral lens billing and coding.
Market Your Services
Is the goal to obtain patients with dry eye who are looking for other management solutions? Is the objective to engage patients with keratoconus? For scleral lenses related to dry eye, it may be best to post to social media where older people spend more time, like Facebook, while scleral lens services for prospective patients who are younger, could benefit by posts to Instagram, including photos or even a short video on your services.
Other Pieces to Explore
A new, or enhanced, scleral lens product may be posted on the practice web site or via a blog. The importance of an eye examination for children may be shared via social media, which could potentially draw prospective scleral lens patients to your practice. Topics shared may be diverse including a new technology or innovation in contact lenses, or those relating to ocular health or the expertise of practitioners and staff within the practice. Focusing on different areas will help grow the practice, which in turn, can generate more scleral lens referrals.
Market Internally to Your Employees
With internal marketing, employees are treated as “internal customers” who must be convinced of a company’s goals and worth, just as “external customers” do. All staff, from schedulers, technicians, managers and opticians, should discuss scleral products and services that complement point-of-purchase materials within the practice such as brochures, posters or videos. An internal marketing goal is to align every aspect of a company’s internal operations in a coordinated and standardized way, to provide a consistent experience for its customers, in our case, patients.
Apple does an excellent job of internal marketing. The company is extremely selective in recruitment and exceptionally thorough in training to align its image. Employees are experts in all products and positively represent the company to provide excellent customer service.
In an eyecare practice, staff members, who become experts and advocates for scleral lenses, can identity appropriate patients to enthusiastically recommend unique scleral lens technologies and the expertise of the practice.
Evaluate Your Existing Patient Population
Scleral lenses are beneficial for those with ocular surface disease and dry eye, those with corneal irregularities that require visual rehabilitation, and those with normal corneas with refractive error. Scleral lens indications are expanding to be used for normal, healthy eyes.1,2
In a study of asymptomatic contact lens wearers, large diameter rigid gas permeable lenses can be a good alternative to soft toric lenses for the correction of refractive astigmatism.3 Scleral lenses may be benefit a patient who is intolerant to GP lenses or for a presbyopic patient with dry eye due to Sjögren’s disease who requires vision at all distances. Offer this technology to existing patients who are good candidates for scleral lenses.
Use Advanced Instrumentation & Incorporate Fees Appropriately
When fitting scleral lenses, it is critical to be embracing of scleral lenses and utilize advanced instrumentation such as corneal topography, scleral topography/profilometry, anterior segment OCT and/or specular microscopy. These tools can both assist with fitting and ensure ocular health. When using advanced instrumentation, either bill for the specific test done or incorporate the fee into the fitting.
Tap the Expertise of Laboratory Consultants
Laboratory consultants have a wealth of knowledge and are extremely helpful with scleral lens fitting. Yet, a consultant needs accurate information to design a lens appropriately. In addition to corneal mapping and lens information, good clinical observations are necessary for lens design. Here are a couple helpful tools for slit lamp photography:
Prior to taking photographs, allow the lens to settle to avoid overestimating clearance and confirm that bubbles are not present to obtain accurate results.
Inquire about the laboratory warranty policy prior to fitting a specific lens. A liberal return policy is beneficial when fitting scleral lenses. Ask about shipping fees, return fees and cancellation fees; all can influence the scleral lens fee structure. Having several scleral lens designs is helpful to properly fit a wide array of conditions. It is important to inquire about policies from each company.
With these tips for success, scleral lenses will grow and benefit your practice.
References
1. van der Worp E, Bornman D, Ferreira DL, et al. Modern scleral contact lenses: A review. Cont Lens Anterior Eye. 2014 Aug;37(4):240-50.
2. Barnett M, Ross J, Durbin-Johnson B. Preliminary Clinical Exploration of Scleral Lens Performance on Normal Eyes. JCLRS [Internet]. 22Nov.2018 [cited 2Dec.2018];2(2):e14-e21.
3. Michaud L, Bennett ES, Woo SL, et al. Clinical Evaluation of Large Diameter Rigid-Gas Permeable Versus Soft Toric Contact Lenses for the Correction of Refractive Astigmatism. A MultiCenter Study. Eye Contact Lens. 2016 Nov 24.
Melissa Barnett, OD, FAAO, FSLS, FBCLA, is principal optometrist at University of California, Davis Eye Center. To contact her: drbarnett@ucdavis.edu
Edgar Davila-Garcia, OD, FSLS, FIACLE, NCLE-AC, practices in Bayamon, Puerto Rico. To contact him: dr.davila@hotmail.com
