Contact Lenses

Design Thinking: What It Is & How It Helped Me Build a Specialty CL Niche

By Justin L. Manning, OD, MPH, FAAO

Sept. 11, 2019

Developing a specialty niche in a practice is a challenge. You need to determine the pain points for patients, how you can best alleviate those pain points, and then make the practice investment and implement processes to bring your plan to fruition.

I found a business approach known as Design Thinking to be invaluable in my efforts to serve specialty contact lens patients through The Keratoconus and Scleral Lens Institute, a part of Bettner Vision. Through the Institute, I offered a wide array of multifocal contact lenses, Ortho-k, corneal RGPs for normal and ectatic corneas, hybrid and scleral lenses, including multifocal sclerals.

The institute became such an asset to Bettner Vision that it is still in existence, even though I recently moved on to a new position outside of the practice as executive vice-president for professional strategies at Healthy Eyes Advantage.

What Is Design Thinking?
Design thinking is a process of product and service design through creative problem solving utilized for complex and challenging problems. The first step in design thinking is to understand the problem from the standpoint of the individual, who has the problem, through empathetic interviewing with open-ended questions. Before any ideas for a product or service are generated, substantial time is spent to understand the problem and the internal problem behind the external problem.

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Once the problem is clearly defined, brainstorming takes place to re-frame the problem and develop ideas to address the problem. After an idea is developed, it is prototyped. This prototyped product or service is then evaluated, gaining feedback from those who would be utilizing the service.

From there, changes are made, further iterations are generated and the feedback loop continues. In short, it involves understanding the pain points of those involved, experimenting and trial and error. The goal is an effective and efficient solution to a complex problem.

How Did Design Thinking Help Me Build Specialty CL Care?
Design thinking begins with immersing yourself in the actual needs of the customer, or in our case, the patient, so I started there. While I would love to say I sat down and interviewed individuals with keratoconus, I was able to understand a lot more of the patient experience from participating in the Keratoconus Group on Facebook. The biggest struggles I noted:

1. Patients struggle with the fitting process, including turnaround time and ability to get in after lenses arrive.

2. Patients have a daily struggle with the condition both with and without the contact lenses.

3. The severe worry of losing or breaking a lens and the costs associated with it.

4. Significant feelings of shame due to the effects of the condition.

5. Not being understood by their community.

6. Very poor education on their condition: Doctors telling them, “You have a degenerative condition that will permanently affect your vision,” and nothing more.

7. Difficulty identifying who they should go see. A lot of optometrists don’t have a clear public presence identifying them as fitters of scleral lenses or that they have experience fitting patients with kerataconus.

We re-framed those patient problems to state the primary problem as a desire to be known and understood for their condition. From there, the platform of The Keratoconus and Scleral Lens Institute started by understanding the personal needs of patients and asking open-ended questions to address the effects keratoconus has on their own life.

During each patient visit, my staff and I reiterated that the patient is “home,” that they could leave their baggage at the door and that they didn’t have to explain away their condition. Instead of treating contact-lens checks as a burden, we utilized the time to build a relationship. We built close relationships with our specialty contact-lens lab to bring in newer, more advanced fitting sets, and negotiated two-day shipping on lenses.

We implemented a guarantee that if the patient broke their lens outside of their breakage warranty, but within their first year of the lenses (or lost the lens altogether), we would replace the lens at a cost that covered our cost of the lens and was also affordable to the patient.

We also put together a public-facing entity, our Institute, with a social media presence. This way when those interested would search for “sclerals,” they would find The Keratoconus and Scleral Lens Institute.

Keeping Costs Down, Profits High
As The Keratoconus and Scleral Lens Institute exists within a primary care practice, the infrastructure was already built, making the primary investment into launching the specialty lens practice mostly time in understanding what keratoconic patients need and how to tell the story. In addition, we needed to expand our specialty lens fitting sets.

We started with a $300 toric scleral fitting set that included the first pair for free, and at the same time, worked to build a relationship with the specialty-lens laboratory. This relationship resulted in multiple fitting sets at no charge. In addition, time was spent developing the process and procedures and marketing to providers and the general public.

The laboratory consultants provided the greatest level of fitting education, taking the time to discuss any case, any question, and any problem with any patient. ROI was significant due to the experience the patients had in the office, and the little investment. We utilized the topographer the practice had for years and the basic anterior segment capabilities of the OCT.

The growth was significant. The Institute generated more than $40,000 in revenue from specialty lenses alone in its first three months due to growth of patients and marketing. At the time I left the Institute this year, that growth was continuing at a rate of 4-5 new scleral lens fits and 4-5 new ortho-k fits a month.

The practice is located in Colorado Springs, one hour south of Denver, a much larger city. Business and specialty healthcare almost always flow north, yet we were able to reverse that trend, attracting multiple patients from Denver and the surrounding areas.

Encouraging Continuous Improvement
Early on in the process of creating the Institute, we realized that we needed a highly detailed process to communicate, organize and track all of the specialty-lens patients. This further addressed the needs of the patient by guaranteeing the entire office knew where each patient was in the care process, their warranty period and where all newly ordered lenses were. This prevented missed patient notifications, delayed scheduling and delays in ordering lenses.

To further differentiate the experience of scleral lenses, we educated patients on how we could take care of all their concerns and needs related to keratoconus.

As effective as this system was, we realized that we needed to up the experience even further. It was here we developed the idea of a specialty-lens folder for each patient that contained all of the patient’s consent forms, warranty information, information on the doctors, when to call the office and information about how to care for their lenses.

By taking specialty lens patients from being a challenge/ burden/ time drain in the office and re-framing the process, so it was more similar to the approach taken to specialty services like refractive surgery, we created a more positive and engaged patient experience.

Design Thinking focuses on re-evaluating based on patient experience to continue identifying further growth areas. As with all specialty lenses, there are always opportunities to improve fitting skills to reach a finalized lens earlier in the process. While we were able to fit among the most advanced cases of keratoconus, there was still a small population of patients that needed a lens designed from anterior surface molding or computer analysis. At the time I left the Institute that was the next step in the advancement of the Institute.

In addition, we were limited in the quality of Ortho-K lens that we were fitting, and planned to add a new, more customized lens design to be able to fit more individuals and reach finalization in a more efficient timeline. Beyond this, we planned to add a higher quality topographer/Pentacam to improve the fitting process even further.


The Harvard Business Review and the Stanford has a lot of great articles on design thinking:
The Essential Guide to Design Thinking from Darden Executive Education


Justin L. Manning, OD, MPH, FAAO, is executive vice-president for professional strategies at Healthy Eyes Advantage. To contact him:


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