By Eric Rettig, OD
Sept. 4, 2019
Scleral lenses give you an opportunity to serve patients with significant visual challenges.
This area of my contact-lens practice has become a source of growth in patients and revenues, allowing us to provide much-needed services.
I have roughly 50 patients whom I have fit with these lenses over the past 2-3 years in addition to patients I have fit with other specialty lenses. Over the past year I have probably fit a new scleral lens patient every 2-3 weeks.
If you can offer scleral lenses in a geographic area that doesn’t have another doctor who fits these lenses, it can be a huge advantage for your practice. Most of the new fits that come into my office are referrals from MDs, or other ODs, who don’t fit scleral lenses. It’s been a great practice builder.
Patients in Need of Help
Scleral lenses are almost always used on individuals who have a corneal disorder that causes them distorted, irregular vision. This includes: keratoconus, post-corneal transplant, post-LASIK, corneal scarring, pellucid marginal degeneration, irregular astigmatism and any other issue that causes vision to be poor with glasses or conventional contact lenses.
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Many of my scleral-lens patients have tried various soft contact lenses or traditional rigid gas permeable lenses with little-to-no success. The patients who come to mind the most are the ones who have never experienced clear vision, or ones who haven’t experienced it in a very long time. Several of these patients have cried the first time they put in their lenses and looked around. Often you can tell just by the look in these patients eyes (no pun intended) how amazed they are with how clear their vision is.
I would estimate gross revenue from scleral lenses/specialty lenses to be about $70,000 annually. Not all patients get new lenses every year, and often we have to accept what their managed-care plan or health insurance pays for specialty lenses. The revenue stems from the fitting of the lenses, the lenses themselves and the office visits/additional testing.
Costs to the practice are surprisingly low. Fit sets range from $200-$500 (we have four). The lenses themselves cost about $200 per lens. We charge $1,000 per lens usually and $500 for the fitting/follow-ups, so the fit sets pay for themselves with a single fitting.
Invest in Helpful Instrumentation
The instrument I find most valuable in fitting scleral-lens patients is a corneal topographer. I use this instrument for every specialty-lens fit. It helps confirm diagnosis, and gives me an idea for where to start with fitting a scleral lens. Another instrument I really like to use is an autorefractor/keratometer. I use this once a patient has a well-fitting lens in. It gives me a rough idea of their over-refraction, as well as if there is any flexure with the lens while on the eye.
The cost of a corneal topographer ranges from around $3,000 for a used unit to around $15,000 to buy it new.
The cost of an autorfractor/keratometer ranges from around $3,000 for a used unit to around $7,000 to buy one new.
How Much Chair Time Is Needed?
The initial visit is always the longest. Most of these patients are referred from other doctors in the area, so an extensive history and exam is performed in addition to any special testing that needs to be done for a specialty fit (i.e. corneal topography). Also, most of these patients have never worn a scleral lens, so I put in the diagnostic lenses to obtain fit for the first lens we order for them. I generally instill a drop of anesthetic in each eye before to make insertion easier.
The best tip I can give for someone starting out is to get comfortable with one lens and do as many fits as you can with it. Like anything else, the more you do it, the more comfortable you will be at each future fit (and the faster they will go).
What Does a Doctor Need to Know to Fit Scleral Lenses?
I was first introduced to scleral lenses in optometry school. We had a few courses on the subject, and then in clinic, we participated in specialty-lens fittings. I gained more knowledge of scleral lenses during my clinical externships where I saw many more patients, shadowing doctors who did scleral fits all the time. Whenever I do a weekend of continuing education, or go to a meeting like Vision Expo or Optometry’s Meeting, I seek out a few classes on scleral lenses or corneal disease that benefits from specialty lenses.
What Does Support Staff Need to Know?
Several of my staff know how to perform a topography and autorefract. They are also trained in teaching patients proper insertion and removal of lenses, as well as cleaning/caring for the lenses. Most of them have para-optometric certification (CPO), and have taken classes on scleral lenses themselves.
What Do Patients Need to Know?
I educate patients similarly to how I educate any contact lens patient: “Don’t sleep in your lenses, clean them every night, use fresh solution when storing them.” I also educate patients that these lenses can last as long as you can take care of them. If they are cleaned and conditioned properly, you can get years of comfortable/clear vision out of them. All first-time wearers are given a starting kit when they get their initial pair of lenses. This includes a case, cleaner, DMVs (the little plungers for insertion and removal) and a bottle of preservative-free saline for inserting the lenses.
Your Scleral Lens Vendor Can Be Great Help
I would tell other doctors to get support from the lab manufacturer of the lenses if you are just getting started fitting scleral lenses. They have a wealth of information, and know the lens designs inside and out. Often, they can help troubleshoot tough fits. I have even sent them photos and videos of lenses on patients’ eyes to get their opinion on adjusting a fit. I’ve worked with the folks at Visionary Optics and Alden/ZenLens,* and they’ve been nothing but supportive, and have made those initial difficult fits much easier.
*I have no financial stakes, or other involvement, with either Visionary Optics or Alden/ZenLens; I just really like their lens designs and customer support, and would recommend them to anyone starting out with scleral lenses.