Contact Lenses

OrthoK: A Practice-Builder

By Paul E. Levine, OD, FAAO, FIAO

Orthokeratology (OrthoK) offers patients the freedom from having to wear contact lenses or eyeglasses during the day. It’s also an appealing alternative to refractive surgery. Add OrthoK services to your practice–and you’ve got a practice-builder.

OrthoK is a growing treatment provided by an increasing number of optometrists. If your practice does not yet offer this form of vision correction, it may be time to do so. Liberating patients from eyeglasses without the need to wear contact lenses during the day is a patient-pleaser that can result in great loyalty to your practice. Allowing parents to make the important decision to attempt to slow down the progression of their child’s myopia will not only improve the quality of their lives, but will help grow your practice and increase your word-of-mouth referrals. Offering OrthoK can also be a revenue-driver. Here is how my practice has made the most of this opportunity.

In my practice, I promote my services in providing Orthokeratology, or OrthoK, as it commonly called, to describe the gentle reshaping of the cornea to correct for refractive errors. In recent years, there has been a focus on new techniques of corneal reshaping, called Corneal Refractive Therapy (CRT) or Vision Shaping Treatment (VST), but I use the term OrthoK to describe the larger category, and I educate my patients about it.

Invest in Necessary Instrumentation

The major piece of equipment needed for OrthoK is a corneal topographer. This instrument costs between $11,000 and $20,000. I purchased mine with a financing program at a cost of $219/month for 60 months. Break-even on my corneal topographer is difficult to assess because topography is not typically reimbursable, and when it is paid by insurance, it is often very low. The value in this instrument is in the ability to diagnose and treat different conditions such as keratoconus and irregular corneas, along with providing OrthoK. Most doctors who offer OrthoK are also expert RGP and scleral lens fitters and topographers help with those modalities as well.

Many OrthoK lens systems use trial lenses; therefore trial lens sets are often purchased. These can run anywhere from $800 to $3000. However, certain manufacturers can send lenses with keratometry readings and refractions, though there is less accuracy this way. Paragon OrthoK offers a SureFIT program where you fit with Ks and Rx and receive three pairs of lenses. You fit pair one, and if they do not fit right, you move to pair two and so on. You also can return unused lenses. This can be a good way to start without buying a large or expensive fitting set. Some custom lens designs come with designing software (WAVE and OrthoTool) which enables some “virtual fitting” of lenses, so you have a good idea how a lens will fit before putting it on an eye.

You also need supplies such as cleaning solutions and patient educational material.

Paul E. Levine, OD, FAAO, FIAO

Vision Care Specialists

Started Cold in 2004

New England College of Optometry
Class of 1997

Doctors

Two full-time and one resident OD

Support Staff: 7

OrthoK Patients: 60

Comprehensive Examinations
Approximately 3,000 annually

Revenue-Building Potential

I have about 60 active OrthoK patients. I see them once every six months after the initial fitting. This is the fastest growing sector of my practice. My gross income from OrthoK has gone up almost 25 percent since 2010.

The typical new-fit OrthoK patient will pay between $1,200 and $3,000 depending on geography and complexity of the fitting. One new-fit OrthoK patient a month brings in between $15,000 and $35,000 per year, so the ROI on OrthoK can be achieved potentially within the first year of offering the service to patients.

In 2012, OrthoK patients represented 3 percent of all of my contact lens patients, but generated 14 percent of my contact lens revenue. These numbers do not include the comprehensive eye exam fees and any eyeglasses or sunglasses they may have purchased, in addition to the OrthoK provided.

Potential Rewards to Practice and Patients

OrthoK offers a practice-differentiating opportunity that can set your practice apart from many competitors. Most ECPs do not practice OrthoK because it is complicated and often time consuming, but it is very gratifying and profitable. A typical OrthoK patient can generate the kind of revenue that four to five traditional contact lens wearers can. Optometric practices that offer OrthoK are typically on the cutting edge of technology and gain many word-of-mouth referrals because they offer a specialty still not offered by most ODs.

Doctor OrthoK Education
Much OrthoK education can be found online and is often free from the manufacturers of OrthoK lenses. For instance, Bausch & Lomb VST has certification tests and education, as does Paragon CRT. The premier OrthoK and Refractive Therapy educational conference called Vision By Design is run by the Orthokeratology Academy of America (OAA) annually. Membership in the OAA is about $300 per year. Conference costs are typically $700 to $800 plus travel expenses. In addition, there are courses at the American Academy of Optometry, Global Specialty Lens Symposium and other national and international conferences. There are also many journal articles on OrthoK.

The time involved in learning OrthoK varies. Systems exist to get started almost right away, but it usually takes dozens of fits to get proficient. There are excellent help systems out there; specifically the OAA Google Group e-mail list where many questions are asked and answered. The OAA also has a mentoring program to help with troubleshooting OrthoK fits. These are free with your membership to OAA. Many lens manufacturers also have consultants available to troubleshoot.

Support Staff Education

Staff needs to be trained so that they can answer patient questions. This is relatively quick. Technician training takes longer. Techs need to be educated on how OrthoK works, how to describe the procedure, answer questions, train patients to apply and remove the lenses, as well as how to clean and care for them. Many techs already know much of this from working with other RGP patients. There are educational seminars for staff also run by the OAA at their annual conference. These cost about $100 per attendee plus travel expenses. It is vital to have your staff engaged in OrthoK. Fitting staff members is an excellent way of having their excitement about the treatment spill over into their communication with patients.

Ideal Practice Demographics for OrthoK
OrthoK is FDA-approved for patients of all ages. In the pediatric population, OrthoK is ideal because it frees children from eyeglasses and daily-replacement contact lenses. Most importantly, though, studies have shown it to be an effective form of slowing down and even stopping the progression of nearsightedness in children.

It is a wonderful option for adults because it is a viable alternative to LASIK surgery. It also provides the desired freedom from glasses and the daily use of contacts lenses. In adults with dry eye or allergies which can interfere with normal contact lens wear, OrthoK is a great alternative.

The FDA approval for OrthoK is for myopia up to -6.00 D with or without up to -1.75 D of cylinder. Many Orthokeratologists have had success with “off label” application of OrthoK in higher powers, as well as in hyperopic and presbyopic designs. The demographic for potential candidates is wide in most practices.

Educate Patients About OrthoK

I ask the patient/parent if they have heard of OrthoK. Often they will say no. I will briefly explain that we use rigid oxygen permeable lenses, like retainers, to gently and temporarily reshape their corneas, the front clear part of the eye. This then shortens the distance from the front to the back of the eye which provides clear vision. I tell them that if they wear the lenses overnight for about eight hours, the effect lasts all day long after removing the lenses.

If it is a child, I tell the parents that of all the options being studied right now, OrthoK has shown to be the most effective method of slowing or stopping the progression of a child’s myopia. I also have a brochure that I made to further explain the process.

Resources

Orthokdoctors.com

okglobal.org

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Paul E. Levine, OD, FAAO, FIAO, is a partner with Vision Care Specialists in Southborough, Mass. To contact: DrPaul@greatvisioncare.com

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