contact lens business
Refractive Surgery Plus
Offering contact lenses is a proven way to diversify and protect your practice financially.
By Bruce Koffler, M.D.

It's certainly possible to run a successful practice by offering only refractive surgery. Ideally, every doctor should focus on the area that interests him or her the most; however, I've found that offering both refractive surgery and contact lenses has some noteworthy advantages:

Contact lens patients often evolve into refractive patients. Some contact lens patients will eventually decide to try refractive surgery. Thus, your practice acts as its own referral source. We also sometimes get new patients who have tried contact lenses and failed for some reason -- allergy, blepharitis, or even a corneal ulcer or conjunctivitis. In those cases we can both treat the problem and offer them a surgical option.

We're protected from unexpected economic shifts. The more limited your practice offerings, the more vulnerable you are to external forces.

The recession in 2001 hurt a lot of doctors who had purchased expensive lasers and built beautiful laser surgery centers in their offices. I know several M.D.s who decided to do refractive surgery full-time and then were forced to return to other kinds of surgery.

Changes in local competition can be equally devastating, especially to a refractive surgeon. Pricing per case tends to fluctuate up and down. You can be doing very well one year, and the next year a corporate center opens up next to you, charging one-tenth of the amount you charge.

Diversity in our practice has certainly helped us. If my surgical practice is slow for any reason, people still need other services, and contact lenses have proved to be a reliable patient draw.

We attract a broader range of patients. Obviously, your patient base will be larger if you provide a wider array of services, and offering contact lenses can enlarge your patient base significantly.

Refractive surgery patients may benefit from contact lenses. This is true in two ways:

► In the short run, a small percentage of patients can benefit by having post-op residual refractive problems such as astigmatism corrected. Also, in addition to simple lens wear, some postoperative problems can now be managed using new contact lens techniques such as corneal refractive therapy (CRT) for uncorrected myopia, or CLAPIKS (Contact Lens-Assisted, Pharmaco-logically Induced Keratosteepening) for residual hyperopia.

► In the long run, many refractive surgery patients will benefit because contact lenses can help compensate for natural changes in the eyes that occur over time, such as presbyopia.

Patients who aren't good candidates for refractive surgery can still have their needs met within your practice. No patients need to be turned away.

Variety keeps my job interesting. For me, life is a little more exciting and gratifying when I'm able to offer multiple solutions to patients' problems.

You don't have to manage the contact lens service yourself. Many practices who choose to expand into this area simply hire an O.D. to be part of the practice. You can also promote or hire a qualified technician to fill the post of contact lens coordinator, taking much of the management burden off of you.

An Option that Works

Of course, it's important to do what you love. But it never hurts to make sure your practice also offers your patients what they need. Contact lens services are certain to benefit a sizable portion of your patient base, no matter what kind of practice you have.

Dr. Koffler is director of the Kentucky Center for Vision in Lexington, Ky., and associate clinical professor of ophthalmology at the University of Kentucky Medical Center. He is past president of the Kentucky Academy of Eye Physicians and Surgeons, and past president of the Contact Lens Association of Ophthalmologists.