gp success
Profitable Prescribing with GP Lenses
Learn new ways to prescribe more GP contact lenses and watch your contact lens practice grow.
BY BARBARA ANAN KOGAN, O.D., Washington, D.C.

According to Cornel LeBlanc, O.D., of Alexandria, La., too many O.D.s are driven by the market and are cosmetic- and soft lens-oriented rather than therapeutic oriented. He's been fitting GP contact lenses for 27 years and explains all options to his patients but points out that GPs can slow or stop the progression of myopia.

It's always good policy to present all options to your patients, but there's nothing wrong with telling them that you think one option (in the case of this article, GP lenses) is better than the rest. I'll explain when GPs make the most sense and how to profit from this gem of vision a correction modality.

Dave Rusch, GP Committee chair of the Contact Lens Manufacturers Association (CLMA), suggests following this plan: "First, analyze your short- and long-term practice goals." Then, he advises, "Evaluate your staff as well as your capabilities, develop the necessary skills to differentiate your practice and product mix from your competitors, and communicate this to your patients."

High-volume practitioners have differentiated themselves by learning how to fit and market specialty products, such as bifocal and bitoric GPs. "Fitting GPs, from single vision to keratoconus and post-refractive designs, gives your existing patients a medical device to differentiate you from a commodity fitter [someone who selects contact lenses that are in ready-made parameters and powers]," Mr. Rusch adds.

The oxygen permeability direction of GP lenses, describes Mr. Rusch, proves through clinical and research evidence "that high-Dk materials from 60 to 160 will provide your patients with the healthiest options and fewer long-term problems." Lens costs are minimal, but "can result in retaining that patient for many years."

Market yourself

If you want to grow the GP segment of your contact lens practice, then consider marketing yourself and your practice to attract potential GP candidates. Send e-mail notices to your current patients about how your practice is different from other colleagues, including:

► your problem-solving abilities; keeping up-to-date with the most advanced GP technology for excellent visual acuity, comfort, ocular health and durability and working closely with your manufacturing laboratory consultant to design your custom-made contact lenses

► Offer family plans and discounts on spare pairs of GP contact lenses and up-to-date, backup eyeglasses and sunglasses

► Borrow the motto, "If you like us, tell everyone you know, but if you don't, then tell us" and offer unhappy patients a discount on their next office visit examination.

► Fit newscasters, athletes and legislators with GPs and get coverage about these patients in your local print and broadcast media about their success. Such attention is reinforcing to existing and new patients. (This may seem daunting, but it only takes a little time to call these people, tell them what you offer and how it could benefit them and then suggest they come in for a no-charge consultation.)

► Consider taking out Yellow Page ads or making in-house pamphlets and videos marketing your practice as specializing in fitting GP lenses.

Figuring out fitting

Differentiate your GP candidate selection (by identifying patients' visual needs, previous problems [if a dropout], wearing time plans, lifestyle, etc.) to improve your bottom line (through creating and maintaining loyal patients and through referrals).

From restoring and maintaining vision functioning, permitting development of the visual system, prescribe GPs for:

Pediatrics. Post-congenital cataract removal, post traumas, amblyopia, strabismus, nystagmus, type I and type II diabetic, congenital, beginning and catastrophic progressive myopia, strabismus and amblyopia.

Corneal disease progression and surgically induced refractive changes. Keratoconus from early development to corneal graft, post radial keratometry to LASIK; cataract extraction, corneal dystrophies

Astigmatism and presbyopia. From low, medium to high amounts of with-the-rule, against-the-rule or oblique astigmatism in any dioptric amount or combined with myopia or hyperopia or presbyopia and normal add changes to +3.50D. This includes stabilizing toric soft lens rotation and fluctuating vision with high-Dk GP contact lenses. It's easy to fit 30+ year PMMA/GP wearers from numerous bifocal designs and upgraded to +3.50D adds as well as dry eye syndrome presbyopes.

Orthokeratology options. Euclid Systems Corp.'s orthokeratology contact lens for overnight wear recently gained the FDA's Premarket Approval (PMA) and is in the final labeling stages. The company anticipates full approval shortly. When introduced, it will accompany Paragon Vision Sciences Corneal Refractive Therapy (CRT) lens as the only other design that's FDA-approved for overnight corneal reshaping. However, several other designs are pursuing FDA approval and should be introduced in the near future.

Ensuring Comfort

One minor potential setback to introducing someone to GP lens wear is the discomfort that comes with initial wear. Here are some tips for managing that discomfort.

Shelley Cutler, O.D., of Lower Gwynedd, Pa., advises O.D.s to instill an ocular anesthetic drop only at the diagnostic fitting and during dispensing office visits. She says, "After instilling the drop, tell the patient that he'll only feel the contact lens a little bit but not to be afraid because he won't be in pain." She adds, "This is the worst part of adaptation to new contact lenses; the best part is that patients quickly become and stay comfortable."

Ed Bennett, O.D., M.S.Ed., GLPI executive director, adds, "After you instill the pre-insertion drop, the patient's positive response to how well he's seeing influences him to have a good perception of GPs."

Spread the word

How do you educate your self, your staff and your patients about GP contact lenses? Consider the following avenues:

Maintaining O.D. knowledge. The best way to keep updated on GP information (both clinical and practice management) is to read articles such as this and to pay special attention to continuing education articles.

Teach your staff. Dr. LeBlanc ordered a current video from the CLMA (for $10) so the staff from both of his offices would have a better understanding of GPs from all aspects: dealing with patients and labs and communicating with him.

Get your patients up to speed. The CLMA-member laboratory GP Lens Institute "GP Product Directory: Contact Lenses, Materials, Solutions and Accessories" is a valuable resource pertaining to single vision, multifocal, toric, keratoconus and reverse geometry designs. Call Pam Witham, staff assistant at (800) 344-9060 in Lincoln, Nebr. or e-mail her at rgppam@aol.com.

What's so great about GPs?

Now that you've read all of this practice management information about GP contact lenses, let's discuss why GPs are a good option for some patients. (Which is why "selling" GPs to appropriate candidates is easy when you tell them about the benefits of this modality.) Here are just a few:

► GPs maintain ocular health. Giant papillary conjunctivitis onset is 15% in GP wearers after 21 months of wear (compared to 85% for soft lens wearers within 10 to 20 months and 21.27% for soft lens wearers after being refit with frequent replacement soft contact lenses." (Donshik, Transactions of the American Ophthalmological Society, 1997).

► Larger diameter GPs that have Dks between 87 and 125 --particularly scleral lens designs -- "provide enhanced oxygenation and promote earlier corneal epithelial healing without hypoxia," says Ann Laurenzi, O.D., of Cleveland.

► According to Dr. LeBlanc, "Because progressive myopia leads to catastrophic visual impairment, GPs are the medical device to prevent further corneal protrusion and are just like prescribing correct glaucoma medications."

► In my experience as fitter and fitted, I've learned that a finished, custom-designed GP contact lens without added water provides excellent oxygen and tear flow; can't pass infectious bacterial colonies through the lens to the cornea; doesn't dry out and adhere to the cornea and conjunctiva.

► GP contact lenses are ideal for non-surgical corneal reshaping to reduce or eliminate myopia and moderate amounts of astigmatism. And they're the only material FDA approved for this process.

Shoot for success

Now you have the tools to make GP lens fitting profitable for your practice. Figure out the appropriate candidates, be patient and up-front with them and shoot for success every time.

Dr. Kogan has authored nearly 50 contact lens articles since 1983. She frequently prescribed bifocal and specialty GPs in her downtown Washington, D.C. practice for 13 years and relied on lab consultation for successful fitting.