topography

Corneal Topography Benefits

You should consider integrating this device into your practice for four reasons.

DIANNE M. ANDERSON, O.D., F.A.A.O., Aurora, Ill.

Many practitioners don't employ a corneal topographer because they don't want any part of the chair time associated with specialty contact lens patients (i.e. those with astigmatism, keratoconus, pellucid marginal degeneration [PMD], contact-lens ectasia, post-surgical issues, etc.). The time these patients require, they reason, outweighs the benefits to their practice. As someone who performs numerous specialty contact lens fits, I can tell you that this thought process is non-productive.

In fact, here are four reasons you should consider adding a corneal topographer to your arsenal of diagnostic equipment.

1. Specialty lens wearers produce large profits

The fitting fees and cost of lens materials tend to be higher for specialty contact lens patients vs. standard contact lens wearers by virtue of these patients' corneal abnormalities. A corneal topographer enables you to both diagnose and fit these patients. (See "Applicable Diagnostic And Procedural Codes," below.)

For instance, the axial/sagittal map of a corneal topographer enables you to properly identify a patient's astigmatism as limbal-to-limbal or apical, with-the-rule or against-the-rule, oblique or irregular. Then, the device allows you to obtain an accurate measurement of the patient's Horizontal Visible Iris Diameter (HVID), so you can fit the most appropriate custom soft toric lens. The average cost of a soft toric lens is $100 to $150 per eye, while the average cost of a custom toric lens is $200 to $275 per eye. Also, the average fitting fees associated with a standard soft toric lens are $85 to $100, while the average fitting fees for a custom toric lens are $150 to $200.

In addition, a corneal topographer enables you to diagnose keratoconus, PMD or contactlens-induced ectasia and use the cornea's peripheral contours to ensure that the dynamics of the GP lens you choose are physiologically compliant with the underlying cornea (see the photos below). Also, most corneal topographers allow you to virtually create a contact lens design via simulated fluorescein (NaFl) patterns. The average cost of a standard GP lens is $100 per eye, while the average cost of a custom GP lens is $200 to $300. Further, the average fitting fee associated with a standard GP lens is $100, while the average fitting fee for a custom GP is $150 to $200.

Axial topography maps allow you to differentiate conditions such as — from top to bottom — keratoconus, PMD and corneal warpage. These diagnosis will help you expedite a treatment plan for the patient.

In addition, a corneal topographer allows you to offer patients the option of corneal reshaping. Patients unable to undergo refractive surgery due to thin corneas or dry eye; those simply looking for an alternative to the procedure; or myopic children and adolescents interested in avoiding daytime spectacle or contact lens wear are attracted to this modality.

Also, the future of corneal reshaping looks promising. This is because new lens designs, such as astigmatic and presbyopic lenses are preparing to come to market.

Although certification is required for corneal reshaping, the courses are well worth the few hours of time required. As several corneal reshaping lenses are currently available on the market, making a design choice can feel overwhelming. Therefore, should you decide to expand your contact lens practice by offering this service, consult with the vendors and distributing laboratories of corneal reshaping lenses to assist you in selecting the designs best for your practice. (Visit www.Paragoncrt.com, www.BERetainer.com and www.bausch.com for more information on corneal reshaping.)

2. Specialty lens wearers are very loyal

Unlike standard contact lens wearers, specialty contact lens patients tend to be the most compliant to both making and presenting for their scheduled follow-up visits and wearing their lenses as prescribed due to their special visual and lifestyle needs. This is an added bonus to your practice's bottom line.

As a result of working with these patients, I've achieved unparalleled patient satisfaction, which has led to loyalty and referrals.

While all patients stay with a practitioner who can solve their problems, these patients appreciate you even more, as they realize their problems are unique.

3. Several specialty lens candidates exist

If you don't think enough specialty lens candidates exist to make the chair time worth your while, you're wrong. Internally and externally advertise your ability to fit challenging patients and offer corneal reshaping, and you'll soon discover an extremely large number of patients interested in these services.

Personally, I've received and continue to receive several e-mails from patients inquiring whether they can achieve success in specialty lenses. These patients have located articles I've written on the subject through Internet searches. If this isn't an indication of how passionate and determined patients are to free themselves of spectacles and achieve successful contact lens wear, I don't know what is. The bottom line is that these patients are willing to try if you're willing to try. (See "Choosing a Topographer," below.)

4. Corneal topography retains patients

When you send patients who have questionable astigmatic refractions or irregular keratometry readings to another practitioner, you give them the impression that you're not up to date on the latest technology and therefore unable to provide them with the best care. This means they may stay with the referred practitioner not only for their contact lens needs, but also for their future ocular issues, such as cataracts and glaucoma. Retaining patients is more important than ever considering the current economic environment.

As you can see, employing a corneal topographer offers several benefits that outweigh the chair time associated with specialty contact lens patients. Therefore, it's time you conduct research into implementing this device. Talk to colleagues who use a corneal topographer, ask the representatives of the various specialty contact lens companies about how you can become adept at fitting their products, and begin asking patients whether they, a family member or friend would be interested in specialty wear. I think you'll find that an untapped demand exists for specialty lens services. I know I did. OM

Dr. Anderson practices in suburban Chicago, specializing in orthokeratology, keratoconus, post-surgical lens fits and anterior segment disease. E-mail her at dianne.anderson@comcast.net.