Specialty contact lenses (e.g., scleral, hybrid, orthokeratology, torics, etc.) are an invaluable service for patients who have unique eye conditions, such as keratoconus, pellucid marginal degeneration, post-surgical corneal irregularities, corneal scarring, high astigmatism, and irregular pupils. This is because they offer tailored solutions for patients in whom standard contact lenses may either not work nor be appropriate for their needs. What’s more, this increases revenue per patient, as a specialty contact lens fitting can command higher fees due to their complexity and the practitioner’s enhanced fitting knowledge. Further, specialty contact lenses tend to be an out-of-pocket expense, enabling specialists to set their own related fees. Additionally, specialty fits increase patient referrals, which can increase practice revenue. 

To help the OD who does not fit specialty contact lenses determine whether doing so is right for them, here are main questions to consider:

Q: Is there a market for it where your practice is located?
Understanding the landscape of your local optometric community is an essential component in making this decision. The optometrist can identify other optometrists and ophthalmologists involved in specialty fits via a Google search or through listings on support organization websites, such as the American Academy of Optometry or the Scleral Lens Education Society. If a search nets a shortage of eye care professionals offering this service, it may make good business sense for the OD to onboard it in their practice.

Q: Do you enjoy complex cases? 
Specialty contact lens fittings can require more time and patience to arrive at satisfactory vision and a comfortable fit. Therefore, if the OD enjoys complex cases and finds solving patients’ vision and ocular health problems rewarding, fitting specialty contact lenses may be a worthwhile addition to their practice. 

Q: Are you willing to devote yourself to learning something new?
Unlike standard contact lenses, which are readily available, specialty contact lenses are often custom-made and require detailed data, such as pupil size and horizontal visible iris diameter, for a successful fit. Achieving this requires the optometrist make an investment in both the time and effort to learn the nuances of specialty fits. 

Numerous educational resources are available for the OD who wishes to expand their skills in this area. Organizations, such as the American Optometric Association, American Academy of Optometry, and Scleral Lens Education Society, offer CE courses, often featuring wet labs and hands-on patient interaction. 

Additionally, attending specialized conferences, such as the Global Specialty Lens Symposium (GSLS),* provides opportunities to learn about the latest advancements in specialty contact lens technology, from myopia control, to managing irregular corneas.  

Also, many manufacturers and private-education companies offer events, webinars, and training. As an example, the GP Lens Institute (GPLI) is a 501c3 non-profit organization whose mission is to provide educational and practice-building resources to eye care practitioners. Subscribing to the GPLI and spe-cialty contact lens manufactures’ newsletters and regularly visiting websites can help the optometrist stay updated on events and educational
opportunities.  

Further, shadowing an experienced OD who specializes in complex fittings, such as scleral, hybrid, or orthokeratology contact lenses, can be an invaluable experience: Observing experts fitting contact lenses can give the novice optometrist the practical insights needed to handle complex cases with confidence.

Q: Can you manage patient expectations? 
Managing patient expectations is a crucial aspect of fitting specialty contact lenses. This is because some patients may expect instant beneficial results or believe that their contact lenses will provide perfect vision, which isn’t always the case. I have found that this can particularly be the case when fitting keratoconic or post-surgical eyes.

The specialty contact lens fitter must be able to have an open conversation with these patients about potential limitations, the adaptation period, and possible outcomes.

For example, scleral or gas permeable contact lenses often require a period of adjustment during which both vision and comfort improve gradually. Explaining this to patients and confirming their understanding manages their expectations, making them more comfortable about the possible journey ahead. It’s also important to be prepared to halt a fitting if necessary, maintaining a direct and honest tone. Empathy and emotional support can make all the difference for patients who may feel frustrated by their visual impairments. 

Additionally, providing written materials detailing the fitting process, possible outcomes, and the adaptation timeline ensures that these patients have accurate information to refer to after they leave the practice. 

Q: Do you have the needed technology to assist in these fits?
As specialty contact lenses require a more customized approach, the following technologies will be needed to assist in these fits: corneal topography, optical coherence tomography, meibography, a slit lamp camera, and custom impression technology.

Your answer
If you answered “Yes” to all these questions, it makes sense to investigate offering specialty contact lens services. This investigation should include determining whether there are enough support staff and whether the patient schedule can be altered to accommodate these patients. Offering these lenses can be one of the most rewarding aspects of optometry. Specifically, these custom fittings allow ODs to make a profound difference in the lives of patients who have challenging visual needs. OM

*GSLS is an event run by Conexiant, the publishers of Optometric Management.

Denise Burns-LeGros, OD, FAAO, FSLS, practices at Brevard Vision Care, where she specializes in contact lenses with a focus on rigid gas permeable lenses, hybrid, overnight orthokeratology, and scleral contact lenses.