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We're In The News!
The following are reprints of articles written: about Dr. Maller, from interviews with Dr. Maller, or by Dr. Maller that have
been published in various professional journals.
Parklander - Yes EyeCare Offers Progressive Eye Care And Traditional Values.
Coral Springs, Parkland Forum - An eye for detail distinguishes office.
Coral Springs, Parkland Community News - Parkland Music Guild Needs Your Help.
Optometric Management - How RGPs Can Change Your Patients' Lives.
Review Of Optometry - Eight Great Ways To Reel In RGP Patients.
Coral Springs, Parkland Community News - Accelerated OrthoKeratology.
Review Of Optometry - The WWW Page of Ken Maller, O.D.
Optometric Management - Attracting Challenging Cases.
Review Of Optometry - Cornea And Contact Lens Q & A.
Optometry Today - Giving Back What Presbyopia Steals.
Optometric Management - Helping Patients Make The Hard Choice.
Optometry Today - Solutions From Our Readers - Give Group Contact Lens Lessons.
Contact Lens Spectrum - RGPs And The Young Practitioner.
Optometry Today - PERRL Of The Month - Refitting Soft Lens Wearers Into RGPs.
Optometric Management - Disposable Lenses Aren't A One-Size-Fits-All Option.
Contact Lens Spectrum - Photodocumentation: Optimizing Today's Contact Lens Practice.
Optometric Management - Venturing On To The World Wide Web.
Optometry Today - PERRL Of The Month - Low Astigmats May Need Toric Lenses.
Optometry Today - PERRL Of The Month - Managing RGP Patient Expectations.
Review Of Optometry - 10 Lessons For All Time From The Start-ups Of The ’90s.
Optometric Management - Specialty Lenses: Don’t Let Your Best Patients Disappear.
Optometric Management - Witnessing Change.
Optometric Management - Prescribing Contact Lenses For Today's Presbyopic Patients.
Optometry Today - Getting The Word Out About Contact Lenses For Presbyopia.
Optometric Management - Solving Mysteries with Corneal Topography.
Review Of Optometry - Contact Lenses - Small Steps to Big Rewards On Your Multifocal Fits.
Optometric Management - Want to Get Ahead? Get a Gimmick.
The Pompano Pelican - A.O.K. Can Let You "Sleep On It" To Improve Vision And Drop Glasses.
The Pompano Pelican - Accelerated OrthoKeraology Heralds The Demise Of Glasses.
EastSider - Procedure Can Give Patients Insight.
en USA - Vea mas claro con El Metodo Orthokeratology.
Good Health & Beauty - Non-surgical Process Offers Long Term Benefits For Nearsightedness.
WSVN 7 News Broadcast - Television News Story on Dr. Maller.
Review Of Contact Lenses - Using CAD/CAM Lenses For Orthokeratology
Optometric Management - Achieve Favorable Post-Surgical Results with Ortho-K Rehab.
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| By Barbara Marrs |
June 1996 |
Yes EyeCare Offers Progressive Eye Care And Traditional Values
"Progressive Eyecare and Traditional Values" is the philosophy at a unique eye care center in Coral Springs. Following
five years of private practice in Broward County, Dr. Kenneth Maller established Yes EyeCare. Relying on patient input,
Dr. Maller became aware of a need to provide a center for eye care, glasses, and contact lenses to treat patients
in the manner that they deserve - Progressive Eyecare with Traditional Values in a warm, friendly environment.
The advancements that have taken place in his field have been encouraging to Dr. Maller. With the help of computers
and technology the examining equipment has become more "patient friendly." An example of this is the
"Refraction Station." Using automation and infrared beams the station allows Dr. Maller to determine the
patient's best prescription in a method that is actually easier for the patient. Yes EyeCare is the only office
in South Florida to offer this sophisticated technology.
Dr. Maller is involved with a revolutionary surgery using the Excimer Laser - revolutionary in that no knives
are used. "The Excimer Laser uses a beam of light to reshape part of the eye allowing patients to see clearly
without glasses or contacts." Many other advancements are incorporated into Yes EyeCare, all with the same
goal in mind - to provide the very best visual and medical eye care available.
The developments in contact lenses over the last few years have been overwhelming. Disposables, daily disposables,
frequent replacements, torics, gas permeables, bifocals, daily wear, extended wear, handling tints, enhancement
tints, opaque tints and prosthetics, to name a few. "We offer FREE contact lens consultation and have had
numerous success stories with patients who have been told that they could not wear contact lenses," says Dr. Maller.
Dr. Maller fits all types of lenses. He will use standard design or personally design a custom lens to
achieve the proper lens for the patient's needs.
Yes EyeCare has a beautiful selection of quality ophthalmic frames and sunglasses that are very competitively
priced. All types of options are offered such as the newer thin and light weight lenses, progressive bifocals,
and photochromatics (lenses that change between light and dark when going outdoors). It is not uncommon for
children to have subtle visual problems (for example, eyes that don't function together as a team). Unless
specifically tested for, this will typically go unnoticed, delaying or stagnating proper development. Children
will rarely complain that their eyes don't work properly because they don't know what "normal vision" should be.
It is recommended (but not generally known), that a child should have their first comprehensive eye
examination in their thire year of life. Yes EyeCare also has a nice choice of children's frames for these
little and very important people.
Dr. Maller's progressive yet traditional approach to eye examination and treatment is refreshing. Where old is new
again, the return of caring professionalism and personalized service, is much appreciated and a benefit to all patients.
About Dr. Maller
Dr. Kenneth E. Maller is a Board Certified Optometric Physician. He received his professional training in
Chicago at the Illinois College of Optometry which included specialized pediatric optometric training. He
earned his undergraduate degree in the biological sciences in New York at New York University. Dr. Maller has
been practicing in Broward County for five years and is an active member of the American Optometric Association,
The Florida Optometric Association and the Broward County Optometric Association.
Reprinted with permission from Parklander - Copyright 1996. All Rights Reserved.
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| By Christa Dean |
September 1996 |
An eye for detail distinguishes office.
From all indications, one of the region's best eye care practices sits right here in the city's
own back yard.
The 1,600 square foot office sits quietly, an unimposing figure in the northeast corner of a
shopping center at the intersection of Wiles Road and University Drive. But this office is no
small deal.
Step inside and the eyes are greeted with carefully planned eyeglass displays and sleek, spotless
display cases. But you won't smell any glass cleaner here. The openness and the professional
decor of the entry and awaiting space is further enhanced by the faint sound of contemporary jazz
music throughout the room.
However -- there is an obvious lack of paper in this office. In fact, you don't even see any
filing cabinets. That's because there is very little paper at Yes EyeCare. And lots of computer
screens.
Dr. Kenneth E. Maller, optometrist, owner and creator of the practice he opened last March, has
installed an integrated database and examination system to replace much of the manual, handwritten
work of his profession.
The result is an unobtrusive, non-threatening eyecare experience that requires virtually no effort
for the patient. For Maller, it means a more efficient, accurate consultation and an immediate
record of patient data.
"(And) it makes my day go better," Maller added.
At the patient's first meeting with Maller, eyecare history is entered into a database and
instantly assigned a number. No charts, no clipboards. Patients already wearing eyeglasses
have their current prescriptions read by placing them underneath the lens meter, a specialized
unit that prints a receipt-sized ticket of the data. The information is automatically added
to the patient's computer record.
On to the Refraction Station, a unit that allows Maller to test a patient's vision and the basis
of any eyecare professional's practice. While the patient is seated in a comfortable office
chair, Maller pulls up the appropriate patient record and begins testing, using a touch-sensitive
console on a small island table. Any need for vision correction can be determined at the touch
of a button -- no clicking and flipping of lenses. Patients can quickly decide which lenses
enable them to see most clearly.
Noticeably absent is the standard letter chart on the wall -- it is now inside the Refraction
Station.
Maller conducts glaucoma testing in an adjoining room using a small machine that literally
photographs the patient's eye and transfers the image to a television monitor for patient
review. Using corneal topography in yet another area of the office, Maller can graphically
analyze the shape of the cornea to determine any corrective action that should be taken or
simply the proper contact lens fitting for a patient's eyes.
Maller hand-picked the equipment used in the office based on feedback from patients he had
examined prior to opening the practice. Offering the patient hassle-free yet accurate
exam was their foremost concern and the thrust of the office design.
Custom display cases and the file cabinets (they are integrated with a reception-area wall)
were drawn by Maller and presented to builders for construction. He realizes most doctors
do not involve themselves with such minor details, but, he explained, sometimes the details
are everything.
"The key thing is doing your homework. I'm not the smartest guy out there -- but I looked!" he
said.
Several area doctors have toured the facility to examine not only the equipment but also the
office design. Maller said at least three local eyecare professionals will implement some of
the concepts he uses in their practices. Much of the technology Maller uses is the first of
its kind in South Florida.
Maller specializes in contact lenses and said his success rate hovers near 100%. The uncommon
is an everyday occurance with this doctor -- bifocal contact lenses and prosthetic lenses are
two of more than 100 different types of contact lenses Maller regularly prescribes.
Larry Wine, a sales and marketing professional from Broward County received follow-up care from
Maller after undergoing photo radialkeratotomy (PRK) to correct a near-sighted condition. The
procedure involves using a laser to reshape the cornea and is non-invasive. After wearing
eyeglasses and contact lenses since childhood, Wine now in his 30's, said he has found freedom.
"For anybody that is a candidate for this, it's a no-brainer," he said, adding a few suggestions
for selecting an eye professional. "Be very, very thorough and selective about where you have the
procedure done and the follow-up care doctor you choose." Throughout the follow-up, Wine said,
Maller has proven himself a professional, convenient and thorough eyecare provider.
Meryl Weiner, resident optician in the office, handles the needs of patients who require or
prefer eyeglasses. Although she uses the high-tech equipment sparingly, she emphasized the
personal service that is integral at Yes EyeCare.
"Whatever their needs are, I can fit people into their glasses," she said. "I treat people
like I want to be treated -- even, if I'm only spending $100."
Reprinted with permission from Forum - Copyright 1996. All Rights Reserved.
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| By Greg Carr |
May 1997 |
Parkland Music Guild Needs Your Help.
The Parkland Music Guild held their Spring Scholarship Luncheon on April 24th at the Coral
Springs Country Club, to raise funds for the guild. Everyone attending the luncheon
enjoyed an intimate concert with three members of the Florida Philharmonic Orchestra,
Edward Martinez (piano), Janet Clippard (bassist), and Huifang Chen (violin). The
musicians donated their time playing for about an hour and a half. Over 60 guests
attended raising a total of $1200 for the scholarship fund of the Guild.
The Parkland Music Guild is a non-profit organization founded in 1996 by Martha B. Stone
and Dr. Kenneth E. Maller, with the intent of awarding scholarships and providing
musical instruments who are interested in musical studies. Further, the Guild's mission
is to promote an increased awareness and a greater appreciation of music within
Broward County. But they can only do this with your help. The Guild is made up of
volunteers and they are always looking for more volunteers to help. Also, any
musical instrument or monetary donation is tax-deductible and would be greatly
appreciated. The next luncheon is tentatively scheduled for September and the
same members of the Florida Philharmonic enjoyed performing in this intimate setting
that they are eager to return. For additional information or to donate a musical
instrument please call 340-2010.
Reprinted with permission from Community News - Copyright 1997. All Rights Reserved.
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| By Carol A. Schwartz, O.D., M.B.A., F.A.A.O. |
May 1997 |
| Case #1: By Ken Maller, O.D. |
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How RGPs Can Change Your Patients' Lives.
The stories of how five fitting specialists helped shape the careers of three adults and the
lifetimes of two children.
Managed care, mail-order lenses and backed-up reception suites can sometimes make us forget why
we went to optometry school in the first place. So much so that we don't always appreciate the
the magnitude of the impact we have on our patients. With that in mind, I asked five leading
contact lens practitioners to share with you case histories that demonstrate how rigid gas
permeable (RGP) lenses can forever change the dimensions of someone's life.
CASE 1: SURGICAL MISADVENTURE TO HYPEROPIA
Paula, a 42-year-old landscape architect, had undergone refractive surgery on her left eye in
1988. Because the outcome was less than perfect, she elected not to have the right eye done
and became a soft lens wearer.
In May 1996, she presented to me complaining of poor vision. Her right-eye vision seemed
blurry through her contact lens and her left-eye fluctuated during the day.
Startling discovery.
With a struggle, her acuity with these contacts was 20/30- OD and 20/40 OS. In doing the
refraction, I made a startling discovery: Other than belonging to the same patient, her
eyes had nothing in common.
Her right, unoperated eye was extremely myopic, with astigmatism (-5.75D - 1.75 x 180, 20/20).
Her left eye had an equal amount of error - but in the opposite direction and with oblique
astigmatism (+5.50D -1.75 x 120, 20/25). At near, she required unequal adds of +0.25 OD and
+0.75 OS. Her keratometry readings were dissimilar as well.
Surgical Overcorrection.
As you can see by the topographical map on the previous page, the refractive surgery had created
a sizable hyperopic overcorrection.
Paula wanted no part of spectacles. Frustrated because she couldn't function, she began to worry
if she'd ever be able to see properly again. When I recommended RGPs, she hesitated. She'd had
a poor experience with them long ago. Still dubious about new materials and technology, she
reluctantly agreed to re-try RGPs. Then - suprise. She was astounded by the comfort and the
vision the first time she wore them.
Bring On Presbyopia.
Paula has worn her lenses 14 to 16 hours a day and her acuity has been OD 20/20 and OS 20/25.
With these lenses, she has no difficulty with near work. Although realizing that soon she
would need to trade in these great lenses for bifocal RGPs, she anticipated she would take
that life event in stride.
Reprinted with permission from Optometric Management - Copyright 1997. All Rights Reserved.
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| By Carol A. Schwartz,O.D., M.B.A. |
June 1997 |
Eight Great Ways To Reel In RGP Patients How to build your contact lens practice among the most loyal of patients.
Simply being excellent at fitting contact lenses is not enough to set yourself apart and succeed as an RGP specialist.
You also need a way to get patients interested in them. Experienced RGP fitters agree: The most powerful tool for
attracting new wearers and keeping existing ones is word of mouth. Hear are some ideas that will help get patients
and prospects talking about your RGP fitting prowess.
1. Target Refractive Surgery Rejects.
The two fastest growing subspecialties in contact lenses are bifocals and myopia reversal. The demand for bifocals will
keep rising dramaticall as baby boomers keep moving into presbyopia. Greater marketing of laser correction as sparked
interest in cornal molding and myopia control among patients who are surgery-averse, too young or otherwise
contraindicated for PRK and LASIK. Adding bifocals and myopia control to your practice can enhance the number of
patients you fit with RGPs, say members of the Rigid Gas Permeable Institute's Advisory Committee. But, you'll need
to let these patients know you offer these services.
2. Say It Again... And Again.
"Never be afraid to be redundant,"says Ken Maller, O.D., of Coral Springs, Fla. "You need to repear the message many
times to be sure that they really get it." This is difficult in the age of managed care, when chair-side education
time is at a premium. That's why it's crucial for your staff to initiate the idea. When the patient finally gets in
chair, she's primed for your recommendation. Never miss an opportunity to educate a potential RGP wearer. The
reason: The choice to wear RGPs is usually an informed one. Besides the old (and effective) standards such as
brochures and newsletters, consider non-traditional outlets. Dr. Maller writes a short column on vision care for
his local paper. No matter what the topic, he finds a way to work in a reference or two to rigid bifocal contacts,
his particular specialty.
...
Reprinted with permission from Review Of Optometry - Copyright 1997. All Rights Reserved.
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| By Greg Carr |
November 1997 |
Accelerated OrthoKeratology
AOK or Accelerated OrthoKeratology has been available for many decades
but even today is still not generally well known. It is the use of
contact lenses to gently reshape the cornea to reduce the prescription,
in a similar way to the surgical procedures. This story is about Patti
Velle, a Coral Springs resident, who recently has had great success with
this procedure.
"I have been wearing contacts for maybe 30 years, I never had glasses.
Actually, I was devastated when I was told I would have to wear glasses.
I really only had a problem with seeing long distances in the beginning.
Going to a drive-in movie was hard to watch. But I insisted that I was
not going to wear glasses so I got contact lenses. I Always wore hard
lenses, because back then that's all there was. They were a lot more
durable than the soft lenses of today, I wore one pair of hard lenses
for about 10 years." As Patti got older her eyes began to change, her
doctor eventually switched her to mono lens. "They were bothering me at
one point, which is about the same time that I began to hear about RK
surgery, Patti said. I thought it would be great to be lens free all day
long but the cutting when I went in and spoke to my doctor about it I
didn't like the burning and the cutting because if a mistake is made at
that point, that's it." Patti had also heard stories that a blur could
result from the laser surgery and that is permanent. "When I went to see
Dr. Maller I learned that there are actually four choices....RK, Laser,
Bi-Focal, or you can wear these special lenses at night and not during
the day, and I said whoa, backup...what was that last choice?" Patti had
never heard of that last choice, so Dr. Maller proceeded to tell her
about the corneal molding. Corneal molding is a contact lens that fits
on to your eye like a suction cup and actually reshapes your eye to its
proper shape for correct vision. Corneal molding has actually been
around for a long time, but for whatever reason (mainly because some
doctors consider it alternative medicine, and not many doctors are
skilled in fitting this type of lens) it is not a viable option many
doctors suggest.
Now, Velle has been wearing the corneal molding lenses since April. "I
work for a title agency and I do four or five closings a day, talk to
people all day long and you get into every kind of subject, nobody has
ever heard of corneal molding, it's amazing. But then again its just
like anything else." What interested Velle about this option was that
the worse thing that could happen was that if the contacts didn't work
your vision would just revert back to the way it was. You could then go
back to what you were doing before the corneal lens fitting. In Velle's
case she would just continue to wear her old contacts.
"It was interesting, when they came in I went into the office and Dr.
Maller put them in, I wore them for about an hour, basically I am
thinking oh....he wants to make sure they fit correctly....we
chit-chatted a bit, and I read my book...then I went back in and he
popped them out and he said well?...I said well what? he said you don't
have lenses in...and then I said, oh my god I can see! I can read the
chart! after only one hour! He then put them back in, I wore them all
that day and night until the next morning and then I toke them out. I
figured each day I could leave them out for another hour or so. The next
day I had to go to Florida Prudential Realty. I was there talking to
people telling them about it and they didn't believe me. To prove it to
them I started reading license plates from quite a distance, needless to
say everyone was quite surprised."
After about four hours Patti's vision started getting a little blurry,
she had the lenses with her and just put them back in and went about her
day and wore them through the night. Velle explained, "The next morning
I took them out and started my day. That day I had a busy day, about
four or five closing, I had forgotten all about them, at 6:00pm I was
driving home and then I said whoa!....I could see. I called Dr. Maller
on my mobile phone and said you aren't going to believe this....I
haven't been wearing the contacts since about 7:30am. I didn't put them
in until I went to bed that night. From that day on that was it, it took
two days! and now I put them in at night when I go to bed and take them
out first thing in the morning."
Velle used to wear the extended wear lenses where you take them out once
a week, so she was used to wearing and caring for lenses. "I don't
notice they are in when I sleep, they're great! Every now and them when
I wake up in the morning and they might be a little dry I put a drop or
two in them, but I did that with the extended wear also, so that was no
big deal to me. I never wore the soft lenses, but I think they are
easier to wear than those", said Velle. They are fitted, almost like
suction cups, they pop right on, very easy to put on and off. If there
made correctly then they will fit the right way and you shouldn't have
to worry about losing them. "I am on Dr. Maller's web site
(http://www.YesEyecare.com) under patients you can look for my initials P.B.
and see my eyes. Dr. Maller is very progressive which is what I like
about him. It's the main reason I left my old eye doctor. I met Dr.
Maller at the right time I needed a change my old doctor wasn't
responding to my needs, I wasn't happy with the contacts I was wearing
and he made it sound like it was something psychological", said Velle.
The other thing many people like about the corneal molding is that it is
about half the cost of RK surgery. You normally see the doctor about
every two weeks or so, for adjustments and to check on the progression.
"Now I can go swimming at the beach without worrying about loosing them,
because I don't have them in. It's nice not to have that dirty lens
during the day", said Velle. It is very convenient for people active in
sports. "My eyes are currently 20/15, and to be honest I am not sure
what that means, all I know is I can see without lenses all day long, no
matter how long my day seems to get. People that are already contact
wearers and are looking for an alternative to become lens free during
your waking hours, this is great." For additional questions please see
related story on page 4.
Reprinted with permission from Community News - Copyright 1997. All Rights Reserved.
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| By Dominick Maino, O.D., M.Ed. |
December 1997 |
The WWW Page of Ken Maller, O.D. (http://192.41.15.170/yeseyeca/index.html)
In my last column I asked you to send me the URL of your practice's web page. Ken Maller, O.D.,
submitted his web page to be the first one I look at. IMMHO (that's cyberspace talk for "in my
most humble opinion") Dr. Maller has done just about everything right.
His home page initially comes up on the screen and shows the office name, location, hours and
how to contact him. It even asks if you want to make an online appointment. It then goes
on to state all the services he provides, what "specials" the practice is offering, and the
emergency eye-care services that are available. Those visiting Dr. Maller's WWW site can review
information concerning bifocal contact lenses, orthokeratology and laser vision correction.
As you discover what he has to offer, you'll see pages specifically designed for other doctors,
those that discuss medical issues, and reviews of interesting patient cases. He also has a
page just for fun that has links to pages for the "Wonderful World of Disney" and "Star Trek."
One of his best pages features "specialty contact lenses." This particular page should be
interesting to just about anyone -- patient or doctor -- who likes the unusual.
Dr. Maller's WWW site answers the vital questions: who, what, when, where and how. It also
adds in just the right amount of bells and whistles (animated graphics, on-line appointments)
with plenty of reasons for potential patients to come back for more than one visit (like that
strange contact lens page featuring "cat eyes," Halloween contact lenses and "monster eyes"
contact lenses).
Dr. Maino has no financial interests in any services or products described here. His statements
reflect only his opinion and not necessarily those held by any organization or institution
with which he is affiliated.
Reprinted with permission from Review of Optometry - Copyright 1997. All Rights Reserved.
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| By Ken Maller, O.D. |
December 1997 |
Attracting Challenging Cases - Use these tips to establish yourself as an expert at treating
unlikely contact lens candidates.
Plenty of potential contact lens patients could benefit from good contact lens
services. The trouble is, many of them have extensive eye histories, such as vision
loss from glaucoma or retinal problems caused by detachments that discourage them
and their doctors from considering contact lenses.
Instead of shying away from these tough cases, I've carved a rewarding niche for myself
by letting other doctors know that I'm willing and able to treat them. Here are some
pointers to get you started.
What to keep in mind.
Take a creative approach. You'll need to move away from conventional thinking to treat these
patients because most will have unconventional criteria.
Some problems you'll typically address include irregular astigmatism, obliquely oriented
astigmatism, dry eyes, loose lids, and lid disease. Your patients are likely to be presbyopes as
well. So, you'll also need to address their near activities.
I've found that rigid gas permeable (RGP) lenses are a major part of the arsenal in treating
these kinds of cases. I also use corneal topography on each patient so I know what I'm
up against from the start.
Be realistic.
Your first rule of thumb in treating difficult cases is to set realistic
expectations - for yourself and the patient. If a patient has a visual field with large
deficits, no contact lens in the world is going to restore the lost field.
You should also expect to invest some time in managing these cases.
For a post-radial keratotomy (RK) patient who was recently referred to me, I fit an RGP bifocal
on one eye and a distance-only, back surface aspheric RGP in the patient's other eye.
Unfortunately, the over-refraction on the distance-only aspheric had a great deal of cylinder.
So, I had to spend a fair amount of time finding a lab that would manufacture a back-surface
aspheric, front-surface toric RGP.
There's nothing wrong with investing a lot of time fitting a patient as long as you get
reimbursed for it. I charge a flat global fee for my professional services, based on the
time I expect to spend on the case, and a separate lens fee.
Spread the word.
The key to generating referrals is communicating with the physicians who
manage the tough cases. To get started, look no further than your own backyard. You probably
already work with ophthalmologists for surgical referrals. Let them know about the contact
lens services you can offer their patients.
I took this route with an ophthalmologist in my area who specializes in advanced glaucoma cases.
By her own admission, she has no idea of how contact lenses can help these patients. She now
relies on me as her key refractive referral source because I've sent patients back to her with
visual performance beyond what she thought was possible.
This is the kind of result that generates additional referrals. Referring doctors will come
to think of you as an expert, and they'll continue to send other tough cases your way. They'll
also spread the word about you among their colleagues, who may become another source of
referrals.
Follow protocol.
Being on the receiving end of referrals brings with it certain responsibilities.
First and foremost, you must send patients back to their referring physician after fitting them -
regardless of whether you can manage their glaucoma or offer them other services.
Verbal and written correspondence is also very important. When a cataract surgeon refers a
patient to me, he appreciates knowing how his patient is progressing. This courtesy results
in better patient care, keeps the referring physician in the loop, and keeps me in the
forefront of the referring physician's mind.
Rewarding niche.
Most of the patients that I treat are very gratified to have their vision restored to its
best possible function. It's equally gratifying to me to help them and earn the respect of
my colleagues by doing so.
Once you can get a handle on managing these cases, I think you'll agree.
Dr. Maller is in a private practice in Coral Springs, Fla., that provides primary care
and contact lens services.
Reprinted with permission from Optometric Management - Copyright 1997. All Rights Reserved.
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| By Joseph Shovlin, O.D. |
January 1998 |
Cornea And Contact Lens Q & A the Downside to mixing solutions.
Q - I've heard reports of lens swelling when mixing SupraClens daily protein remover with other
solutions. Is this permanent, and are there any other effects of mixing solution?
A - Lens swelling can result from improper use of the product. Alcon Laboratories says it
designed SupraClens to be used by placing one drop in each side of the lens case in Opti-Free
Express multipurpose solution or Opti-One multipurpose solution for soft lenses, or Opti-Soak
conditioning solution for RGP lenses. If a patient uses SupraClens only or rubs it directly on
a soft lens, the lens will temporarily change parameters, says Ralph Stone, Ph.D., a senior
director at Alcon. Storage of the lens in Opti-Free Express or Opti-One will re-equilibrate it.
Frank Fontana, O.D., of St. Louis, says that he's occasionally had patients use SupraClens with
other solutions with no reported problems, but he generally doesn't advocate mixing and
matching solutions. Solutions contain varied ingredients, so you can't predict how they will
work with each other. Dr. Stone cautions against mixing SupraClens with other solutions than
those Alcon recommends. The new combination may change its safety and efficacy. Art Epstein, O.D.,
of North Shore University Hospital in Manhasset, N.Y., agrees. "I think that from a clinical
perspective, products are designed to work as systems," he says. "The only way of being
completely assured that a product is compatible with its components of the system is to use products
within the system." By mixing and matching solutions, you also risk incompatibility between
the solutions and certain contact lens polymers. Says Dr. Epstein: "The concept of labeling
basically says we've used this combination of products with every possible combination of
lenses that you'll come into contact with, and we find that it's safe." If you use solutions
outside the labeling, make sure you know beforehand that there won't be any interactions or
other harmful effects. In any case, regular follow-up with patients is important.
Q - What is modified monovision, and when is it appropriate to prescribe?
A - Unlike conventional monovision, which involves fitting a single-vision lens in each eye
(one for distance, the other for near), modified monovision may involve fitting a single-vision
lens in one eye and a bifocal or multifocal lens in the other. You can prescribe the single-vision
lens for distance or near, depending on the patient's primary visual demands, and the bifocal
for the patient's remaining distance and reading needs, says Robert M. Cole III, O.D., of
Bridgeton, N.J. This technique can benefit unsuccessful bifocal contact lens wearers, or
patients who were unsuccessful with conventional monovision. Janice M. Jurkus, O.D., of
Illinois College of Optometry, adds that it can help presbyopes whos natural ability to focus
at intermediate range has diminished, usually around age 55. To determine if a patient might
benefit from modified monovision, Dr. Jurkus suggests you ask: What visual distance do you
need most for your daily activities? What distance are you willing to compromise? The patient
might require an additional aid, such as a half-eye reader, to read the stock prices in a
newspaper, but would have no problem working on a computer. Some O.D.s prescribe
modified monovision using two different bifocal or multifocal lenses. One lens emphasizes
distance and intermediate vision, the other intermediate and near. This is indicated for
patients who constantly need that intermediate range, such as computer users. Ken Maller, O.D.,
of Coral Springs, Fla., fits a translating bifocal design in the patient's dominant eye
and a simultaneous aspheric multifocal in the non-dominant eye. The translating bifocal,
he says, works well at distance and near, but doesn't address the intermediate zone. The
simultaneous aspheric works well in the mid-range, but doesn't provide as good acuity as
a translating bifocal at distance and near. By fitting one of each lens, he says, "you
get the best of both worlds."
Reprinted with permission from Rewiew Of Optometry - Copyright 1998. All Rights Reserved.
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| By Ken Maller, O.D. |
April 1998 |
Giving Back What Presbyopia Steals Use these practical strategies with RGP multifocals to keep your presbyopic patients in contact lenses.
Contact lens wearers entering presbyopia have three options if they want to stay in contact lenses. They can
wear spectacles over their contact lenses for near tasks. They can wear monovision. Or they can choose what I
consider the superior option - multifocal RGP contact lenses. Multifocals do require a commitment in time and
cost from both you and your patients. But beyond this, I believe they offer the most natural restoration of
the pre-presbyopic state. This article will show you how I've succeeded with multifocal contact lenses in my
practice, and how you can, too.
Selecting the best lens - one lens at a time.
Location, location, location - it's as important to bifocal contact lenses as it is to real estate. If a lens
doesn't position and move as it was designed to, your patient won't achieve the appropriate vision. For example,
translating designs should ride low and center laterally in primary gaze, while freely translating up without
moving laterally on downgaze. Back surface aspheric multifocals should position towards the vertical center or
higher on the cornea. Of course, these are generalities, but if a particular design doesn't move and position
well, it won't work. In fitting bifocal or multifocal contact lenses, you'll address the usual
criteria - prescription, tear film and corneal curvature - as well as such other very important issues as pupil
size, lid position, lid tension, pupillary aperture, occupational requirements, computer use and lifestyle.
Just as you know a flat-top bifocal spectacle generally doesn't function well for the computer user, you also
need to know that a translating bifocal contact lens doesn't work well in these instances either. And forget
the concept of "lens of choice." My lens of choice is the one that works, and there's no single bifocal or
multifocal lens that addresses all the needs of all patients. But because RGP bifocals almost always provide
superior vision, I've concentrated my efforts on becoming proficient with them. Here's how.
The first fitting session.
Selecting the appropriate lens can eat up a lot of chair time, but a little planning can minimize this (see sidebar 2).
After performing a comprehensive eye exam, I schedule the patient for what I call the first fitting session. At this
visit, I try 2 or 3 different designs. While each may be close to an appropriate fit, what I'm actually
looking for is the design that performs best on a particular eye. I use the biomicroscope to see how the lens
positions and moves, and to view the fluorescein pattern. A small amount of nasal rotation is often normal
with a segmented translating design, but too much rotation will negatively affect near vision. If the lens looks
good otherwise, I'll decide if a truncation will help keep it from rotating. If I believe that it will, I'll
design a truncated lens and order it regardless of whether that particular design is usually truncated. Truncation
may also help the translating lens that doesn't translate up adequately on downgaze. Poor translation is usually
due to a thicker upper edge on the lens, or lid architecture that keeps the lens positioned low. It may be difficult
to get a lens to translate up properly on downgaze if 1mm or more of the inferior sclera shows. This often prevents
that lens from giving the patient a usable reading area because the lens won't move high enough to allow a normal
reading postion. An aspheric lens must center laterally. Vertically, the lens must center or ride slightly
high on the cornea. If topography reveals that the corneal apex is decentered laterally or inferiorly, it may be
difficult to position an aspheric lens properly. Against-the-rule corneal cylinder is another tough factor to
overcome due to lateral decentration. This applies to translating as well as aspheric designs.
Checking lens dynamics.
To check the lens dynamics, I use the direct ophthalmoscope with the patient's head in free space so that I can
identify the seg position in relation to the pupil. Small pupils can be helpful, but it's sometimes nearly
impossible to get good distance and near vision when a patient has large pupils. Check the patient in a room
with normal illumination. If the pupils demonstrate excessive dilation in dim illumination, night-time flare
may be a problem. Discuss this with the patient to determine which activities are most important and fit
the lenses accordingly. For example, you may decide to position the seg of a translating design lower than
you normally would because your patient is a truck driver who spends a great deal of driving at night. On the
other hand, placing a seg too low won't work for an accountant who spends most of the day doing paperwork. Let
the visual requirements of the patient guide your fit. If the lens is not positioned and moving as it should, I
go on to the next design. Only after I find a lens that performs well do I check the vision. Since the
prescription of the diagnostic lens is usually off by a considerable amount, I do a monocular trial lens
overrefraction in free space ot obtain the appropriate power for the lens. I also check the usable near
range both in distance from the eye (12 to 20 inches) as well as reading height (an arc of 20 to 45 degrees
below primary gaze). Very often I'll end up with different design on each eye. Don't be intimidated by mixing
designs (see sidebar 1). Capitalize on it by taking advantage of the strengths of each design. If all goes well at the first fitting
session, and I have two lenses that I believe will perform well, I calculate the actual design parameters for these
lenses. If I haven't come up with an appropriate design, I schedule the patient for a second fitting session to
try additional lenses. I rarely need more than two fitting sessions before having a pair of lenses that I
believe will work.
The dispensing visit.
When the lenses arrive, I schedule a dispensing visit to evaluate fit and vision. The fit of the new lenses may be
quite different from the diagnostic lenses due to the prescription (a high plus translating bifocal will sit lower
than a minus diagnostic lens, for example). I check the vision in a binocular field and perform a monocular
trial lens overrefraction from +0.50 to -0.50. If the vision is not reaching the goal and takes more than the
+0.50 to -0.50 at distance or near, the patient will not leave with the lenses that day and I'll perform a
full overrefraction. It's important at this point to reorder lenses rather than let the patient leave with them.
If the patient takes these lenses he'll have problems, and this will make it much more difficult to fit him
successfully. if all is as it should be, however, I instruct the patient on lens application, removal and care, and
explain any limitations of these lenses. Set reasonable goals and make sure the patients understand what they'll
be able to achieve. If you prescribe a translating lens, be sure to include instructions on head and eye position.
One-week follow-up.
At this visit, I check vision binocularly in free space at distance and near, and we review any problems that the
patient has encountered. Unless the vision is not even close to the goal, I only overrefract with trial lenses over
each eye from +0.50 to -0.50 while the patient is viewing binocularly. Sometimes, I do my "hall" overrefraction
where I take the patient into the hallway where he as an unobstructed view of true distance in free space. The hall
measures about 60 feet to the glass front door where patients can see outside. Remember, this free space is how
they're going to use these lenses, so don't use the phoropter for any evaluations. A biomicroscopic exam will
confirm that the lenses fit well and the cornea is healthy. At this visit, we review lens application, removal
and cleaning techniques to reassure the patient who is still new to contact lenses.
A creative and systematic approach.
There's no cookbook approach to prescribing multifocal contact lenses, and creativity is important to fit these
lenses successfully. The general protocols I've outlined here help me give patients the best of what's
available. Until we can restore full accommodative functions through innovations like implantable liquid
collagen, movable IOLs or whatever else might be coming to help us give back what presbyopia steals, bifocal
and multifocal contact lenses are the best options for the presbyope.
Sidebar 1: Mixing and Matching Multifocals
An approach that works exceptionally well for me is to use a translating design for the dominant eye and an aspheric
multifocal on the non-dominant eye. Among the strengths of a translating design are crisp distance and near
vision, and the ability to address the high add. Unfortunately, comfort can sometimes be a problem. Also, the
translating designs are highly head and eye-position sensitive, and they're not the optimum choice to correct vision
in the midrange. Aspheric multifocals perform exceptionally well in the midrange, but tend to give slightly
softer vision at both distance and near. They're also limited to the lower add powers. By combining these designs,
however, you can provide sharp distance and near vision while also giving a very useful intermediate range. Mixing
designs also comes with a cautionary word. You can't mix a translating design that's prism ballasted, such as a
typical crescent seg type bifocal, with a concentric design. This combination creates a vertical imbalance that's
likely to cause vertical diplopia. - Ken Maller, O.D.
Sidebar 2: Fees that Make Sense
You may wonder how I account for the increased chair time that bifocal contact lenses take, particularly with a
potential for mor than one fitting session. In my practice, I charge a flat, global contact lens fitting fee
based on the type of lenses I'll be prescribing. this fee also includes any follow-up visits. My fee schedule
covers more than 200 different scenarios in contact lens fitting - everthing from a simple spherical soft lens
fit to a complex specialty RGP case. It took some time to calculate these fees (they're all in my computer now),
but I believe this is the only way that's fair to both me and my patients. - Ken Maller, O.D.
Sidebar 3: Preparing Patients
Preparing your patients to wear bifocal contact lenses is at least as important as your ability to fit them. By
establishing reasonable goals, you'll avoid undue cost, chair time, aggravation and disappointment. I always
begin a new bifocal contact lens fit with a review of the available options, comparing the pros and cons of
each. I make it a point to explain the two important negative factors - time and cost. Patients are very
understanding if they know what to expect. You can head off impatience and unreasonable expectations by
informing patients at the first session that it will be at least a month before they'll receive their contact
lenses. New lens wearers only know what their friends have told them, and current wearers may have been
conditioned in the past to expect to leave your office with lenses that day. Explain that these lenses are
custom-made, which increases the turnaround time from the lab. Remember, you can wait 10 to 14 days for a lens to
come in, and if you need to reorder, a month can go by very quickly. When a patient asks why it's so difficult
to fit these lenses, I explain that we're dealing with a moving lens on a moving eye that still must always be in
the correct place so that they can see clearly whenever they're looking. That means that measurements of tenths and
hundredths of a millimeter can make the difference between success and failure. - Ken Maller, O.D.
Dr. Maller, who specializes in contact lenses, is in a solo practice in Coral Springs, Fla.
Reprinted with permission from Optometry Today - Copyright 1998. All Rights Reserved.
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| By Kenneth E. Maller, O.D. |
June 1998 |
Helping Patients Make The Hard Choice How to position RGPs in a favorable light.
Many patients, and even some doctors, are leery of rigid gas permeable (RGP) lenses because they have a reputation
of being uncomfortable. But I've fitted between 65% and 75% of my contact lens patients in these lenses by
presenting them in a positive light. Here, I'll give you some suggestions on how you can increase patient
acceptance of these lenses along with your percentage of RGP fits.
What's in a name?
The first step toward making RGPs more popular with your patients is to stop referring to them as "hard lenses."
This conjures up an image of pain - and image your patients aren't likely to embrace. If you described a soft lens
as a floppy, slimy, hard-to-handle piece of plastic, you wouldn't see many patients excited to take that path, either.
When discussing RGPs, I refer to them as "inflexible oxygen permeable" (IOP) contact lenses and stress that they
aren't to be confused with the old hard polymethylmethacrylate (PMMA) lenses from 40 years ago.
Talk 'em up.
The next thing to do is change your own bias that patients won't tolerate the sensation of the inflexible lenses.
Remember, the patient sitting in your chair only wants to accomplish three things - to see, be comfortable and have
healthy eyes. If you explain that an inflexible lens accomplishes these criteria better than a soft lens, then
the patient is likely to accept this modality. When discussing the benefits of IOPs over soft lenses, I say that
IOPs provide sharp, non-fluctuating vision, transmit more oxygen, are deposit-resistant, don't dry out, are easier
to maintain, are more durable, provide better long-term comfort and are less costly in the long run. To overcome the
comfort issue during the adaptation period, I tell my patients that they'll have success and satisfaction with the
lenses, but they'll need to give themselves from 1 to 3 weeks to adapt to the sensation (not the pain) of the lenses.
Get the right fit.
Because IOPs take a little more effort and chair time to fit, I explain the extra cost and chair time to my patients.
I use the analogy of a tailor-made suit and explain that the lenses are custom fit to their unique set of eyes. Rather
than trial fit the lenses, I design them and have them manufactured based on exam data. This ensures an accurate fit and
lets the patient leave with the lenses the same day he first experiences them. I use a topical anesthetic to help the
patient adjust to the initial sensation of the lenses. Because the lenses settle quickly this way, I can usually
evaluate the patient for fit and vision without delay. When the anesthetic begins to wear off, I explain that the sensation
the patient is experiencing is normal and the lenses will gradually become more comfortable. If the patient reports any
lingering discomfort at the follow-up visits, I modify the lenses on the premises while the patient is in the office.
I've found that very minute changes can take a pair of lenses from just being tolerated to being entirely comfortable.
Not so hard.
Offer this modality freely to all your appropriate patients, not just the difficult refractive cases, and you'll
find that many will make the "hard" choice very easily.
Dr. Maller is in private practice in Coral Springs, Fla., specializing in contact lenses.
Reprinted with permission from Optometric Management - Copyright 1998. All Rights Reserved.
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| By Ken Maller, O.D. |
July 1998 |
Solutions From Our Readers Give Group Contact Lens Lessons
Try to schedule several patients at a time for lessons in contact lens care. Patients
enjoy learning from and encouraging each other, and they'll ask about how their classmates
are doing when they're in for subsequent follow-up visits.
Dr. Maller is in private practice in Coral Springs, Fla., specializing in contact lenses.
Reprinted with permission from Optometry Today - Copyright 1998. All Rights Reserved.
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| By Edward S. Bennett O.D., MsEd |
July 1998 |
RGPs And The Young Practitioner
During a recent discussion on Walt Mayo's Optcom e-mail network, it became apparent that many young
practitioners ar not fitting any RGP contact lenses! In addition, some participants of the discussion
suggested that the "20/80 rule" exists, indicating that only 20 percent of all eyecare practitioners
fit 80 percent of all RGPs.
Many Optcom participants placed much of the responsibility for this trend on the the contact lens
educators. However, I can justify that my colleagues in the Association of Optometric Contact Lens
Educators (AOCLE) and I are only a small part of the problem. Certainly one factor for why our students
insufficient RGP experience is the impact of, and fascination with, treating ocular disease. Likewise,
the curriculum at some schools has been changed to limit students' exposure to contact lenses, often to
the dismay of the affected contact lens educators.
Addressing The Problem.
Enhancing students' RGP fitting experience is extremely important and accounts for a significant part
of the Rigid Gas Permeable Lens Institute (RGPLI) budget. Many RGPLI dollars fund a one-day, hands-on
workshop and seminar program conducted at most schools of optometry with the gracious support of the
AOCLE members at each participating institution. There are spherical, aspheric, toric, bifocal,
keratoconic and postsurgical RGP-wearing patients at each workshop. The RGPLI and other cntact lens
industry members try to help students understand how much practice income is derived from contact lenses,
as well as the profitability of RGPs. It's a message that the students can't hear enough (Table 1).
An Optimistic Resolution.
The good news is that several young practitioners on the Optcom list who fit 40 percent or more of their
new patients into RGPs spoke up about taking the initiative to try RGPs and about the subsequent benefits
of practice growth and profitibility, vision, ocular health and ease of care. RGPLI advisory committee
member Ken Maller summed it up best when he said, "If RGPs are so wonderful for so many reasons, why are
they being reserved for only the exotic cases? Instead of waiting for the next keratoconus patient,
maybe this [discussion] will inspire some doctors to try them on the next easy one who sits down in the
chair."
Patients may be "soft" in their thinking, but if you recommend RGPs, most will be satisfied and
successful with them. Remember that they still look to you for advice on which type of contact lens is
best for them.
Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis and
executive director of the RGP Lens Institute.
Reprinted with permission from Contact Lens Spectrum - Copyright 1998. All Rights Reserved.
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| By Ken Maller, O.D. |
August 1998 |
PERRL Of The Month Refitting Soft Lens Wearers Into RGPs
As your presbyopic patient base grows - and it will - you may find that you're refitting some long-time soft lens
wearers into rigid gas permeable lenses. To give these patients greater confidence in their chances of
success, take a little extra time to counsel them. Stress the issues that are most important to patients - ocular
health, sharp vision, ease of care and handling, and long-term comfort. With your reinforcement, they'll
place more importance on long-term benefits than initial comfort.
Dr. Maller is in private practice in Coral Springs, Fla., specializing in contact lenses.
Reprinted with permission from Optometry Today - Copyright 1998. All Rights Reserved.
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| By Kenneth E. Maller, O.D. |
September 1998 |
Disposable Lenses Aren't A One-Size-Fits-All Option Fitting patients with RGPs can be a healthier, more profitable choice.
Disposable lens wearers often consider themselves the experts when it comes to contact lenses. They'll tell
you things like "I can wear these 2-week lenses for a month because they don't really bother me," or "I
sleep in my lenses until my vision gets a little foggy, which is usually after about 3 week." And,
"Solutions? Why would I need to use solution? I wear disposable lenses!" Did you ever notice how their
"know-it-all" attitude disappears when they show up with a painful corneal ulcer? A painful red eye
is an excellent educator, but waiting for a sight-threatening infectious keratitis to educate your patients
about the benefits of rigid gas permeable (RGP) lenses isn't really necessary. You can start this
education the next time they're in for their examination. Here's what I recommend.
Deliver the facts.
Disposable contact lenses can provide many advantages over rigid lenses. However, contrary to public
opinion, they're not "one-size-fits-all lenses," nor are they the best choice for everyone. Many times,
patients will sacrifice their visual acuity or ocular health, consciously or subconsciously, because they
have the erroneous belief that a disposable lens is always best. There's an entire disposable contact lens
wearing population that can be better served by other lens modalities. Instead of watching your profit
margin shrink to $0.25 per box, having your patients leave your practice, and making compromises on the
ocular health and vision of your patients, you should take the time to educate your disposable contact lens
patients to these two important facts:
1 - You're the doctor, and you know significantly more about contact lenses and their eyes than they do.
Therefore, you can recommend a better option.
2 - Wearing disposable lenses may compromise their vision and their ocular health.
Identify the benefits.
I've heard many of my colleagues say that it's impossible to refit a soft lens wearer into rigid contact lenses,
especially a disposable soft lens wearer. But RGP lenses can compete exceptionally well with disposable
lenses if you present them the right way. To be successful with RGPs, you need to identify the specific
weakness that a disposable contact lens presents to a patient and then refit the patient into a rigid
contact lens that improves on that weakness. (See "Success the Second Time" below.) Here are some of the
key advantages RGP lenses can offer your patients.
- Higher Dk.
The oxygen transmissibility of the newest generation of rigid lenses far exceeds the soft lenses of today.
The smaller size of the rigid lenses also allows much of the cornea to remain exposed to the air while the
movement of the lens causes tear pumping and flushing of metabolic waste. Research suggests that increased
oxygen reduces the risk of microbial keratitis and other serious ocular complications. Corneas that require
more oxygen, as well as ocular surfaces that are habitually drier, will maintain better integrity with an
RGP lens.
- Better health.
Because they're composed of such a high percentage of water, soft lenses act as a reservoir for allergens,
protein, bacteria and other contaminants. These factors can all lead to higher risk for infection,
inflammation, allergy and corneal vascular changes. If you have patients who are suffering from any of
these problems with their disposable lenses, they'll probably have more success and feel much better in
rigid lenses.
- Improved visual acuity.
The main reason that patients wear contact lenses is because they want to see better. How often do
patients have some uncorrected astigmatism that you just "let go" to allow them to continue in disposable
lenses? If a patient's vision is better served with a rigid lens and you present the options of better
vision or disposability to the patient, the patient will most likely choose the better vision option.
A Superior Option.
I'm not advocating that all patients stop wearing disposable lenses because there are clearly some patients
who are best served with this modality. But I do think that there are too many patients wearing
disposable lenses for all the wrong reasons. Refitting these patients will better serve their needs.
Refitting disposable lens wearers into more appropriate lenses will also be much more profitable for your
practice. Sure, rigid lenses and bifocals require more chair time, but I don't see anything wrong with
giving the chair time they need as long as I get reimbursed for it. Another benefit of fitting RGPs is
that patients stay loyal to your practice. You're providing them with a premium service that they can't
get elsewhere. You'll rarely have RGP wearers ask for a prescription to fill by mail. Those who do
quickly learn that they can waste time and money trying to get the proper replacement. Don't make
assumptions about whether the RGP option is too costly for a patient up front. When I make
recommendations for the contact lens wearer, I only bear the patient's vision, comfort and health in mind.
It's not my decision whether it's too costly. When you educate your patient's properly, you'll find
that very few will choose an inferior option bases on cost.
Give Your Patients The Filet.
The next time a disposable lens patient is sitting in your chair giving you and "order" think about the
possiblity of refitting him or her into a superior lens option. Instead of taking the order for the "eight
boxes, fries and shake," offer the filet that your patient didn't even know was on the menu.
Sidebar 1: Success The Second Time
Here's an example of how a refit benefited both the patient and my practice. A 52-year-old woman came
to my office complaining that her near vision was poor. She was wearing a -6.50 disposable lens on
each eye, which I guessed to be a monovision prescription, using the left eye for near vision. Her
distance acuity with these lenses was OD 20/25, OS 20/30. Both lenses were coated and deposited, and
both corneas were showing 1.5-mm, 360-degree limbal superficial vascularization. She commented that she
liked the convenience and comfort of her current lens modality. She'd been wearing them daily for 10
years, with 1-month replacements. She was in good health and the only medication she was taking was a
hormone supplement. Her refraction was OD -6.75-1.50x030 20/20, OS -6.75-1.00x140 20/20 with a +2.00
add in each eye. Her keratometry was OD 44.37/45.12@112, OS 44.25/45.25@058. After the exam, I explained
to the patient that her distance vision, as well as her near vision, was not very sharp and could be
improved. I recommended that we abandon her disposable lenses for the superior option of inflexible
oxygen permeable bifocals. (I refer to RGPs this way when talking with patients to present them in a
more favorable light. See "Helping Patients Make The Hard Choice," page 28, June 1998.) The patient
told me that she had tried and failed in RGPs several years ago. I explained that she would be better
served with the option I recommended and she agreed to try it. I refit her into a translating design RGP
bifocal on each eye. Her corrected distance vision is now 20/20 in each eye, and she has 20/20 near
(Snellen equivalent) with a clear reading range of 13 to 22 inches. She says that she is able to see
the television clearly and didn't realize how blurred her vision was with her disposable lenses. She's
also delighted that she has such clear near vision and has started to read for leisure, an activity she'd
discontinued. She is wearing the lenses 16 to 18 hours per day, and they're remaining clear,
comfortable and uncoated. Her corneal limbal vessels have receded to about 0.5 mm. It's easy to see how
the patient benefited from being refit with RGPs, but I would like to point out the benefits to my
practice. An average life expectancy of a pair of these bifocals is about 2 to 3 years. Even if the patient
came to me for disposable lens replacements every year for 3 years, the profit of those replacements would
yield less than 25% of what I collected in profit up front at the refit. Maybe it's time for you to consider
fitting this modality more for your patients, as well.
Dr. Maller is in private practice in Coral Springs, Fla., specializing in contact lenses. He also serves on
the RGP Lens Institute Advisory Committee.
Reprinted with permission from Optometric Management - Copyright 1998. All Rights Reserved.
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| By Carol A. Schwartz, O.D., M.B.A. |
November 1998 |
Photodocumentation: Optimizing Today's Contact Lens Practice
There was a time when records consisted of only paper and ink. What the doctor saw and then wrote or
dictated to file was pretty much all that could be expected. Technology has changed all that. The
definition of what constitutes a patient record or what serves as the standard of care in keeping
patient records is somewhat more obscure today, but may include slides, hard copy images and digital
images. Chief among these elements for contact lens practitioners are digital or film images, but
the type of services you provide dictate to some extent the type of record that will prove useful. For
example, an eyecare professional performing an orthokeratology procedure needs to document baseline findings to
illustrate the patient's status prior to contact lens fitting. In addition to refraction, some description
of the corneal shape is a must. Keratometry readings might suffice, but the standard of care is quickly
moving to corneal topography.
Photography often comes to mind for documenting pathology, but it also has great potential for use in
contact lens practice. Contact lens fitting following penetrating keratoplasty, radial keratotomy,
photorefractive keratectomy, giant papillary conjunctivitis and neovascularization are all examples of
cases where photodocumentation of baseline findings and progress examinations are useful.
Dr. Maller uses a digital camera mounted on a slit lamp and a software package called "Reveal TV for PC" to
capture, freeze and save images. He admits his set-up is cumbersome, but when he purchased it two and a
half years ago, it was the only thing available. Dr. Maller cautions those shopping for photodocumentation
systems to brace themselves. "It's exactly the same as computers - whatever you buy, you don't even make it to the
checkout counter before it's obsolete!" he says. "You have to figure out if it will do what you want it
to do, bite the bullet, and then just use it until it's absolutely antiquated." For example, his current
unit cannot easilly make a hardcopy image to file, but he promises that his next system will include this
capability.
Other incentives.
Of course, liability is not the only reason to perform photodocumentation. The most common reason is simply
to refresh your own memory. Instead of trying to remember how big that infiltrate was last week, you can compare
the two images and measure. "There are many things you see that you want to follow," agrees Douglas P. Benoit, O.D., of
Concord, N.H. "It's more accurate to follow conditions from a photo than from a simple diagram." The
biggest payoff, however may be in patient education. "It gives patients a better understanding of their
conditions," adds Benoit. Dr. Kenneth Maller of Coral Springs, Fla., uses his video capture unit to show presbyopes
how their multifocal lenses move on the eye. "It helps them understand how their lenses work and how to make
them work better," he says.
Reprinted with permission from Contact Lens Spectrum - Copyright 1998. All Rights Reserved.
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| Ken Maller, O.D. |
November 1998 |
Venturing On To The World Wide Web Why you should consider developing a site and how to get started.
Continuing to attract new patients and keeping existing ones is at the heart of every practice's
development. One of the newest means to achieving this goal is creating a personal Web site on
the Internet. I decided to create my own office Web site (http://www.YesEyecare.com) 2 years ago,
and I've had tremendous success with it. Here, I'll explain why I think you should consider reserving
your own place on the Internet and how you can benefit from it.
What is a Web site?
A Web site can be anything from an advertisement to a more in-depth communication vehicle from your
office to the general public. It can be as simple as a "billboard" to tell the public who you are
and what you do, to a totally dynamic interactive site that allows patients to make appointments, ask
you questions or get directions to your office.
Starting construction.
Getting started on a Web site is easy. Approach it the same way that you would any venture. Start
by outlining what you want to accomplish. Then, allot an appropriate amount of resources, time and money
toward accomplishing your goal. The actual nuts-and-bolts construction of a Web site requires a
variety of disciplines - from information and design, to writing the code, registering your domain
(address) and updating the site. If you have a fair amount of computer knowledge, it's possible to
develop your site yourself using one of the Web authoring tools currently on the market. However, if
you're looking for something unique and dynamic, and you don't have much computer experience, you may
want to hire a Web site development service to create your site. Depending on your budget, a Web site
developer can create an inexpensive "generic" Web page, or provide you with a fully customized site.
The cost increases proportionately.
What to put on your site.
Take full advantage of this unique medium by posting information about all of the services you offer.
This will inform and educate patients and potential patients in much the same way that the brochures in
your reception area do. In addition, you can use your Web site to record patients' medical histories
and allow patients to make appointments online. This will give your patients 24-hour access to your office.
I also use my Web site to provide my patients with a free e-mail newsletter. To sign up for this service,
patients and Web surfers simply enter their names and e-mail addresses. My e-mail newsletter accomplishes
several goals. First, it conveniently delivers eye information that might be of interest to my patients
directly to their e-mail addresses. Secondly, it saves me money on the design, layout, printing and
postage costs associated with a traditional patient newsletter. It's a very cost-effective way to
deliver information to my patients and the public. When you're deciding what to put on your site, keep
in mind that the Web is still very much a wide open playing field. The possibilities are unlimited. Use
your creativity to come up with ways to market your practice so that it'll stand out from what's already
been done.
The advantages are clear.
One of the main reasons you should give serious thought to putting your office on the Web is because your
patients spend a fair amount of time there, searching for everything from pet supplies to tax information
and medical knowledge. Having a Web site will also give your patients the impression that your office
is up-to-date. Patients want their doctor to be current. Don't make the mistake of assuming that the
Internet is just for younger, computer savvy people. While I was writing this article, I received an
online appointment request at my Web site from a new 61-year-old patient. He filled out my online eye
and medical history forms, and even asked that my office confirm the appointment with him not by
telephone, but by e-mail. The Internet is only going to increase in popularity as more people find
out what a convenient and valuable resource it can be. Those companies and practices that don't invest
in developing a Web site may be at a disadvantage when it comes to advertising their services.
The potential is unlimited.
The ideas I've shared with you really just scratch the surface of the Internet's power and potential.
Taking advantage of this medium by developing your own place on the World Wide Web will enable you
to effectively communicate with your patients now and in the future. The key is to start simple and build
on your site gradually. Remember, the Internet is an evolving medium, so everything doesn't have to
be perfect right away. You can modify your site as often as you like. One of the things that's so
great about the Internet is that it's always changing. So take the plunge. Hopefully, I'll see you
in cyberspace!
Dr. Maller is a private practitioner in Coral Springs, Fla., specializing in contact lenses. You can visit his
"sight" on the web at http://www.YesEyecare.com
Reprinted with permission from Optometric Management - Copyright 1998. All Rights Reserved.
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| By Ken Maller, O.D. |
November 1998 |
PERRL Of The Month Low Astigmats May Need Toric Lenses
If you've fitted a spherical RGP lens on a toric cornea of low cylinder (1.50D, for example) and the patient
complains of discomfort, Ken Maller, O.D., suggests you try an aspheric or even a bitoric lens instead. Often
the specialty lens will enhance comfort even though it isn't required for vision correction.
Dr. Maller is in private practice in Coral Springs, Fla., specializing in contact lenses.
Reprinted with permission from Optometry Today - Copyright 1998. All Rights Reserved.
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| By Ken Maller, O.D. |
January 1999 |
PERRL Of The Month Managing RGP Patient Expectations
Warn first-time RGP wearers that side-to-side eye movements will be the last of the comfort adaptations to come
and can take as long as a month. Knowing that this sensation is a normal part of the adaptation keeps patients
motivated.
Dr. Maller is in private practice in Coral Springs, Fla., specializing in contact lenses.
Reprinted with permission from Optometry Today - Copyright 1998. All Rights Reserved.
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| By Judith Lee |
January 1999 |
10 Lessons for All Time from the Start-ups of the ’90s. Despite heavy debt and managed care,
the way is still open for doctors who want to start their own practices. O.D.s who have “opened cold” share
what’s worked for them, and how it can benefit even established practices.
For optometrist Pam Ellis, the drudgery of working in a commercial setting was getting to her. For
Arlene Hughes Gorny, the desire to call her own shots motivated her. For Steven Maxwell, O.D., the
clock was ticking. For all three, the dream of private practice lives on, and they’re making a go
at it despite a health-care marketplace that ranges from indifferent to hostile. These optometrists
are among the few who have opened new practices in the past several years. A select group, they freely
acknowledge the challenges and rigors of starting a practice in the 1990s, but at the same time their
practices are growing. Some have recently transitioned from part-time to full-time hours. Dr. Maxwell
has even opened a second location. “I was never comfortable in a commercial setting, and did not enjoy
it,” Dr. Ellis says from her Bel Air, Md., practice. “I worked in other settings, too, but I never felt
I could practice as conscientiously as my patients deserved. I never felt my professional service was
valued.” Despite the pressures of opening a practice in the 1990s, these doctors are finding success.
“My practice is right on target with the busi- ness plan I wrote before I opened. We’ve had a lot of
repeat business and referrals from patients,” says Dr. Gorny, who opened a practice in Cape May, N.J.
in mid-1996. Dr. Maxwell agonized over his decision to open cold in Dubuque, Iowa. “I thought about
this for 10 years,” he says. “My wife reminded me I wasn’t getting any younger.” The lessons they’ve
learned apply to any independent practice. These doctors say there’s no secret to their success. Along
with constant dedication, they put everything they have into making their practices grow. And, nobody
told them it was going to be easy. Says O.D. Tim Van Kirk, of San Diego, “In optometry school, they told
us it takes three years to establish a practice. They didn’t say the first year was pure hell.”
Lesson 1: Invest in Yourself
All of these O.D.s who started their practices cold say you must invest in the practice. That means new
instruments, appealing decor and a total look that tells patients you intend to succeed. “We put in the
best of the best; we’re dressed to the nines,” says Kenneth Maller, O.D., of Coral Springs, Fla., near
Fort Lauderdale. “Our office reeks professionalism. We do not carry schlock frames. It all helps to
attract quality patients, and that’s how we make money.” When Dr. Maxwell first planned to open his
practice, he budgeted $50,000. After seeking the advice of Denver consultant John Gay and office designer
Will Rogers, he upped that four times, and it has paid off. “Right from the first month we opened, we earned
three to four times our projections,” he says. “Patients keep mentioning that this is the nicest office
they’ve seen in Dubuque”—a city of about 60,000 on the Mississippi River—“and I think that has a lot to
do with our success.” Dr. Gorny put together an experienced staff that projects a competent, professional
image. Her opti- cian came out of retirement to work four days a week at Dr. Gorny’s new practice. Her
office manager (who is training to become an optician) and part-time assistant both were prior workplace
acquaintances of Dr. Gorny’s. “I knew these people and knew their work. I know I can trust them,” she says.
When Michael Bacigalupi, O.D., opened his practice in rural Ballinger, Texas, he also chose not to skimp.
“The office is high-tech and professional. It tells people that we are here to stay; we won’t be gone next
week. By investing in a nice office, we were investing in this community,” he explains.
Lesson 2: Operate Lean
Some experts will tell you to hire more staff, but these doctors believe in operating as lean as possible.
Several of these doctors even answer their own phones at times. “It’s important not to hire staff that
you can’t afford,” Dr. Maxwell says. “This places a burden on the practice, and will keep you in the
red. Besides, I never want to get so high and mighty that I can’t pick up the phone in my own practice.”
After a year in practice, he has one full-time employee, a part-timer and another employee for his
second location. He says it’s particularly important to select staff mem- bers who work well as a team.
“We had several that didn’t work out,” he says. “Now we have a good team, and I think patients can sense
it. People enjoy it when the staff works well together.” Dr. Maller has just one employee who is a
trained optician and operates the front desk. He says she does an excellent job of projecting a
professional image. Dr. Bacigalupi has two employees, both trained vocational nurses. Right away,
he says, this told the community that his office was oriented toward primary care. “This sets the
tone for the practice,” he says. “When patients walk in and recognize a nurse they’ve seen in a family
practice or at the hospital, they know we are offering professional health care.” These staff members
have lived and worked in Ballinger for many years and helped introduce the new doctor to his community.
“These are local people who know so many other people. It’s hard to measure the value of that for a new
practice,” he says.
Lesson 3: Reach out to Everyone
These practice owners say you can’t be shy about promotion. They’ll do almost anything to gain visibility.
“I wrote a column for a local paper that gives me editorial space along with my ad,” Dr. Maller says. “I’ve
done school screenings and given talks at schools. I also have an interactive web site.” Dr. Ellis also
writes a column, and shares the expense and the space with an ophthalmology group. Dr. Bacigalupi sponsors a
radio show that runs before the broadcast of local high school football games. “Every week, people listen
to the City Eyecare Pre-game Show. It keeps our name out there,” he says. Dr. Maxwell stresses that
optometrists must do more to mine their current patient load. Along with advertising for new patients,
he works hard to encourage referrals from current patients. “I’ve learned to get comfortable with this,”
he says. “I’ve found that if people are happy with your service and products, they are willing to refer
others to you. I give referral cards to every patient and ask them to send friends, coworkers and family
to me. When I get a referral, I send a thank-you card, and I think this goes a long way.” Dr. Gorny’s
practice also is growing from patient referrals. Although she does not ask for them directly, she feels
patients truly appreciate her practice’s focus on service. “Before becoming an optometrist, I was a
nurse,” she says. “I saw the other side of things, when some doctors are arrogant with patients. I
just hate that, and patients do too. When you treat patients like human beings and valued customers,
they really respond to you.”
Lesson 4: Go West, Young Doctor
New practice owners say it’s critical to locate your practice where you’re needed. If you have too much
competition nearby, consider moving to a community that has few, if any, eye-care providers. “My wife
and I were welcomed here with open arms. That would not have happened in a suburb of Dallas or Houston,”
Dr. Bacigalupi says. “If you really want your own practice, you need to go where patients need you.”
Ballinger is in central Texas, about 300 miles from either Houston or Dallas. If you’re unwilling to
pull up stakes and move, you might find an opportunity nearby. Dr. Maxwell found out that an optical
shop in an adjacent town had closed, leaving that town without any type of vision care. Because some
of his patients lived on the side of Dubuque near that town, he worried that they might be attracted
to a new practice that would open there. “I opened so no one else would. Now my patients on the south
side aren’t so vulnerable to being drawn away from me,” he says.
Lesson 5: Subsidize Your Dream
A new practice, or even an established one that’s struggling, can greatly benefit from supplemental
income. For three years Dr. Ellis worked three days a week at her own practice about 20 miles northeast
of Baltimore, and three days at Aberdeen Proving Ground, a military installation nearby on the Chesapeake
Bay. “It was exhausting, but it gave me an income while my practice was growing,” says Dr. Ellis. While
Dr. Maller was dealing with contractors and setting up his practice, he worked for other optometrists
who needed temporary help. One practice was 180 miles away, requiring him to stay over one night a week.
“I did a lot of driving and it was tough on my family,” he says. “But we had an income during the
time that I was spending money on the practice but wasn’t yet ready to see patients and make money there.”
Arthur Clarke, O.D., of Landing, N.J., continues to work in jobs outside of optometry as his fledgling
practice becomes established. A former teacher and coach, he now supervises lifeguards at all New Jersey
state parks. “It’s a seasonal job that gets busy when the optometry practice isn’t. It helps me be
patient as I wait to become established,” he says. Dr. Maller warns against spending too much time
away from a private practice: “It’s like a baby—it needs you a lot in the beginning, and you don’t
get that much in return.”
Lesson 6: Don’t Compromise Care
New practice owners say they took the big step to offer truly professional care, and all private doctors
should be careful not to compromise on this. “Building a practice is like building anything of value,”
Dr. Ellis says. “It takes time, and you can’t be in a rush to generate income. It only takes five years
to pay off your equipment. We can outshine the retail establishments by providing great care and by
really taking charge of our profession.” Dr. Maller observes that managed care squeezes doctors to
reduce the time spent with patients and the service they provide. This only reduces the value of
care and makes all practices look the same. “The only way we can be different is to be better,” he says.
“We don’t chase after managed-care patients because managed care pressures us to be just like other
providers. We’re chasing after the private patient who wants better care, values it, and will pay for it.”
In the resort area where Dr. Gorny practices, many patients are small business owners without vision
plans. She’s found that quality care is important to them, and appreciated. “This is a small town;
everybody knows everyone else. If you give people quality care and treat them right, they’ll be back.
If you don’t, they will take their hard-earned money elsewhere.” Dr. Ellis, who put in an optical
dispensary in deference to vision plans, refuses to be paid mainly through optical sales. “It’s OK to
offer the service of an optical, but that is not what our profession is about,” she says. “We must
act like doctors and insist on being treated like doctors, or we will no longer be doctors.”
Lesson 7: Abolish Receivables
While some new practitioners complain about not being included in managed-care panels, others purposely
shun them. That’s because managed care creates such a backlog of receivables. “Managed care costs doctors
too much in three ways,” Dr. Maller says. “First, the fees are discounted. Second, we have to wait to be
paid. Third, we have the cost of processing and re-processing claims.” Instead, he developed a complex
fee structure that allows the office to cover all professional services. This has been input into the
computer, and his optician/assistant uses it when presenting the final bill to patients. “It’s good to
be able to show that there’s a system to your fees,” Dr. Maller says. “You aren’t just picking a number
out of the air. We like to be able to explain exactly what the charges are for.” His assistant simply
presents the bill to the patient without apology or embarrassment. She asks the patient if they would
like to pay by cash, check or credit card, and almost everyone pays the whole bill up front. “We
absolutely insist that the professional fee be paid that day,” Dr. Maller says. “If the patient is
concerned about the cost, we tell him that he can pay for half the materials at that time, and we will
order them. But he must pay the entire balance before taking contact lenses or eyewear with him.”
Lesson 8: Opportunity Knocks
Even though these new practice owners don’t have much of a security net, they say it’s important to
continue to take risks. This is the only way practices can grow. Says Dr. Maxwell: “When I heard
about the opportunity to open an office in Cascade, I wasn’t sure it was the right time to expand.
But if I hadn’t opened the office, someone else would have. Then I wouldn’t have had the chance to
gain a foothold in that community.” Cascade is a small town about 20 miles southwest of Dubuque.
He could already see that his investment in Dubuque was paying for itself with revenue above his
projections. “This [the Cascade office] is a much smaller investment, and it’s good for the future
of the practice,” Dr. Maxwell says. In Maryland, Dr. Ellis finally was able to work at her practice
full-time this year, but she is not about to become complacent. “Things are better,” she says.
“They are going well. But I will have to partner with other doctors to achieve my goals. I’m not
sure how I will do this, but I am seeking a window of opportunity. If you don’t capitalize on that,
you lose the opportunity.”
Lesson 9: Be Proactive
New practice owners say they are trying to stay one step ahead of the marketplace. This means creating
solutions to problems that aren’t big problems yet. Dr. Bacigalupi created his own vision plan and
marketed it successfully to four large employers in Ballinger. He has gained 850 employees and their
spouses as patients. “This is a simple discount plan,” he explains. “The patient presents a card and
I give a discount on eyewear. It doesn’t cost the employer anything, and I have grown my patient base.”
He says that vision plans are not common in west Texas, but he decided not to wait around. “Why wait
for a big plan to call up your local employers? Why not call them yourself? I just presented a
one-page proposal and got a very positive reception,” he says. There are two new companies in
Ballinger, and Dr. Bacigalupi intends to offer them the plan next.
Lesson 10: Work Harder
Established doctors may bristle at this advice, but new practice owners say there’s no bigger boost
than the doctor’s energy. “When you open a new practice, there’s no end to the work,” Dr. Maller says.
“In the first year, there was no week I worked less than 90 hours. There’s always stuff to do. Nothing
is in place, and the only way it will get in place is if the doctor does it.” Even though many optometrists
work harder these days to see more managed-care patients, he believes this is misdirected energy. If you’re
going to work hard, direct your energies toward building practice visibility and performance. He says you
will be repaid with growth that will carry your practice forward. Dr. Gorny believes she is gaining new
patients from patient referrals because of the time she puts into each exam and patient interaction. “I
have the luxury of time because I am not super-busy, but I do not intend to become too busy to give patients
the time they deserve. I just want to have my own practice where I call my own shots, and do things the way
I believe they should be done.” Opening cold has never been easy. Whether it’s any harder than it was
25 years ago depends on the generation of the doctor you ask. Despite some new twists and turns, the path
to solo practice success remains fairly constant. And even those doctors who are new at it have learned
a few things from which every practitioner can take a lesson.
Reprinted with permission from Review Of Optometry - Copyright 1999. All Rights Reserved.
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Carol A. Schwartz, O.D., M.B.A., F.A.A.O.; Edward S. Bennett, O.D., MsEd, F.A.A.O. |
February 1999 |
Specialty Lenses: Don’t Let Your Best Patients Disappear. RGP wearers can be your practice’s biggest asset. Don’t allow your lack of knowledge to drive them to a competitor.
How much do you know about fitting specialty contact lenses, like rigid gas permeables (RGPs)? Maybe
you’re not anticipating making these lenses a big part of your practice. You may even think of RGPs
in particular as something most patients aren’t interested in. If that’s what you’re thinking, you’re
not only selling these lenses short, you may be selling the future of your practice short as well. These
lenses provide crisp optics that soft lenses can barely equal. And patients who wear them often become
diehard supporters of the doctor and practice that prescribed them. In these economically tough times,
that’s a factor you can’t afford to overlook.
A cautionary tale.
Unfortunately, ignorance and negativity about these lenses is widespread. The following true story
illustrates the frustration many RGP wearers experience dealing with optometrists today. Our story is
about a young man we’ll call Joe. Joe’s dad owns a contact lens lab, so when Joe was a teen and decided
he wanted to wear contacts, his Dad hand-picked an O.D. who fit Joe with RGPs. Joe loved his -9.00D
lenses and wore them all the time when he was awake. Everything was fine — until one day he lost his
lenses. He had a spare pair, but it turned out that they needed polishing. He called his regular
optometrist about getting them polished, but he was told that he’d have to leave his lenses in their
office. Since he needed immediate help, he tried every O.D. in town, but he got the same response.
Finally he called the optometry school clinic, and they said they could polish them, so he made an
appointment. But as soon as he got there he discovered that they couldn’t find a record of his
appointment! When they did find it, he waited 20 minutes and then a student in a white coat came
to him and said, "Are you here for an eye exam?" Joe repeated that he was there to have his contacts
polished. This was followed by another 20-minute wait. Finally a senior student came and asked Joe
to follow him. When they arrived at their destination where another senior student was waiting,
Joe started to take out his lenses. One of the students said "Oh, PMMA I see," then added, "That’s
polymethylmethacrylate," obviously trying to gain some points with his erudition. "No," Joe answered,
"As a matter of fact they’re high Dk fluorosilicone acrylate gas perms." "I thought all rigid lenses
were PMMA!" said the surprised student.
Setting the record straight.
What’s wrong with this picture? Aside from the fact that Joe had so much trouble getting a simple
need met, the students "helping" him weren’t second-year students on their first case. They were
seniors just weeks from graduation. And yet their patient knew more about RGPs than they did!
Unfortunately for us all, this sort of thing isn’t rare. Many RGP-fitting optometrists have heard
stories similar to Joe’s from their patients. For example:
• Dr. Bob Copeland tells of a nurse-practitioner who could find only one practice in the Philadelphia
area that was able to replace a lost RGP lens. Was this because RGPs aren’t popular in Philadelphia?
Apparently not — the practice had a 6-month waiting list of new patients!
• Dr. Kenneth Maller of Coral Springs, Fla., fits about three quarters of his patients in RGP lenses.
Although he opened cold a few years ago, referrals from enthusiastic RGP wearers have fueled the growth
of his practice. Dr. Maller tells the story of a 16-year-old patient who lost a lens while out of town
on vacation. Her father took her to a local O.D. who told her how awful rigid lenses were and insisted
on refitting her into soft lenses. When vacation was over the teen insisted on being taken back to Dr.
Maller, and proceeded to tell him how much she wanted to get back into the RGPs.
• Dr. Donna Higgins of Prairie du Chien, Wis., tells the story of a teen-age Type I diabetic patient whom
she fitted in high Dk RGP lenses because of health concerns. The patient proudly showed off her lenses
at a family reunion, also attended by her uncle — who happened to be an O.D. Her uncle got very upset
that she was wearing rigid lenses, believing she’d be better off in a soft lens. The upshot? The young
lady ignored her uncle and remained in rigid lenses. And she still sees Dr. Higgins for her eyecare, proving
that blood is not thicker than saline.
The four R’s of rigid lens patients.
While we find true stories like this frustrating, they illustrate the four characteristics of the
typical RGP wearer:
• Respect. The first of these attributes, and the most important for optometrists to note, is that
RGP wearers respect their fitters. Conversely, they don’t respect those who speak ill of the lenses
or who don’t seem to know much about them. In fact, if an RGP patient discovers that his present doctor
falls into the latter category, the patient will go out of his way to get a new doctor and delight in
telling the new doctor what an idiot the previous doctor was.
• Reliability. As demonstrated in several studies, RGP patients are loyal to a fault. Once they find
an optometrist who understands rigid lenses and can fulfill their needs, they’ll stay with that fitter,
no matter how inconvenient it becomes. They recognize a specialist’s knowledge and value his or her expertise.
• Referrals. These are the heartblood of any practice, and to a new practice they’re vital. Even if your
"practice" is a position in a hospital or HMO, you’ll be expected to cultivate your own patient base and
help grow the aggregate practice by bringing in new patients. Studies have shown that RGP wearers are more
likely to refer their friends and co-workers than soft lens or spectacle patients. Young practitioner
Dr. Maller, whose story we told earlier, proves that specialty contacts are something you can build your
future on. If you’re one of those young O.D.s who believes your prowess in treating ocular disease will
be your ticket to the future, think again. Pathology patients rarely refer. You seldom hear someone say
"Gee, Harry, the next time you get a nasty red eye, run right in to see Dr. Smith." But patients often
recommend their contact lens fitter. And this is a service patients can initiate at any time; they don’t
have to wait for an annual check-up or a disease occurrence.
• Retention. Marketing experts will tell you that it costs five times as much to find a new patient as
it does to keep one existing patient. That’s why it’s so important to hang on to patients once they
choose you as their doctor. And as you can see from Drs. Higgins’ and Maller’s stories, retention is a
key attribute of RGP patients. Rigid and specialty lens patients return year after year for contact lenses
and professional services.
Treating the whole patient.
Awareness of the advantages of specialty lenses like RGPs seems to come hard to new O.D.s. Some never
get the message, spending their careers wondering why some of their classmates are so much happier and
more successful in their work. After long, hard years of thinking about the minutia and complexities
of the eye, it’s hard to change gears and think about the whole patient — relating what you’re doing
for your patients’ eyes to their systemic health, their lifestyle, their occupational needs and their
overall happiness. (Note how many practices didn’t think that it might be inconvenient for a 9D myope
to walk around uncorrected while they mailed his lenses to the lab for polishing!) But meeting the
needs of the whole patient is what really counts, and specialty lenses like RGPs are an important way
to do exactly that.
How your patients see you.
Earlier, we talked about the issue of respect, and how your attitude toward (and knowledge of) lenses
like RGPs affects your patients’ attitud |