In summary, thefees must be higher than for conventionalcontact lens patents because ofgreater chair time and the higher level of training required for you tobe confident in offeringthisspecialty. Also,the lenses, which are custom-generated, will cost more and need to be replaced at leastannually since corneal conditions in these patients changes frequently. You alsoneedto conduct cornealtopography and see the patient repeatedly. The contact lenses may range from $200 to over $800 for an annual bilateral supply.Īkereatoconus specialist needs to haveseveraltrial sets of contact lenses on hand, since there is agreat deal of “trial anderror” in addressingthe unique challenges of such patients. But for most keratoconus patients, the usual and customary new contact lens prescribing will carry a global fee over $700, excluding the actual lenses. The contact lens services in mild cases may be no different than a patient without keratoconus, if the prescribed lens is a simple disposable soft lens. In other cases where the keratoconus is more severe and causing problems with vision or comfort, the patient may need examinations every week during the contact lens prescribing process.įor many keratoconus patients, the services revolve around contact lens prescribing, typically custom lenses. In these cases, annual eye examinations are adequate. In some cases, the disease is so mild that it’s virtually undetectable and eyeglasses and disposable contact lenses are sufficient. There are tremendous variations in severity in keratoconus cases, and the amount of care required also varies greatly. But there is great opportunity here if you develop skills in fitting rigid lenses for this condition.Overthe pastseveral decades, soft contact lenses, easily fit, have become a commodity while specialty contact lens practices that fit contact lenses and rigid lenses have become increasingly rare.Ifyou can fitrigid, oxygen-permeable lenses, you have something that differentiates your practice. Since it’s estimated that one out of every 500 to 1,800patientshas keratoconus, it is not plausible for every ECP to develop a significant keratoconus practice. I’ve probably had over 30 different ECPs refer me their irregular cornea patients. Quite a few ophthalmologists also refer me their keratoconus patients for contacts lenses, as well. I’m fortunate to have a number of optometrists, many in retailsettings, refer me their irregular cornea (trauma, scars)patients. Since few optometrists and ophthalmologists specialize in keratoconus, you can generate patient visits best by referrals. In our practice, theinitial treatmentfee is$700.Also, your staff must understand coding and billing for this treatmentfor you to get a decent return on your investment in gaining clinical skills and acquiring instrumentation and fitting sets. Treating keratoconusrequires significantly more chair time, and you need to set premium treatment feesto cover that. This experience alsoled to having strong referral relationships with other ODs and ophthalmologists. You don’t need this type of a background to provide keratoconus treatment, but undergoing a contact lens residency or fellowship provides invaluable experience treating irregular cornea patients. Inorder to develop clinical skills and launch a specialty intreating irregularcorneas,Icompleted a year-long fellowship at UCLA Jules Stein 11 years ago where I cared for many keratoconus patients. This has become a significant part of my practice, and I encourage othersto develop this specialty if theyhave a strong clinical interest in helping patients. In my practice,I have built up a keratoconus specialty over time.I care for six to eight keratoconus patients each week, which is more than what an average ECP probably sees in a year. Keratoconus is a distortion of the cornea thatcan progress, especially during adolescence, and neithereyeglasses nor standard soft contact lenses can improve the poor vision caused by this condition. With new surgical and contact lens treatments available, this translates to greater treatment opportunities. Increased screening for keratoconushas greatly helped toidentify keratoconus patients over the past two decades. Specializing in this area requires clinical skills, investment in instrumentation, and building a referralnetwork. Treatingkeratoconus with contact lensescan greatly improve lives–and create strong bonds with patients who can be your best source of referrals.