Contact Lenses

Command Premium Fees for Corneal Refractive Therapy

By Brian Chou, OD, FAAO

Providing CRT can free patients from daytime eyewear–and provide you with premium fees for your expertise in this specialty niche.

Corneal refractive therapy (CRT) is a specialty area utilizing specially designed gas permeable contact lenses for overnight wear that reshapes the cornea. This specialty helps differentiate my private practice from retail chains (e.g.,LensCrafters) and warehouse locations (Walmart / Costco). There is genuine consumer demand for CRT, especially among the Chinese-American demographic. In Southern California, where I practice, I’d estimate that 90 percent of patients that are in CRT are Chinese-American children. This is because there is a very high anxiety level of myopia progression among Asian parents, given the higher-level incidence of myopia in the Chinese-American population.

CRT is for both children as well as adults. CRT is approved for correcting, but not for reducing myopic progression. However, there is reasonable evidence that CRT can slow down the rate of myopic progression. In addition to children patients, I have CRT adult patients. These patients tend to be the ones who like the idea of reversibility, for example the -1.00 diopter 36-year-old, who wants improved distance vision, but also wants the ability to regain his or her myopia when presbyopia hits.

A Practice Growth Sector–with Marketing

I received Paragon CRT certification in March 2003. Currently I have about 20 CRT patients. That number is growing in my practice with targeted promotion with both internal and external marketing. Internal marketing includes communication with patients that CRT is available through various points of contact including web site, by doctor, by staff, brochures and posters. External CRT marketing includes local advertisements. Due to these efforts, I expect to double the number of active CRT patients by the end of the year.

Charge Global Fee
In my area, a typical global fee for CRT for both eyes (including CRT lenses) ranges from $1,000 to $2,000. For the new CRT wearer, I am able to complete the necessary services within three visits. There is recurring revenue in subsequent years for eye exams and also replacement CRT lenses, which are intended to be replaced each year. The global fee includes any necessary lens exchanges within a 90-day period.

Importance of Selecting Patients Carefully

I feel I am able to complete most CRT services efficiently because I am selective in who I prescribe these lenses for. For example, even though the FDA approval is for the temporary reduction of myopia for those with up to -6.00 diopters of nearsightedness and -1.75 diopters of astigmatism, I generally will only select patients with up to -3.00 diopters of myopia, moderate to steep corneas, and realistic expectations for treatment outcomes.

FSA Dollars and Contact Lens Allowances Can Be Used for CRT

CRT services are not covered by vision benefit plans. But flexible spending dollars can be directed toward it. It also is possible to allocate any contact lens material allowances toward the purchase of the CRT lenses themselves, billing under the V2531 HCPCS code for “contact lens, gas permeable, extended wear, per lens.” It is best to illustrate the value of CRT services by describing the cost of CRT relative to LASIK (with CRT about half the cost), or about the same cost of orthodontics. I don’t recommend comparing the cost of CRT to disposable contact lenses.

Invest in Necessary Instrumentation: Under $20,000

Corneal topographer:$15,000. It is not mandatory to have a corneal topographer for CRT, although it is very helpful.
100 Lens Diagnostic Dispensing System (DDS): $2,600. I use the 100 lens DDS and I recommend having it. But it’s possible to also prescribe using the Paragon SureFit system where three lenses are ordered per eye based on empirical measurements, which significantly lowers the practitioner’s start-up costs.

ECPs should already have the other necessary instrumentation and supplies: slit lamp, phoropter and fluorescein.

Train Staff

There also is the cost related to undergoing practitioner training (see box below), training staff how to answer questions about this modality, and having staff feel comfortable in training patients on application, removal and lens care.

Use Consent Form

Each practice offering CRT should have a standardized consent form and policy. Paragon Vision Sciences offers templates, and also various marketing brochures. I often hand interested patients (or their parents) all these aforementioned materials, and also direct them to visit www.ParagonCRT.com. I let patients know that for carefully selected individuals, CRT is an excellent vision correction which offers freedom from corrective lenses during the daytime. But because it’s reversible, it’s necessary for most patients to wear the lenses each night to maintain the vision correction.

CRT Keys to Success

Undergo required certification. This can be done at http://www.paragoncrt.com/getcertified/. Here is the link to Paragon’s CRT Certification Guide: http://www.paragoncrt.com/getcertified/. If you are not certified, patients will go elsewhere.

Educate patients. Temper patient expectations by explaining that they should expect most of the visual changes to take place the first few days, but it can take several weeks for the visual changes to stabilize. It also takes time for patients to become familiar and comfortable with application and removal.

Market to Asian populations. CRT is potentially for patients of any demographic, but recognize that the majority of patients in CRT will be Asian children. If your community demographic does not have a significant Asian population, it may be difficult to develop a thriving CRT practice, just as it would be difficult to have a thriving glaucoma practice if your demographic lacked many elderly patients.

Manage adult patient expectations. The same concepts in expectations management with LASIK apply to CRT, especially with adult patients. All patients undergoing laser vision correction or CRT need to know that there is individual response and that their vision probably won’t become perfect. In fact, eyeglasses prescribed afterward will almost always exist to make vision even better. The rationale is not to have perfect natural vision, but functional vision. Children seem to be more accepting , whereas adults are more critical in their visual outcome.

Related ROB Articles

Treating Keratoconus with Contact Lenses Helps Your Patients and Generates Referrals

Children in Contact Lenses: Introduce and Train Young People to Wear Contact Lenses

Work with MDs to Treat Ocular Conditions with Specialty Contact Lenses

Brian Chou, OD, FAAO, is a partner with EyeLux Optometry in San Diego, Calif. To contact him: chou@refractivesource.com.

To Top
Subscribe Today for Free...
And join more than 35,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.