By Brad Dobson, OD
Feb. 17, 2016
Educating contact lens patients about the importance of adhering to the recommended wear and care regimen for their lenses is always a challenge. Patients tend to want to stretch wear out as long as possible to save money and put off the hassle of changing contacts. They also may assume there is no need to change lenses if the ones they’re wearing (regardless of how long) are still comfortable. An instrument we’ve added to our practice, the specular microscope, gives me a way to show patients what improper wear and care is doing to their corneas, so they literally get the picture.
Specular microscopy is a non-invasive photographic technique that provides a way to accurately diagnose and monitor corneal endotheliopathies. The specular microscope is used to examine/count corneal endothelial cells. You only have a fixed number of these cells at birth. These cells keep the cornea clear. If the cell count is decreased, then the cornea loses its ability to be transparent. Overwear of CLs can cause corneal endothelial cell death.
The cornea gets so much attention in our practice, and optometry in general, that this instrument has been a great addition to our office. I feel it compares with the profitability of our retinal imaging, as well as visual fields. Specular microscopy has proven itself as a strong clinical and financial player in the pre-test room.
The specular microscope in Dr. Dobson’s office. Dr. Dobson says the instrument helps underscore to patients the importance of following the proper contact lens wear and care regimen.
Make the Investment
We invested in this instrument three years ago. We are a practice that is heavy with contact lens evaluations, and I wanted another way to evaluate corneal health. We also needed a pachymeter, and the specular microscope provides that extra function.
This instrument new ran in the low $30,000 range. We decided to do a typical loan to finance and see how profitable it could be without a large cash outflow. Our payment was a little over $500 for 60 months.
I was impressed from the beginning with the amount of patients that I could utilize this instrument on for some aspect of their care. We could have paid the instrument off in nine months. With low interest loans, I carried the note to make sure there wasn’t market change. In fact, insurance slashed reimbursement for the instrument the year after our purchase, which created less profitability. But revenue is still solid, generating income 7-8 times the monthly payment on average.
Fit Into Office
The table and instrument takes up a 2.5’ by 2’ space and has the operator and patient on the same side. We keep the instrument in our pre-testing room.
Create Protocol for Use
We use the instrument on all patients with contact lens evaluations and any patient with a prior diagnosis of glaucoma or corneal endotheliopathy. We usually incorporate this instrument into our preliminary testing when appropriate.
When we have a patient visiting for the first time, and they are in a low-oxygen disposable, or have been over-wearing their current lens product, we can easily show the patient endothelial normals, as well as their cornea after poor contact lens wear. It can be a powerful statement as to why we are switching to a high-oxygen material or to a daily disposable schedule.
Include in CL Umbrella Fee & Properly Code
As our contact evaluation fees increase over the years, we try to add technology and advancement within that service. Specular microscopy is one of those tests that has added to the value of our contact lens evaluations. Always utilize the instrument for medical insurance billing for all the glaucomas (The clinical reason for utilizing this instrument for the glaucomas is for pachymetry purposes, to provide central corneal thickness measures for IOP accuracy), any corneal endotheliopathy, or corneal pathology you are interested in tracking. That alone will supply you with a library of codes that are covered for this instrument.
Educate Patients About Instrument & Findings
We tell patients we are taking a photo of their cornea, which will help screen for disease and monitor contact lens wear. We keep it short and sweet. Because of the immediate cellular view the microscope creates, I often field questions patients have regarding their images after they see them. It does take time to answer these questions in the exam room, but I feel it adds to the exam experience, and shows a new level of care on our annual visits.