Cold Start Practice

How I Built a Specialty CL Practice Generating $300,000 Annually

By Jamie Kuzniar, OD

Oct. 12, 2022

Specialty contact lenses can transform patients’ lives and practice profitability. Here is how I helped build a highly profitable contact lens practice within a private primary care office.

Exponential Growth
When doctors talk about specialty contact lenses, they are typically talking about anything that is custom-made or designed for individual patients, like gas permeable lenses, scleral lenses, custom soft lenses and orthokeratology lenses. However, it is important to keep in mind the importance of utilizing the common lenses we all have at our disposal such as multifocal contact lenses, which are a huge source of word-of-mouth referrals.

My specialty lens practice has grown exponentially year after year. I started out in a full-scope private practice optometry office and networked in the area to gain specialty lens referrals. I was fortunate to gain referrals quickly, and grew each year to the point where by year five at that office almost half of my patients were specialty contact lens patients.

Last year, the specialty lens portion of the practice was approximately $300,000 while working three days per week in a primary care private practice setting.

Now that I am opening a cold-start office, about 80 percent of my appointments are specialty lens patients who have researched and followed me to my new office or came to me via referrals from area ophthalmologists who are supporting my new office.

Office Visits & Fitting Fees Drive Revenues–Don’t Undercharge
Most of the profitability of my specialty lens services comes from office visits and fitting fees. It is really important for practitioners to sit down and calculate their chair time and estimated follow-ups required for specialty lens patients, and set their fitting fees appropriately.

I often hear of offices undercharging for these premium services, and ending up in the red due to the amount of chair time they spend with the patient. Some of these offices charge only slightly above what they would charge for a basic soft lens fit, which requires far less chair time. It is also always important to price your materials appropriately, as you would for any other type of contact lens.

Helpful billing codes to use in billing for specialty lens services include using proper CPT codse such as 92072 and 92313, especially if patients are medically necessary fits, so that you can receive the appropriate reimbursement from insurance companies. Patients who are not being fit for medical reasons, such as custom toric soft lenses or custom multifocal lenses, almost always have to pay out-of-pocket.

Invest in Corneal Topographer
A key investment that you need for specialty contact lens patients is a good corneal topographer. Unfortunately, topographers are not typically profitable as a standalone device to your practice. However, you need to think about how it will elevate your specialty lens fittings and allow you to fit lenses, such as orthokeratology  lenses, which you are not able to do without a topographer.

Just billing for corneal topography on occasion will not allow you to break even quickly due to low reimbursement rates. I invested in a good topographer that could also image meibomian glands for dry eye assessments and treatments, which is much more profitable when you factor in office visits and private-pay dry eye treatments than billing for a basic corneal topography.

My advice, if you are starting out in the specialty lens world, is to find a topographer that can cover many different procedure codes. You can easily become profitable with a mid-market topographer within a year if you are utilizing it for both your specialty contact lenses and  dry eye services.

Another key investment is scleral lens fitting sets from specialty lens manufacturers. The cost of each fitting set is low compared to the profit you can make on just your two first scleral lens patients and onward.

Invest in Your Own Education: Jump-Start Specialty Lens Niche
After graduation from optometry school, I completed a corneal disease and contact lens residency. This allowed me to jump-start my experience with specialty lenses in one year, and I continue to expand on that knowledge every year by attending meetings like the Global Specialty Lens Symposium (GSLS).

Other great meetings to attend are International Congress of Scleral Contacts (ICSC) and Vision by Design, which offer a truly immersive experience in the specialty lens world. There are also great resources on the GP Lens Institute (GPLI) website  and the Scleral Lens Education website. Both of those organizations also provide free monthly CE webinars open to all doctors.

In addition, specialty lens manufacturers, such as Bausch + Lomb SVP, have created many resources for doctors.

Editor’s Note: Other specialty lens manufacturers also offer specialty lens education resources, such as CooperVision Specialty Eyecare, Eaglet Eye and BostonSight Scleral, among other manufacturers.

Train Employees to Support Your Specialty CL Services
Support staff needs to be educated about the basics of the specialty lenses that you are offering to patients. Front desk support staff needs to be educated so that when potential patients call, they can reinforce the message that your office is a specialty lens center. They should have the confidence to answer basic questions about specialty lenses.

Technicians need to know which products and solutions are compatible with the different types of specialty lenses. Training on insertion and removal by support staff is also a huge part of making a successful specialty lens practice. This allows the doctor to use their time efficiently seeing patients, while staff works one-on-one with patients. Having a specialty lens patient drop out due to failed insertion and removal not only affects the patient’s quality of life moving forward, but can lose your practice a huge source of potential revenue over the years.

Manage Patient Flow to Maximize Productivity
I try to dedicate specific days to my specialty lens patients. That way I can provide uninterrupted care for them and see multiple fittings and follow-ups all at once. However, that is not always possible if a patient’s schedule does not line up with mine. To maintain efficiency, I usually will schedule the specialty lens fitting so that I can see an exam in a second exam room while the patient is settling with trial lenses on.

When you are new at specialty lens fittings, I would recommend giving yourself more time than you think you need so that you are not rushed and make incorrect first lens orders, which will just create more needed chair time on the back end. As you gain experience, shorten the allotted fitting time and implement help from technicians and support staff.

Some complicated patients may have to return for a fitting on a separate day from their comprehensive exam. Explain to them that you want to provide the highest level of care and you need to spend more time with them than the typical allotted time for a routine exam. This not only conveys the importance of your services, but communicates to the patient that they can expect a one-on-one experience with you during the custom-lens fitting.

Talk to Patients About the Value of Your Care & Services
I explain the patient’s condition to them, the need for a specialty lens, and talk about which lenses I recommend for their treatment. I always have the front desk tell me if the patient has medically necessary benefits or what their contact lens allowance is before walking in the room.

After discussing how I will be custom-designing their lenses, and what to expect during the fitting process, I discuss cost with the patient. I rarely have push back since I have already built up the value of my services and the product in their mind. If the patient seems hesitant, I give them the option of thinking it over and calling back to schedule a fitting when they are ready. The last thing you want to happen is for a staff member to sticker shock a patient over the phone without taking insurance into account and without discussing why a specialty lens is the right choice for their needs, especially if they have been unsuccessful in contact lenses in the past and may be skeptical.

With the right education, knowledgeable care and a great office experience, you will find a multitude of returning patients who refer many others to the doctor who changed their life.

Jamie Kuzniar, OD, is the owner of Elevate Eye Care + Eyewear in Rochester Hills, Mich. To contact her:


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