Diagnostic Instrumentation

Specular Microscope: A High-Tech Way to Monitor Eye Health of CL Patients

By Ken Krivacic, OD, MBA

For a contact lens specialty practice, a specular microscope is a highly effective tool to monitor corneal health and promote good care and adherence to replacement schedules. Used well, it can generate revenues, too.

A specular microscope allows you to show patients the effect their contact lens wearing habits have on their eyes, and demonstratethe value of wearing the most advanced, healthy lenses available. In our practice, which specializes in contact lenses, we utilize the instrument to monitor the health of our patients’ corneas and show the importance of proper contact lenscare and lens replacement.The instrumentalso generates $1,000 in added revenues each month.

Click HERE to download an Excel spreadsheet with the financial details of this investment.The formincludesspace for you to plug in your own numbers.

ROB Bottom Line: Specular Microscope

Practice size: 500 annual exams per month between two full-time ODs (200 of the 500 also receive contact lens exams)

Cost of equipment: $30,000

Total cost: financed at 2.49%: $30,747

Term of Loan: 60 months

Monthly Payment: $512.45

Income Per Test: $500

Tests per Month: 200

Increased Revenue Per Month: $1,000

Two scenarios for generating revenue:

Scenario #1: Use the specular for medical conditions which on average pay $50 per scan.

Scenario #2: Use the specular in screening mode to get a cell count in contact lens patients only.

We add $5 to each contact lens evaluation, and with our volume of contact lens patients (200/month), that generates $1,000 per month. We use both scenarios, but the medical portion only generates 4-5 patients per month, so most of our revenue from the specular is derived from our contact lens patients.

Number of Months to Break-Even: 31

Learn About the Instrument

A specular microscope is an instrument that provides imaging and assessment of the corneal endothelial cell layer, morphology of endothelial cells and corneal pachymetry. Specular microscopy is a noninvasive photographic technique that allows you to visualize and analyze the corneal endothelium. Using computer-assisted morphometry, modern specular microscopes analyze the size, shape and population of the endothelial cells.

The instrument can be used to analyze the cornea regarding several abnormal states such as corneal dystrophies, keratoconus and trauma. In our office we use it occasionally for those medical conditions and can bill for the test when deemed medically necessary. More commonly we use it as a screening device to assess the health of the cornea in relation to contact lens wear, or as most practitioners would be concerned about, contact lens over-wear.

The instrument is fairly compact. We have it on a table about 2 ft. by 4 ft., and this includes the monitor and CPU. It can be placed against a wall since the patient and technician can be on the same side of the table during testing.

It gives our contact lens patients feedback about the health of their cornea in relationship to the type of contact lens they are wearing and their wear schedule.

Calculate Finances/ROI; Decide How to Purchase

We’ve had our specular microscope for about five years. The instrument cost was close to $30,000. We took out a loan to purchase the specular microscope, and financed it over a three-year time period. The break-even on the instrument was close to that three-year time frame. My philosophy on instrument purchases is that it’s a good deal if you can break even within three to five years. Anything more than five years potentially becomes a drain on a practice’s finances.

For instruments that have a substantial cost we would rather spread the cost over a few years and not get squeezed in a cash flow crunch. We generally tend to buy via loans versus lease, especially if we feel like we will use the instrument for a number of years.

When we added the specular microscope to our practice we had a decision to make on how to pay for it. The instrument has two modes–a standard exam and a screening exam. The standard exam pays more (hence the $50-$85 fee) but requires a medical diagnosis code to get reimbursed. On average, 2 percent of the population would have a medical condition that would warrant this test. So, on average (for our size office) the monthly reimbursement would be $50 x 10 (500 exams x 2%) = $500

We elected to concentrate on the screening exam for contact lens patients. We increased our contact lens evaluation by $5 and included the screening specular exam. Since we average 200 CL exams per month, our income from the specular addition averages 200 x $5 = $1,000.

We do a full specular scan on patients who have a medical reason to have the test–a small number monthly. We average approximately four full scans per month, and are probably under-utilizing the instrument at that level. Those ODs who are more medically oriented will use it much more.

Specular photomicrograph of a normal corneal endothelium in a 21-year-old female patient.

Photo: Courtesy of Konan Medical

Educate Patients About Effect of Non-Compliance

The main benefit of the specular microscope is as a teaching tool used to help educate patients to understand there can be consequences for not maintaining proper lens care and wearing schedules. The instrument provides us insight as to the health of the cornea, and this is shared with the patients when I review their scans and cell counts.

The screening mode provides a picture of the endothelial cells and a cell count. The cell count is also related to age. I believe patients can relate to this type of testing in that it gives a number to quantify the health of their cornea. Similar to a blood pressure reading or a blood sugar level, patients can relate to the number.

Take Time to Train; Expect Learning Curve

We purchased a Konan specular microscope, and the company provided an initial day of training for the staff and doctors. Our technicians administer the test and I interpret the results in the exam room as I review the scans with the patient. As with any new piece of equipment, there is a learning curve, but the instrument is user friendly and easy for technicians to grasp the testing process.

Send High-Tech Message About Your Practice

A specular microscope sets you apart from the average optometric practice and is a great educational tool. The other thing the specular provides is a way for us to justify our contact lens fee. Patients are better able to understand that there is more involved in a contact lens evaluation, especially for the returning patient who has no change in prescription from the previous year. The specular microscope allows us to justify our contact lens fee because we are providing a more in-depth evaluation.

Seen through the specular microscope: the endothelium of a 55-year-old woman with a 30-year history of PMMA and gas-permeable contact lens wear.

Photo: Courtesy of Konan Medical

I also realized the instrument was a great asset to the practice after we had it for a year. It was amazing how many patients returning the next year asked if their cell count was normal. I knew then that we had connected with our patients and they understood that there can be side effects to not wearing contact lenses properly. In turn, I believe this education has made our patients more compliant. The instrument has made me more aware of the pitfalls of contact lens over-wear by reviewing the scans with each patient. It has almost gotten to the level now where I can look at a scan and see that a patient is being non-compliant or needs to upgrade to a higher-oxygen lens modality, without even looking at their cell count.

My recommendation is that if a practice has a large volume of contact lens patients, a specular microscope is a great way to increase the level of care in the practice and provide a patient a great experience that will be unique to that practice.



Ken Krivacic, OD, is the owner of Las Colinas Vision Center in Irving, Texas. To contact him: kkrivacic@aol.com.

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