Your success rate with OrthoK is linked to several factors: good patient selection, taking accurate measurements during initial visits, working with a leading lab to ensure a high success rate with the first lens you fit on your patients’ eyes, and an effective presentation of fees and potential outcomes.
I practice in a largely ophthalmological practice where we deal with a wide variety of cases, and as a group we try to deal with every challenge in house. In recent years, there has been increasing awareness of myopia as a condition with long-range health implications, in addition to being a condition requiring refractive correction.
While new studies from the Brien Holden Vision Institute and elsewhere are enormously helpful in my presentations of one myopia solution — OrthoK — ours is a rural area with a conservative patient base. “Give me what my plan pays for” is an ingrained mentality here. We work with that reality.
Just the same, we see about a 50% adoption rate of the OrthoK option when we present a global fee. In fact, a recent OrthoK study determined that a majority of doctors practicing myopia management use a global fee.
We consider this rate to be good, just as we see potential for improving it. One reason is that we achieve an 85-90% success rate with the first lens we fit on a patient. We also know that OrthoK has been a tremendous practice builder because of several things we do right. And we’re still learning.
The key to remember: We address the vision correction and eye care needs of all our patients, whether they elect OrthoK or go with eyeglasses and contact lenses.
The Multi-Visit Process
Usually, our process begins at a patient’s routine exam. At this point, I present OrthoK as one of a number of options to address myopia progression; others are soft multifocal contact lenses, low-dose atropine, or a combination treatment.
Right up front, I mention the global fee for OrthoK, should they elect to go this route. This includes all visits and the cost of the custom-made contact lenses. At this point, we schedule patients for a consult visit.
At the consult, we discuss OrthoK in a little more detail. We explain that the patient’s custom-made GP lenses will be worn only at night and will have an immediate effect. Low myopes can expect to see profound improvements in nearsightedness that last nearly a full day after just the first night of wear — and then for an entire day after several nights of lens insertion. Higher myopes will require up to a week to see the same level of refractive change in a day’s time.
We also obtain quality corneal topography scans. We provide these data to our lab along with refractive information so they can create a custom-lens design specifically for that individual. After that, we outline the follow-up schedule and answer any questions patients may have on the specifics of the OrthoK fitting process.
If a patient does elect to pursue the OrthoK fitting, their consult is included in the global fee. If they decide not to pursue it, a charge is collected at the end of the visit.
An additional point I make during the consult is that I personally wear OrthoK lenses to maintain good visual acuity all day. For one thing, this helps the patient overcome any fears of OrthoK. For another, it shows that l have skin in the game. I’m not just pushing something to generate revenues.
When Patients Say Yes, We Deliver the WOW
The moment that often generates the most buy-in for patients is at the one-day follow-up. We create “Wow!” moments when patients take off their lenses in our office after the first night of wear. They see more clearly than they ever have without the aid of glasses or contact lenses, and that makes a great impact. That buy-in builds after the first week as patients see their vision becoming more stable as they continue to wear the lenses. We check back in a month to confirm all is well. From that point on, I tell patients who are at more risk of myopia progression that I will see them at six months, otherwise just for annual check-ups.
When Patients Say ‘No,’ We Respond
As I mentioned, our patients are largely conservative, rural folks, and many will flat out say, “I’m not going to spend anything beyond what my insurance pays.” That is understandable. For most families, such a one-time cost for a child (and then siblings, potentially) is a lot of money.
We have several responses to that:
Cost over time. With an adolescent experiencing creeping myopia, we point out that, unchecked, their myopia will require a new Rx and new eyeglasses or contact lenses at least once a year. Figure that over six to seven years, and the long-time costs exceed a one-time treatment fee.
You have a benefit. While we don’t “accept insurance” for OrthoK, some patients have an eye care/eye wear benefit. We can help them get reimbursed by their insurance by providing needed documentation.
We offer patient financing. We offer CareCredit, which allows patients immediate credit (in most cases) for medical expenses. This allows patients to pay over time. We have looked at developing in-house financing, but this is outside the general parameters of an ophthalmology practice, where fees for cataract surgery and other procedures are just as high or higher.