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Corneal reshaping is anotherservice we added to our own servicemenu. The procedure helps ourpatients, increases our bottom line,and often serves as a bridge to andfrom refractive surgery.

What Is Corneal Reshaping?Also referred to as corneal refractivetherapy, vision shaping treatment, orcorneal molding, corneal reshapingconsists of fitting FDA-approvedreverse geometry overnight lenses tocontrol myopia and mild astigma-

As astute ophthalmicadministrators in achanging healthcare envi-ronment, we pay carefulattention to the latest

revenue-enhancing services that arenot only beneficial for patients, butadd to the bottom line. Opticalshops, refractive surgery procedures,PIOLs, and hearing services are nowon our menu of services to enhanceour practice service lines and helpsoften the threat of declining reim-bursements.

An Unexpected Journey—Corneal Reshaping As a Revenue-Generating Service

Running the Practice Marketing

Judy O’Hara, COE

tism. During overnight wear, thecenter of the lens temporarily flat-tens the cornea, resulting in tempo-rary vision correction. The daytimevision is similar to the results oftenfound with refractive surgical treat-ment but is completely reversible.

Our Journey It is common knowledge that oph-thalmologists are generally resistantto offering any kind of treatmentthat remotely resembles the ortho-keratology of the past. Admittedly,our doctors never actively sought toimplement corneal reshaping in ourpractice. We discovered the therapyand the associated revenue-enhanc-ing benefits by accident.

One afternoon in fall 2002, amanufacturer’s representative arrivedat our doorstep and caught ourphysician, Dr. Lisa Wohl, during arare break between refractive proce-dures and clinic patients. She hadrecently learned that she was not acandidate for refractive surgery,despite a lifelong desire to be rid ofcontact lenses and glasses, which shehad worn for more than 30 years.She had hoped to become a LASIKambassador by sharing her ownLASIK outcome with her refractivesurgery patients. Now motivated tolearn more about her options for cor-recting her vision non-surgically, shewas curious to discuss her potentialvisual outcome with the recentlyFDA-approved reverse geometry lens.She challenged the representative’steam to successfully fit her and herhusband in the overnight lenses.

Not unlike our LASIK patients

Offering corneal reshaping can differentiateyour practice in the marketplace.

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who can recall their first glanceacross the laser room as being themoment that changed their lives,November 13, 2002, became a turn-ing point in Dr. Wohl’s life—and inher professional opinion of this typeof therapy as a viable option for tem-porary vision correction. Only laterwould we learn of the generousadded benefit to our refractive prac-tice and our bottom line.

Ideal CandidatesPatients who were not candidates forLASIK or PRK due to thin corneas orother contraindications were excitedto find an alternative to soften theirdisappointment. These patients werethrilled to learn they might still beable to enjoy freedom from daytimecontact lenses and daily eyewear.Others who were fearful of perma-nent surgical procedures have alsobeen able to be free of glasses anddaytime contact lens wear.

Post-surgical PRK and LASIKpatients who are not candidates forenhancements also benefit: Thetreatment has allowed these anxiouspatients to avoid wearing daytimecontact lenses or eyeglasses.

Additional bottom-line perkswere discovered when our adultrefractive patients asked us to fittheir teens and children who areactive in swimming, soccer, andother outdoor sports. Children andteens must have the support of par-ents who will ensure that childrenare compliant with attendingappointments and are willing topractice safe contact lens handling.Children catch on to insertion andremoval of the lenses and are veryadaptable to the overnight wear ofthe lenses. In fact, Dr. Wohl’s 12-year-old daughter successfully wearscorneal-reshaping lenses nightly.

Risk ManagementRefractive surgeons should discussany and all alternatives to refractivesurgery as part of the surgical coun-seling. We now mention cornealreshaping to all of our qualifiedrefractive patients who could benefitfrom an alternative to permanentprocedures. This full disclosure is justanother safety net in our policies formanaging risk during the surgicalconsent process. Our patients appre-ciate knowing we have educatedthem on all surgical and non-surgicaloptions prior to consenting to per-manent procedures. Our doctorsnever want to hear a patient say,“Why didn’t you tell me about thisoption?”

Physician Buy-In Dr. Wohl, along with colleagues Dr.Penny Asbell and Dr. Bruce Koffler,have presented talks at professionaldevelopment seminars on the clini-cal outcomes, risks, and benefits oftreating myopia and mild astigma-tism with corneal-reshaping lenses.We have fitted approximately 500patients and to date, we have notexperienced any significant compli-cations, due to what we believe isproper patient selection and properlens-handling techniques.

Getting StartedTo date, both FDA-approved cornealreshaping products require onlinecertification for providers. Ourrefractive counselor screens for suit-able candidates; the screenings aresimilar to those for refractive surgerycandidates. The upfront costs tobegin fitting the lenses were mini-mal. We purchased a set of starterlenses and already had a topogra-pher.

In our practice, one of our ABO-and COA-certified technicians whowore the lenses herself became a cer-

tified fitter. She is now our primaryfitter of the lenses, further reducingour overhead to deliver the service.

The Bottom LineThe typical fee charged for cornealmolding can vary depending onyour region. Patient financing isoften useful when discussing pay-ment options. Patients are requiredto return for annual exams, andreplacement lenses are sometimesrecommended. For practices withoptometrists who participate invision plans that deplete the profitmargin of their bottom line, this is agreat way to improve revenue-per-encounter benchmarks.

Your Menu of ServicesAs you can see, a personal experienceby our own physician became thecatalyst for a change in her mindsetabout orthokeratology in an oph-thalmology setting. There are only ahandful of ophthalmology practicesoffering this therapy in the UnitedStates, despite its popularity abroad.Additionally, offering corneal reshap-ing can differentiate your practice inthe marketplace. I would encourageyou to help your physicians take alook at how new technology haschanged the design of these lensesand reconsider the therapeutic andbottom-line benefits of addingcorneal reshaping to your menu ofservices. AE

Judy O’Hara, COE (630-351-2030; johara@wohleyecen-ter.com), is the practice admin-istrator for Wohl Eye Center,Bloomingdale, Ill.