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I was not hired to fit specialty contact lenses.

That was not part of the deal. My position within our practice happened quite by accident. Plus, I was the new guy and we all know how the new guy gets treated. I’m often asked for advice by new graduates considering marketing themselves to practices as capable of fitting specialty contact lenses. I also get inquiries from others considering adding it to their repertoire. When is the right time? What lenses should I utilize? I have found that most of my advice coalesces around five main points.

Find a mentor.

Seriously, find a good mentor yesterday. There are numerous resources now available through social media, local societies, and national organizations. You need someone to be honest on whether you are on the right path. Also, you’ll need someone to nicely tell you that your fit looks like you did it with your eyes closed. Trust me, it happens to us all.

You better love it.

As with anything else that you’ll pursue in life you will need to be fully immersed. If you’ve completed a residency this has likely been accomplished. Attend a wet lab or two, find CE courses that go beyond the normal talking points, and buckle up. You’ll need to fight for every dollar and some days are harder than others. Now that I type this out it sort of sounds like parenting my children…

Pick two designs and get really, really familiar.

I tell all of the students that rotate through my practice that there is no such thing as a one-size-fits-all design. I recommend having on hand a smaller, mini-scleral design for mild to moderate cases as well as a larger scleral design for more advanced cases. Each lab has its own nomenclature and nuances so get used to having to jump between diopters, steps, and microns.

Do not cut corners.

There will be a time where one will find that there are steps that you can inherently skip or combine throughout the fitting process. That time is not on your second or third fit. Get really good at troubleshooting with simple fixes such as detailed over-refractions, detailed drawings of compression and edge lift, and estimating central and limbal clearance. Walking always comes before running…

Invest in technology.

Do you want more irregular corneas? Then you best have a way of scanning the cornea to determine if the patient has one! Having trouble justifying the monthly payment of an OCT? It may become more palatable if you are able to measure lens clearance of the cornea in great detail. Those that are the most successful and profitable have invested the most. In the words of Dan Gilbert, money never leads. It follows.

Lastly, let’s state the obvious: I’m still learning just like the rest. I certainly do not have it all figured out. Let’s work together to raise the level of care that we provide to our patients each and every day. Once you are in the club you may just find that you love it…

Ryan McKinnis
Dr. Ryan McKinnis is an optometrist with the Cleveland Eye Clinic. He is a Fellow in the American Academy of Optometry and a Fellow of the Scleral Lens Education Society.

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