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Optometrical Practice Management Monthly Newsletter - Tips & Reviews. Volume 2. March 2006


Business Tip: Are you charging appropriate contact lens fees?

Many of us are charging contact lens fitting fees if we are refitting with a new lens design but how many of us are charging a contact lens review fee over and above the normal testing fee, every time a stable contact lens wearer comes in for an eye exam?

Read on for more.


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Rodenstock Australia

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Get your patients to test drive this premium product.  It's success in our practice has amazed us.



IT Tip :

Richard Rees from Lookup is back again next month

Lookup has a great understanding of the two main practice management systems; Vision and Optimate. They also have experience in configuring diagnostic instrumentation such as Retinal digital imaging systems to your practice management software and to your network.





Visit Lookup for all your IT needs


Therapeutic Review: Meibomitis
Dr Anthony Maloof (Anterior Segment & Oculoplastic surgeon). Expands further on this very important topic

More Detail.

Business Tip: Are you charging appropriate contact lens fees?

Unless you are doing high volume specialty contact lens fittings you might be finding that only a small percentage of your patients that require optical correction wear contact lenses. On top of this your profit margin might also be slipping as less of your patients are purchasing their lenses from you. This trend is inevitable as the internet is going to play a larger and larger role in the marketplace.

Just have a look around the web and in two seconds flat you can find a three month supply of silicon hydrogels for $35 per eye. Even if you purchase the lenses at 50% of this, the average optometrical practice will struggle to make the sale of contact lens product worthwhile, as time goes on. If we go back 10 years ago, hydrogel disposable lenses were being sold for around $50 per three month supply per eye. They are now cheaper (not counting inflation) and the technology is far superior.

This might work with the computer industry or the mobile phone industry because they are growing exponetially so profit margins are being sustained due to growth in volume. It will never work in contact lenses whilst the market is flat.

Contact lenses represent one of the four profit centres of an optometry practice. The other three are consultation fees, frames and spectacle lenses. Right at this point if contact lenses represents less than 10% of your turnover, you have a huge opportunity. The first is to introduce more patients to at least part-time contact lens wear and secondly to charge a reasonable fee for supplying this service.

Now for the clincher! How many of the patients that you are not offering contact lenses to will end up at the local optical chain store and be fitted there. The result is you not only have lost the consultation fee and possible contact lens product sale but also the future spectacle sales from that patient. It is therefore imperative that we do not give up on contact lenses as we have given up on contact lens solutions to pharmacies.

Possible Contact Lens Fee Structure:

If you start offering contact lenses to your patients you will create at least a 10% growth to your business overnight. The key here is choosing to charge apppropriately for your time. The following is a hypothetical example:

1. Contact lens trial (this is separate to your normal examination fee)

  • This could involve a corneal topography to monitor future corneal shape
  • Choice in contact lens (if a disposable is chosen put it on, on the same visit)
  • Check the fit
  • Use this lens to choose frames with. This is a huge opportunity to demonstrate how great contact lenses can be.
  • Anything between $75 - $130 is reasonable to charge for this component


2. On separate visit a teach could be organised (not for the optometrist to do). One of the support staff would do this component.

  • An insertion and removal fee can be charged here
  • Anything between $50 - $100 would be fair for this, as up to an hour can be required here

3. An aftercare visit a few weeks later

  • Anything between $25 - $50 would be fair for this

4. A yearly contact lens assessment fee (separate and on top of your normal eye testing fee)

  • A topography would be reasonable to do on this visit
  • Corneal, limbus and conjunctiva check
  • Lid eversion
  • Disinfection compliance discussion
  • Offer upgrade to a potentially better lens
  • Anything between $75 - $150 would be fair here

Now that we have got this far, as the Americans say: "Do the Math." If you only introduce one patient to contact lenses per week you will generate $12,000 in non Medicare fees and we have not talked about any sale of contact lens product, nor have we discussed the potential referral of new patients, when your contact lens patients start talking to their friends about how good the contacts are.

On top of this you are introducing your patients to fair out of Medicare fees, which allows you the opportunity to discontinue bulk billing in the future. I could go on and on but I'll stop here for this month. Next month I will discuss the delegation issue. This in itself will liberate you from the grind of contact lenses and all of a sudden make them a fun activity in the practice for you and your staff.










The 7 Critical Mistakes that


Optometrists Make in Their Practices

… And how to avoid them

By Jim Kokkinakis







From February this year I have started a BLOG called Keratoconus. Many of you will know that I see many keratoconic patients and the misconceptions I encounter every day require discussion. Follow the link below, all comments are welcome. Your keratoconic patients are welcome to visit and comment also.








Therapeutic Review: Meibomitis by Dr Anthony Maloof

Read this for Dr Anthony Maloof's biography


Meibomian gland dysfunction (MGD) is a broad term encompassing disorders of the Meibomian Glands (figure 1). The classification of MGD remains in dispute. Conceptually, the Meibomian glands may be affected primarily or secondarily, and may produce seborrhoea (abnormal oil production) or become inflamed (Meibomitis). In the presence of Meibomitis, two thirds of patients show evidence of Rosacea (also known as Acne Rosacea). MGD destabilises the tear film, with adverse effects on the ocular surface, and virtually all patients with MGD have evidence of sebaceous gland dysfunction elsewhere, even if subtle.


This is a very common diagnosis which refers to inflammatory changes in the eyelid skin, with secondary changes affecting the ocular surface. The pearl to remember is that the diagnosis is really one of exclusion…other discorder, in particular, lupus and discoid lupus, can mimic rosacea and should be excluded. Although the disorder is very common, it presents with ocular rather than skin symptoms which can delay it’s diagnosis. It may also be referred to as Acne Rosacea

Rosacea is a chronic, facial, inflammatory skin disorder featuring symmetric flushing that leads to dilated telangiectatic vessels of the malar eminences, acneform type changes, and in some cases, rhinophyma. It commonly fluctuates in intensity, and is more common in light skinned blue eyed individuals between 30-50 yrs of age. It is significantly more common in females, and the cause is unknown.  Symptoms may be exacerbated by the use of alcohol, hot drinks, spicy foods, sun exposure and emotional disturbances. Topical corticosteroid may lead to a steroid induced rosacea, and the mechanism is unclear

When fully developed, there are erythema, telangiectasis, swelling and acneform lesions of the mid face regions. The acneform lesions are both papular (slightly raised) and pustular, as in acne vulgaris, however there is no development of comedones and no scarring. The skin is oily in appearance. Months or years after onset, the skin becomes thickened, telangiectatic and red or purplish. Rhinophyma is a bulbous hyperplasia of the soft tissue of the nasal sebaceous tissue (oil glands), and connective tissue, with a purplish red colour. It frequently develops in males.

Ocular rosacea refers to the ocular changes that occur in rosacea. This can be very difficult to diagnose, as the changes are not pathognomonic, and may occur in other disorders. The diagnosis depends on the overall pattern, rather than one or two particular features. In some cases, the eye is involved first, and this can be extremely difficult to diagnose. Once again, it becomes a diagnosis of exclusion, usually requiring assessment by an experienced clinician to elucidate the subtle signs.

The symptoms of ocular rosacea include a burning discomfort, itchyness, irritation and foreign body sensation. It is frequently associated with staphylococcal blepharitis, which is secondary rather than primary. The disorder may affect all layers of the eyelid, resulting in Meibomian gland inspissation, oversecretion, seborrhea, collarettes and chalazia. Typically, the posterior lamella is involved more than the anterior lamella.

The conjunctival component of the disease causes irritation, photophobia, epipora, mucus or mucopurulent discharge, edema and redness. Conjunctival vessels are dilated typically. Secondary marginal keratitis may be an acute presentation, with peripheral corneal inflammation and superficial or mid stromal infiltration. The shape of such a marginal keratitis lesion is said to represent a Spade in a deck of cards, with the base towards the limbus being narrower than the more central part. In some instances, scarring and superficial focal pannus formation can occur. Severe pannus is very uncommon in rosacea, and may mask other disorders such as complete androgen insufficiency or limbal stem cell failure.

Inflammatory disease of the skin need to be distinguished from lupus, other autoimmune disease, epithelial turnover disorders such as psoriasis and seborrheic dermatitis.


The principles of treatment can be simplified as follows:

  • Avoidance factors
  • Eyelid management
  • Medications local and systemic


Avoidance: Simple avoidance of trigger factors (above), may be of help in minimising effects of rosacea

Eyelid management: management of lid margin disease is critical. Cleaning of the anterior eyelid with a weak bicarbonate solution, dilute baby shampoo or commercially available products such as Lid Care ®. The posterior eyelid can be managed with heat and massage to reduce chronic Meibomian disease

Local medications include topical chloromyectin applied at night to the anterior lamella of the eyelid to control anterior staphylococcal blepharitis. Topical steroids such as FML are useful to control ocular inflammation and infiltrates. When used acutely, be wary to exclude bacterial or viral causes of infiltrates. Long term use must always be monitored with topical steroids. Lubricants may be of benefit to reduce symptoms attributable to a secondary unstable tear film which often occurs in rosacea.

Systemic medications include oral Doxycycline (50mg bd or nocte) or minomycin (50mg daily). In other countries, Tetracyclines are more commonly used (100mg 2 – 4 times daily). These medications are believed to have an effect via antiinflammatory, antibacterial pathway, as well as a direct pathway on lipids, altering the lipid molecule. The antiinflammatory effect may partially block the bodies response in inflammation by inhibition of Matrix metalloproteases. There are potential side effects such as photosensitivity and gastrointestinal symptoms such as nausea and dyspepsia. Doxycycline must always be taken with food, and not alone. As would be expected when the pathophysiology of a disease is unclear, treatments will vary. Dosage of tetracyclines vary between countries. Some advocate higher initial doses of tetracyclines, and whilst this may influence the initial effect of the drug, over the longer term, the clinical effect of the higher and lower doses are much the same. Patients suffering adverse side effects to Tetracycline or Doxycyline may be changed to Minomycin; medical monitoring is required on Minomycin. Erythromycin or Bactrim may also be used.


Anthony would welcome your enquiries at:


Phone: 1300 303 669

Rooms (Sydney city):

Suite 13, Level 9, William Bland Building, 229-231 Macquarie St Sydney 2000

Rooms (Westmead):

Suite 7, The Ashley Centre, 1a Ashley Lane, Westmead 2145

Meibomitis and ocular roscacea deserve to be in a whole days seminar. Register your interest for Ocular Therapeutics 2006 , which will devote a session to the diagnosis and management of this ocular disease. Efficient implementation of ocular therapeutics is another great way to differentiate your practice and thus make you more profitable.






Meibomitis with associated conjunctivitis


Severe long standing ocular roscacea can cause corneral pannus



Ocular and acne roscacea notice the telangectatic vessels on the cheeks








Find out more about Acne Rosacea here



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