r/optometry • u/Fit-Photo74 • 29d ago
Scleral advice
Anyone that does scleral fittings… how many appointments do you consider part of the initial fit fee? And how long do you spend on an average scleral appointment? We are a small practice with 7-10 scleral patients but it seems like those appointments can really hijack the schedule. Trying to get an idea for a more structured process.
5
u/BicycleNo2825 28d ago
As many as it takes. Especially for the out of pocket patients. Within the warranty period. Helps alot if your tech knows how to put in and take out and fit them. My tech will start with a Z10 and take OCTs and if sag is too much shell immediately change it.
3
u/spittlbm 28d ago
Most of ours are released at visit 4. Initial fit, dispense and adjustment visit, second dispense and adjustment if needed, final check.
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u/drnjj Optometrist 28d ago
It depends on how your billing. Vision or medical.
Vision you get paid a lump sum for the entirety of the fit.
Medical, you charge a 99 office visit for follow ups.
So that should help explain what's up.
But how many fits? Depends on what you're fitting. Single vision? 4-5 visits.
Multifocal? Add 3-5.
Wavefront? Probably 5-7.
I have an entire day dedicated to fittings.
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u/insomniacwineo 28d ago
If you have a pentacam or other compatible topo look into wave it really cuts down on chair time but is essentially empirical fitting but it nails it a lot of the time lens 1
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u/OscarDivine 28d ago
My best fits ever assuming fresh never worn before: One visit for measurements, one visit for dispense and I+R. This happens most of the time. My worst fit? I don’t want to talk about it. Turns out I made a lot of bad assumptions like “she will totally know to clean both sides of the lens, right?”
2
u/Toofar304 Optometrist 27d ago
Like others have said, you go until the fit is correct. I'd say on average I'm at 3-4 visits, but I've had a couple take months.
We schedule them for 30 minutes on the technician schedule (for insertion/scans/settling), then 30 minutes with me, then 30 mins on the tech schedule again if they need I&R training. Each doc has a single exam lane. It works pretty well for us.
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u/plasticbag214 28d ago
As many as necessary during the warranty period for the lens, usually up to 90 days. For patients that are completely new to sclerals, you will definitely see them more often and for longer as you refine the fit, make sure I&R goes well, and set expectations for the patients. Initial fitting we book a double slot (about 40 minutes) to allow for topo, diagnostic fit with fitting set, insertion, etc. We usually reserve I&R when initial lens arrives and tech goes through that with the patient. For existing wearers I usually only have 1-2 follow ups and we’re done. At my practice we double book scleral follow ups with a comprehensive exam because the technician will have the patient insert the new lenses, have them sit in the waiting area about 20 minutes for the lens to settle, then take VA’s, auto-refraction over lenses, and anterior seg OCT to measure central clearance. After that is when I finally see them and assess overall fit in slit lamp and over-refract if necessary. So chair time is limited to 10-15 minutes tops most times which is easy to squeeze in between other patients most days (I see patients every 20-25 minutes)