The roundtable

Optos opportunities

OT  spoke to three ECPs about making Optos imaging a success in independent practice

An optometrist having the ability to see behind the eye might seem, to some patients, like something out of a science fiction film – even though the technology has been available in some optical settings for decades.

Imaging devices in practice are not a new concept, but neither are they always an easy thing for independent practitioners to invest in: the associated costs, integration into practice and marketing to patients are all very valid considerations for optometrists to have. 

In partnership with Optos and alongside three independent practitioners, OT explored the issues, and the solutions, at hand.

Investing in Optos

At Edmonds & Slatter, Saagar Hirani has had imaging devices in practice since the early 2000s – so investing in Optos’ current models (three Monacos and two Daytonas across the group’s five practices) wasn’t a huge leap of faith. Rather, it was based on a proven track record of success.

In the early years, Hirani said, the decision was based on “how unique the technology was, and its ability to capture such a wide field image compared to other ophthalmic equipment on the market at that time.”

He added that the machines have since proved their worth in terms of patient retention, and that upgrading to newer models when needed came relatively naturally, even if he has sometimes had to ‘pick his moment’ rather than making a purchase as soon as a new model has been released.

“We’ve kept in touch with the change in technology and upgraded where we can,” Hirani said. “The demand for optical coherence tomography (OCT) started to build three or four years ago, so we took the opportunity then to look at the Monaco machine. We were impressed with it, and it’s got better as it’s evolved over time.”

In London, independent practice owner, Arif Karim, also noted that “OCT was making a big foray into the market a few years ago,” and saw this as an opportunity to differentiate his business from the competition.

“It was clear that the imaging space was a very hot topic in optometry,” Karim told OT. “As a practice, we’re always looking for things that clinically or commercially differentiate us. The Optomap tool is unique because it’s an instrument that is virtually unparalleled in its ability to deliver amazing images of the back of the eye. We felt it delivered the best instrument characteristics for our patient base.”

Research considerations ahead of making an investment included the cost of the instrument and how it would be integrated into practice, Karim said: “Those were the tangible things that we looked at, to see whether this would be a suitable instrument.”

Ultimately, he “felt that the Optomap hit the right note when we looked at those factors.”

Meanwhile, David Bennett, principal optometrist at Brooks & Wardman in Nottingham, found that investing in his practice’s California device when he went entirely private two and a half years ago was a “no brainer.”

Now, Bennett explained, his Optos machine is “part and parcel of a routine eye examination” - something that he felt was non-negotiable when opting out of the General Ophthalmic Services contract. Once the decision was made, Bennett had few qualms about incorporating the device into his practice routine.

In private practice, he explained, “You don't even have to sell it. It saves time, rather than takes up chair time.” He pointed out that the time spent using a Volk lens or performing an ophthalmoscopy is cut down significantly with an Optomap, “even with elderly patients.” It offers, Bennett said, “Great images all around.”
He added: “It’s an amazing machine.”

Hirani agrees that his Optos device saves time during busy clinics, although “Chair time has always been a consideration: how we're going to fit it into our normal routine with patients.”

He added: “We have found over the years that diary management and incorporating it into pre-screening routines are important. We like to recommend the Optos when making the appointment: the patient rings us directly, so it helps to have the staff on board.”

In order to justify the cost of his Daytona, Karim sought to develop a business case through collecting the thoughts of his patient base. Ahead of installing the device for a week-long loan, patients were told about what the device would do, how much a retinal scan would cost, and ultimately asked if they would consider the offering.

“That was very interesting,” Karim said, “because even before we had the loan instrument, we had a really strong take-up and a positive response.”

He has a tip for anyone using this small piece of market research ahead of making their own investment: “If you multiply how much you think you’re going to charge by the positive responses, it more than covered the lease.”

Making an Optos device work for your practice

Bennett explained that having a local rep on hand made the process of integrating his California into practice a very smooth one. The machine was in practice for a few weeks before the purchase decision was made, with training provided to staff and introductions made to the website and the images that can be viewed on it.

“It’s not a steep learning curve,” Bennett said, “but it’s a bit of a learning curve to know what’s going on in the periphery of the retina. Particularly with peripheral lesions, we’ve got to interpret them and know what they look like and know not to worry, or to worry, or know when to refer or not to refer. That training is crucial.”
He added: “If anything breaks or goes wrong, you give Optos a ring and they come out and sort it out for you. It’s very good.”

At Eye Contact, it was agreed that the Optos device would be optometrist-led, so it was placed in the consulting room straightaway.

“The optometrists were trained to take the images and discuss them with patients,” Karim said. “We spent a long time with our team, to try and refine how they learnt to interpret images, but also the way of approaching images with the patient and how what it delivered was discussed with them.”

He added: “We wanted an end-to-end focus on our imaging; this was a big purchase and a key differentiator. So, the integration was quite holistic. It was front and centre with all our marketing, in our recalls, on our website, when a patient made an appointment, and when they came in. It was given a lot of prominence.”
This is still paying off, he said: “even today, we are known as that practice that does all the scanning and imaging.”

When advising others on getting the most out of the technology, Hirani emphasised the value of getting all staff on board early on. Ensuring that they are bought-in and can explain the benefits to patients clearly cuts down on chair time.

“We do it from inside and outside the consulting room,” he said. “Going through what you are seeing with the patient is very important. When I have patients in my room, I show them the images and explain to them exactly what I’m seeing, and what I’m looking for.”

He added: “That’s what they are paying for: the explanation of what you’re doing; you showing them, and explaining the benefits and why they should have it on a regular basis. That’s what the fee is for. We’re the experts; we’re the professionals. You’re selling the whole idea and ensuring that patient comes back to your practice, and has the experience of having Optomap on their eyes at every visit.”

Hirani explained that prices for the service have changed over the years, with options including the Optomap on its own or alongside the OCT.

Giving patients these options helped to identify the differences, he said - although the most important aspect when deciding on pricing is to know what your break-even figures are, “that you know and your staff know where you should be, what your numbers should be, and making sure that you’re not under-charging.”

There is another key takeaway too, and that is: “Don't be afraid to charge for your time. It’s an important test. It’s a unique piece of kit. When the patients have seen what the machine can do and what you can detect, they see the value in it. They value their sight.”

Hirani added: “It’s also worth checking to see what your peers are charging. The private route may have a monthly fee or a system where it’s all incorporated into a direct debit, but if you are charging on an ad hoc basis, you need to be mindful that you know what you’re doing, and you’re setting your pricing accordingly.”

Communication has to be the key element that influences that take-up. That’s the key. It’s all about the journey that leads up to and during that pitch. And if you get all those dots joined up properly, you will see a take up of 85% or 95%

Arif Karim, head optometrist at Eye Contact, City of London

Karim emphasised that the communication used when pitching the offering to patients has to be carefully planned: if the service is included as part of an overall fee in private practice, for example, messaging will be different to if it is offered as an add-on to a standard eye examination.

In the latter case, “Communication has to be the key element that influences that take-up. That’s the key. It’s all about the journey that leads up to and during that pitch. And if you get all those dots joined up properly, you will see a take up of 85% or 95%, like we do.

“But if you don't get that right, you can see a far lower take-up, because it’s quite an abstract thing. Patients don’t think about their retinas every day of the week, even if they’re sitting in your chair. There are plenty of clinicians that perhaps underestimate the value of what the Optomap delivers, never mind a layperson.”
The key to this is clear messaging, almost a scripted approach, across front of house and optometry teams, he believes, “so there are no differences in the levels of communications across different team members.”

His practice’s message, Karim said, “has been refined to the point where we see significant uptake of the instrument. You want to craft your message so that you get to that point, and that will change over time. We didn't have a 90% uptake in the first month that we got it. We changed the message, we changed the way we approached our patients, and then slowly we started to see a better uptake of the instrument as we got better at communicating it and integrating it into our sight test routine.”

Patient response

Karim believes that going through the scan and explaining what it shows means patients “leave with a wow factor that’s unparalleled in any other field. They leave with a very powerful visual image of the back of their eye, and what you’ve done and what you’ve seen. That gives them a huge sense of security and safety, and a feeling that they’re in good hands for their eye care, they’re being looked after way beyond anything that they may have experienced before, and that you’re a serious practice that is spending money on diagnostic tools to help them to have a better standard of eye care.”

Hirani believes that, in the 20 years that he has used Optos imaging devices, he could “count on two hands the number of patients we’ve seen who would not be here had we not had that machine.”

He added: “It is that invaluable, and independent practices up and down the country should really be thinking about having it in their practice. It is what’s going to make you stand out on the High Street. This is probably one of the most important examinations that any person could have, and it should be seriously considered to be part of your routine examination.”

This is probably one of the most important examinations that any person could have, and it should be seriously considered to be part of your routine examination

Saagar Hirani, optometrist and director at Edmonds & Slatter Opticians, Leicestershire

So, with the value and potential health benefits clear, how can optometrists market these scans to their patients - either in the practice or outside it?
Bennett’s answer is simple: he emails every patient the image he has taken, which allows them to show family members. He finds that it’s the “best marketing tool ever - to download that JPEG and send it by email.”

Karim and Hirani both find that word of mouth is a huge driver too, and that family members and friends of patients are regularly contacting their practices asking for a scan.

Trust and loyalty build solidly through peer recommendation, but traditional marketing works too.

“It’s front and centre in our online presence,” Karim said. “It’s featured in most of our communications with our patients, in any clinical communications, newsletters, that sort of thing. It is the hub around which all the other factors of the practice connect, because it’s the one that is most impactful. Patients value it the most highly out of everything.”

When discussing imaging with patients, Hirani said, it’s important to explain the differences between this level of technology and that that they might find elsewhere. That means explaining ultra-widefield status and why it is important, and “what is it you’re going to see with an Optomap image that you can't see with the normal fundus image.”

Older patients appreciate being told the history of how the technology came about, he explained, while telling families that the machine’s creation was inspired by a child can increase uptake of children opting for a scan – something that Edmonds & Slatter is actively looking to increase.

Being able to easily compare images year-on-year, Hirani said, is also valuable when talking patients through the value of the technology. He makes the case of a patient who may or may not have had thinning in their optic disc: going back to scans from 2009, “without having to dig through USB sticks,” he was able to ascertain quickly whether this was the case.

Karim agrees that clear explanations are key: “Letting them know what you’re going to be doing is an important thing,” he said.

“Then, when you bring up the instrumentation, your investment in technology, and how that leads to a better standard of patient care for them, and when you introduce the concept of having to pay a bit extra, it really becomes an incidental. It becomes easy, at that stage.”

Hirani said: “They’ve got to know what they're paying for. If the patient trusts you, and what is being said is communicated across to them effectively, they will go for it.”

Retention, loyalty, and the future

Karim calls the long-term lease of his device “probably one of the best decisions I’ve ever made,” citing the intangible benefits that it delivers as something that is hard to understand until it is in use in practice.

“It still surprises me how patients respond, how they feel about you and the practice, and the bond it creates,” he said. “An Optos instrument helps you to retain patients. It creates all these soft, fuzzy, essential little things that bind a patient, in an increasingly complex and competitive world, to your practice.

“Loyalty is a hard thing to come by. If you’re a good independent practice, the lifetime value of a customer is enormous, and the loss of one customer is also enormous. So, you’ve really got to try and build for that lifetime value.”

He emphasised that, as an optometrist, he is able to sleep more easily at night with the awareness that he has seen the whole retina, rather than just part of it. At the end of the day, “You can be pretty sure you haven’t missed anything once you’ve done one of those scans.”