- Consultation time is the time spent in the fitting chair during a consultation, and this time determines how many consultations can be accommodated in a day.
- When fitting multifocal lenses, most of the time is spent on follow-up appointments rather than the initial fitting.
- A standardised procedure for each consultation, with a clear explanation given in advance, reduces the number of unnecessary follow-up appointments.
- A successful first fitting saves the most time, as each round of adjustments requires an additional consultation.
- Work out the profit using your own practice’s figures, as the number of consultations varies depending on your working method.
Reducing consultation time does not start with a quicker examination, but with fewer follow-up appointments. A multifocal fitting often spans several appointments, and every extra appointment takes up a slot in the diary that cannot be used for a new consultation. In this blog, we’ll look at what chair time is, where time is lost during the fitting process, how to establish a standard procedure for each consultation, and how to use a calculation method to plug in your own figures. This will help you get a handle on your diary without compromising the care provided to the wearer. The article deliberately makes no promises regarding returns, as the number of consultations varies from practice to practice and a profit model from another practice rarely fits your own. You should therefore plug in your own practice figures throughout.
What does ‘chair time’ mean in a contact lens practice?
Consultation time is the time a customer or patient spends in the fitting chair, including the explanations and measurements associated with that consultation. The chair time per process is the sum of all the consultations required to find a suitable lens. Anyone wishing to reduce chair time should therefore look not only at the duration of a single appointment but also at the number of appointments required.
It is helpful to distinguish between three concepts. Chair time is the time spent in the chair itself. Turnaround time is the period from the first appointment to the completion of the process, including the waiting time between consultations. Administrative time is the time spent on preparation, record-keeping and ordering in connection with a consultation. These three factors influence one another, but each requires its own approach. By measuring them separately, you can see where the gains lie: sometimes in the chair, sometimes in the number of appointments and sometimes in the ordering process. The information for opticians and clinics is aligned with this way of looking at practice management.
Why does fitting multifocal contact lenses take so long?
A multifocal fitting involves more variables than a single-vision correction. In addition to the prescription strength and lens fit, the wearer’s adaptation to the lenses also determines their satisfaction. This adaptation cannot be assessed during a single consultation, so a follow-up appointment is scheduled. If an adjustment is required as a result, another appointment follows. In this way, the number of consultations per treatment course increases without anything going wrong.
The most common reasons leading to an additional consultation are an adaptation period that still needs to be assessed, a prescription that requires adjustment after the initial period, and a complaint that is actually part of the normal adaptation process but for which the wearer returns unplanned. The latter can be partly prevented. You can read about why a multifocal fitting takes time and how the visual system adapts in the blog on adaptation to multifocal lenses. The General Dutch Association of Contact Lens Specialists and the Dutch Optometrists’ Association describe the structure of such a fitting process.
How can you reduce consultation time during a multifocal fitting?
The greatest benefit lies in avoiding follow-up appointments that serve no purpose. This can be achieved through three measures: a standardised initial consultation in which you ask about the most important viewing distances, an explanation in advance of what the wearer can expect during the initial period, and a follow-up appointment that you deliberately schedule rather than waiting for a request. Document the procedure so that every member of staff follows the same steps.
A step-by-step checklist for each consultation sets out the procedure in detail. During the initial consultation, you record: the main viewing distances in the wearer’s daily life, their previous experience with lenses, the measured values and the chosen design. At the initial fitting, you provide the explanation in advance and schedule the follow-up appointment straight away. At the follow-up, you assess how well the wearer has adapted to the lenses and their comfort levels, and determine whether the fitting process is complete. By documenting these steps, you prevent the approach from varying from one staff member to another and avoid unnecessary appointments. The recommended fitting procedure for a specific lens is set out in the manufacturer’s documentation.
What is a first fit and why does it determine the consultation time?
A ‘first fit’ is the first lens you fit which proves suitable for use without any adjustment to the prescription or design. If that initial fitting is successful, the process is limited to a follow-up appointment. If it is not successful, a correction round follows with a new lens and a new consultation. That is why the quality of the initial fitting carries greater weight in terms of consultation time than the speed of the fitting itself.
You can increase the chances of a successful first fitting by completing the full initial assessment, asking about the most important viewing distances and checking the design’s correction range before proceeding with the fitting. A cylinder that falls outside a design’s range will almost certainly lead to a correction round, so check this beforehand. The correction range and suitability of Opzie Omnifocal are set out in the manufacturer’s European product information. Do not use ranges taken from older presentations, even if they have been in use for years. Thorough preparation for the initial fitting is the most direct way to reduce the time spent in the fitting chair for each patient.
How do you work out how much chair time costs your practice?
Take the number of consultations required for an average multifocal treatment programme in your practice and multiply that by the average duration of a consultation. Also note down what a consultation slot in the diary normally yields. The difference between a treatment programme with a single follow-up consultation and one with multiple follow-up consultations highlights the potential gains. Use your own figures for this, rather than estimates.
The calculation example uses input fields for your own practice. Enter: the average number of consultations per multifocal treatment plan, the average duration of a consultation in minutes, and the number of treatment plans per month. Multiply the number of consultations by the duration to get the chair time per treatment plan. Then compare a scenario with one fewer follow-up consultation per treatment plan and see how much chair time that yields over a month. Do not base your calculations on assumptions about numbers or rates from another context, as these rarely apply to your own situation. Measure your own figures over a defined period, so that the outcome reflects your practice. The Dutch Union of Opticians publishes key figures that can serve as a framework.
What role does the adaptation period play in the number of consultations?
Getting used to a multifocal lens often determines whether a wearer is satisfied, and this adjustment cannot be assessed immediately. A wearer who does not know what to expect is more likely to return unplanned with a complaint that is actually part of the normal adjustment process. Providing an explanation in advance and scheduling a follow-up appointment make all the difference. This way, you can turn an unplanned appointment into a consultation that you have arranged yourself.
The checklist for the fitting consultation helps with this: explain the principle of the adjustment period, highlight the situations that may be more challenging at first, indicate which symptoms warrant an earlier return visit, and agree on a specific follow-up appointment. The distinction between adjustment symptoms and symptoms requiring attention is described on thuisarts.nl under ‘symptoms associated with contact lenses’. You can read about exactly how the adjustment process works and why explaining things in advance makes such a difference in the blog post on adapting to multifocal lenses. A good discussion beforehand shifts work from unplanned to planned appointments.
Establishing working procedures and sharing knowledge in the practice
Establish a standardised procedure so that every member of staff follows the same steps: for each consultation, describe the steps to be taken, the data to be recorded and the follow-up appointment to be scheduled. Include this description in the induction programme for new staff, so that the approach does not vary from person to person. Also, review the ordering process relating to a consultation: if ordering a lens or solution takes time each time, that is efficiency to be gained outside the fitting chair. A quick ordering system for the practice can reduce that administrative time.
Knowledge-sharing within the team ensures working methods remain up to date. SMEYEL webinars for professionals are a way of providing staff with further training on fitting and product ranges. When communicating about results, please observe the restrictions that apply to claims regarding medical devices; the Health and Youth Care Inspectorate supervises the sale and distribution of these products. Please discuss the application with our team if you wish to tailor the working methods or product range. Please contact SMEYEL to discuss the approach for your practice.
This information is of a general nature and is not a substitute for personal advice. If you have any concerns or are in any doubt, please consult your contact lens specialist, optician or (eye) doctor.
Frequently asked questions about reducing consultation time
What is chair time?
Consultation time is the time a customer or patient spends in the fitting chair, including explanations and measurements. The chair time for an entire process is the sum of all the consultations required to find a suitable lens. This concept helps to assess the schedule: it is not the duration of a single measurement that determines capacity, but the total number of appointments a wearer requires. By measuring chair time per process, you can see how much capacity a multifocal fitting actually requires. This provides a useful basis for identifying areas for improvement without compromising the care provided to the wearer. Measure the chair time in your own diary, as the number of consultations and their duration vary from practice to practice and depending on the approach taken.
Why are you looking at the number of consultations and not just the duration?
Because saving half an hour per consultation yields less benefit than having one fewer consultation per treatment course. As well as the fitting itself, every appointment involves preparation, administration and a slot in the diary. Cancelling a consultation therefore means you not only save on fitting time, but also on the time spent on related tasks and a diary slot that you can allocate to a new wearer. Faster measurements help, but the benefit is limited as long as the number of appointments remains the same. You should therefore focus first on preventing unnecessary follow-up appointments, for example through a more accurate initial fitting and a clear explanation beforehand. If the number of appointments per treatment course falls, this frees up space in the diary on a structural basis, and that carries more weight than a few minutes per appointment.
What is a first fit?
This is the first fitted lens that proves suitable for use without any adjustment to the prescription or design. A successful first fitting limits the process to a follow-up appointment and avoids the need for a correction round. If the first fitting is unsuccessful, a new lens and a new consultation are required, which prolongs the process. That is why the quality of the initial fitting is more important for consultation time than the speed of the measurement. You can increase the chances of a successful first fit by conducting a thorough initial assessment, asking about the most important viewing distances and checking the design’s correction range in advance. Thorough preparation for this initial stage is the most direct way to minimise the number of consultations per process.
How can you increase the chances of a successful first fitting?
By carrying out a full initial assessment, asking about the main viewing distances, checking the design’s correction range in the product information and making the pre-fitting explanation standard practice. A full initial assessment prevents you from discovering halfway through that a piece of information is missing. Asking about viewing distances ensures that the design is suited to the wearer’s daily activities. Checking the correction range prevents you from fitting a lens that cannot accommodate the cylinder. And providing a standard explanation in advance ensures that the wearer knows what to expect, making them less likely to return unplanned. Together, these four points increase the likelihood that the first lens will be suitable and that the process will be limited to a single follow-up appointment.
On average, how many consultations does a multifocal treatment programme involve?
This varies from practice to practice and depending on working methods. Track it in your own diary over a defined period. Taking a figure from a different context will yield a calculation that does not reflect your practice’s reality. Practices operate differently: the initial consultation, the specialist’s experience, the chosen design and the way in which follow-up appointments are scheduled all contribute to determining how many appointments a treatment programme requires. Therefore, count the number of consultations your multifocal treatment programmes require over, say, a quarter, and work out the average. That figure forms the basis for your own calculation and for identifying where profit can be made. Do not use a target figure, as this will give a result that does not reflect your own situation and could lead to incorrect decisions.
Does a shorter consultation time automatically lead to higher turnover?
No. Free-up time only yields a benefit if that slot in the diary is actually filled. You should therefore base your calculations on your actual occupancy rate rather than on a theoretical maximum profit. If you cancel a follow-up appointment but the slot remains empty, there is no financial gain, just a reduction in workload. The profit only arises if you use that time for a new patient or for work that would otherwise be left undone. So first assess whether there is demand to fill the slot that has become available. In a practice with a waiting list, shorter appointment times directly result in extra capacity; during a quiet period, the benefit is mainly comfort and peace of mind. You should therefore calculate the return based on your actual occupancy rate rather than a maximum-scenario estimate.
Where is most time lost during the fitting process?
This often results in unscheduled follow-up appointments regarding complaints that are part of the normal adjustment period, and in rounds of adjustments following an initial lens that did not fit properly. Both of these can be partly prevented through advance explanation and a thorough initial consultation. A wearer who is unaware that vision will feel different during the initial period is more likely to make an unscheduled enquiry, and that takes up time outside of scheduled appointments. An initial lens that cannot accommodate the astigmatism or does not suit the wearer’s viewing habits leads to a round of adjustments involving an additional consultation. By carrying out the initial assessment thoroughly and making the pre-fitting explanation standard practice, you shift work from unplanned to planned time slots and avoid some of the extra appointments. That is where the greatest time savings can be made.
How do you establish a procedure so that the whole team follows it?
For each consultation, describe the steps involved, the data recorded and the scheduled follow-up appointment. Include this description in the induction programme for new staff. A standardised procedure ensures that every member of staff follows the same steps and that quality is not dependent on who conducts the consultation. Describe the initial consultation, the first fitting and the follow-up appointment as separate steps, with the relevant data for each. Discuss the procedure regularly within the team and adapt it if the practice deems it necessary. By incorporating this approach into the induction programme, new staff members will immediately work according to the same structure. This makes the processes more predictable and record-keeping more consistent, which in turn helps to manage chair time.
What can you do to reduce the administrative time involved in a consultation?
Take a look at the ordering process and stock arrangements. If ordering a lens or solution takes time during each consultation, that’s time that could be saved outside the fitting chair. A smooth ordering process and clear stock arrangements save time that would otherwise be spent per patient. Assess how long the ordering process currently takes and where it is more cumbersome than necessary. An online ordering function for the practice can reduce that time. Setting up standard orders for frequently used products also helps. Administrative time isn’t counted as chair time, but it does determine the total time a consultation takes. By improving this process, you’ll have more time left for patient care and for new appointments, without changing the fitting process itself.
Where can you find a lens’s correction range?
In the manufacturer’s European product information and on the product page. Do not copy product ranges from older presentations or web content, even if they have been on the site for years. Manufacturers may update specifications, and using an out-of-date range can lead to incorrect fitting and an unnecessary round of corrections. Check the power range and correction range of a design before fitting, to ensure that the lens can accommodate the desired power and any cylinder. The official product information is the reliable source for this. If you are unsure whether a given figure is up to date, please contact the supplier for the most recent documentation. This will prevent an outdated figure from causing a fitting to fail and resulting in an additional consultation.
