Why do Optometrists and Ophthalmologists use techs to fit Kerataconus lenses?

Fitting lenses to Kerataconus is extremely difficult, and requires a methodology and lots of knowledge of the cornea in order to fit properly. Topography equipment is fickle and requires great skill to use properly. So why do these most Doctors delegate this task to contact lens technicians? Are there any Doctors who do the work from start to finish themselves?