Optometric Management Tip # 119   -   Wednesday, April 28, 2004
Are you updating your patientsí contact lenses?

It is sometimes just too easy to keep doing what we've been doing. As comfortable and easy as that is, it's not the best management approach for your practice. And with the increasing availability of alternative sources for patients to obtain replacement contact lenses online or by phone, it's all the more important that optometrists maintain the leadership position in the patient's care.

Are you sure it ain't broke?

Let's take an example that we all see quite often in our practices: the happy contact lens wearer that returns for an annual routine eye exam. You first prescribed the contacts about 3 years ago and have renewed the Rx each year. The patient is still doing well; your technician has recorded the history on today's exam as "no complaints." You find good ocular health, good acuity, and no significant refractive change. The patient even has eyeglasses that are the correct Rx. The easy and safe thing to do is to tell the patient there is no change, and just renew the CL Rx for more replacements. After all, we've all learned the "if it ain't broke; don't fix it" rule very well.

Actually the scenario I just described, while acceptable, may not be the best patient care model. We all know there have been significant improvements in contact lens materials and designs during the past three years - even in the last year! Do we not have a duty to mention this to our patient? If I put myself in the patient's position - I'd want my eye doctor to inform me about new advancements - even technical ones. As an analogy, I expect my primary care physician to tell me about a new generation drug that may be safer and perform better - even if the older version of the drug that I'm taking is still working.

Can't get this over the Internet!

I routinely sit face to face with the patient after an exam such as this, and tell him about a new lens that has just been released. I like to mention the brand name of the lens, and explain that it offers more oxygen and better comfort late in the day because the material does not dry out as easily. Patients are very interested when they hear this, and they usually reveal at that time that they do experience some dryness problems. Interesting side point: an executive from a major contact lens company recently shared some consumer research with me that found that patients often don't tell their doctors about contact lens related problems because they are afraid the doctor may tell them that they must discontinue lens wear. So, hearing "no complaints" may not be the whole story.

I go on to tell my patient that to allow him to test the new lenses personally, I'll prescribe a free trial pair. I'll also dispense (or order) a year's supply of boxes of the new lens brand at this visit because I'm confident they will work great, but I also state that we can always exchange them if the boxes are not opened. I'd rather not make a complex ordeal out of this and inconvenience the patient by delaying the order. I remind the patient that his old lens design was still doing pretty well, and that if he does not like the new brand after a few days, we can always go back to the old type. While this does happen, it is extremely rare and my technician can take care of it.

It's pretty obvious that the patient can't get that type of service or expertise over the Internet!

What stops us from being proactive?

Are we too busy to mention the new contact lens designs and benefits? We certainly shouldn't be. Delivering the best care requires us to structure our fees and appointment times to allow time for this. Delegate more data collection so the doctor has time to sit and chat about vision care technology. The patient consultation and treatment plan is the most important part of the visit.

Do we subconsciously shy away from lens changes because our office policy requires a fitting fee if we refit the patient into another brand of lenses, while leaving him in the old brand would only incur the lower CL evaluation fee? If so, that seems sad and antiquated to me. Either charge an increased fee or don't - either approach will work fine, but be fair and consistent. I charge a higher fitting fee if I feel I need to see the patient back for follow-up, and I charge only the CL eval fee if I don't think I'll need any follow-up. But I truly like to simplify contact lens care whenever possible and I never schedule a follow-up visit unless I really think I need one. Many contact lens fitting changes today (on experienced daily wear patients) are so easy that a follow-up is unnecessary.

There is a big intangible benefit, beyond the increased fitting or material fees, in changing patients to new advanced lenses. Namely, the bond between doctor and patient grows stronger and excitement is created. The patient realizes you have his best interest at heart. Now, more comfortable and achieving longer wearing time, he will tell others. The patient will realize that the annual exams are important and productive, and he'll be more likely to return for future care.


Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management