Optometric Management Tip # 136   -   Wednesday, August 25, 2004
Managing Established Contact Lens Patients:
It’s not just about fixing problems – It’s about upgrading


Last week’s tip touched on the need to charge an adequate professional fee for all contact lens work, whether it’s for a fitting or for an annual evaluation of existing, successfully-worn lenses. Let’s face it, we all do much more of the latter than the former, yet I’m not sure we give those returning happy wearers the top level service they deserve. It’s very easy to just leave them in the lenses they are wearing.

When we think about our professional preferences for lens brands and materials and designs, it is often in conjunction with prescribing and fitting lenses on a new patient, or a previous wearer who has dropped out of contacts. That is fresh new territory and we have much influence over the type of lenses that will be used; our recommendations to the patient carry a huge amount of weight. That’s when we can give an overview of all the lens modalities available and by interviewing the patient, and considering lifestyle and occupation, we can prescribe our lens of choice. It might be a color cosmetic lens for one person’s lifestyle, or a bifocal for another’s. It could be a new generation silicone hydrogel for general use, your favorite toric design, a one-day disposable, an extended wear lens, or even orthokeratology. There are many good options to choose from and its fun to hone in on the new technology that will be the best choice for each patient. That type of customized patient care is what builds practices – because of patient enthusiasm and the referrals that ensue.

In an established practice, there are often thousands of current contact lens wearers, and these patients are seen for routine annual exams (admittedly they are not always exactly annual). Compared to patients who are presenting for a new contact lens fitting or refitting, the current wearers far outnumber the new fit requests. So let’s take a close look at how we approach this big segment of your contact lens practice.

As clinicians, our typical philosophy on caring for current established contact lens wearers focuses on ocular health. We examine the eye of the contact lens patient from a general perspective including a fundus exam and tonometry, and then from a corneal health perspective and then from a visual perspective. We are also concerned about lens comfort and wearing time, and we review those issues. If all those aspects of the exam are deemed normal, or have no complaints, there is an overriding tendency to leave the lens design exactly as it is. We may make a minor power adjustment if needed, since the patient is going to purchase a new lens supply anyway, and that is not really a change in “lens fit”.

Why do we prefer to not change anything? Why the safe approach is not really best for the patient: Why the safe approach is not really best for the practice: So sit and chat with your next happy contact lens patient. Let them know what is new and better out there, and why. Put some new trial lenses on the patient. Think upgrade!

Best wishes for continued success,

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