Optometric Management Tip # 303 - Wednesday, November 14, 2007
Dilation and Frame Selection
My goal is to never hear the words: "My vision is blurry from those drops so I
think I'll just come back on another day to look at frames." I'm sure most eye
care practitioners have faced this issue due to the cycloplegic affects of mydriatic
eye drops, but what are you doing about it? After all, if the patient needs a
change in the spectacle Rx and wants to buy glasses, it's logical and efficient to
instill the drops and proceed with frame selection while the drops are working. If
activities occur quickly this can work out fine, but there are certainly cases where
the drops interfere with the process.
I'll come right out and say the main reason I work on this issue is to increase
optical sales. Sure, the patient may come back and place the eyeglass order on
another day, but a basic rule of salesmanship is to strike while the iron is hot. If
a patient decides to buy glasses in my office, we'll see that it happens. It's really
not difficult to achieve both pupil dilation and a frame selection at the same visit
if, as long as the doctor cares.
If frame selection does not occur on the day of the exam, patients may ...
Additionally, new glasses may be a primary reason in the patient's mind for
visiting our offices. My practice achieves high satisfaction ratings and referrals
by caring about patient's wants and needs.
- Change their minds and decide they don't want glasses.
- Decide to shop around.
- Forget much of what my staff and I recommended as frame and lens
options for the new eyewear.
A simple solution that I often use is to instruct my assistant about which drops
I'd like to instill. She places that bottle in her pocket and escorts the patient to
the optical area. This works especially well with the use of scribes who also
perform the frame selection, but that's certainly not mandatory. My technician
proceeds with the frame selection process until the patient has narrowed down
the choices and is close to a decision. Some people decide quickly while others
take a long time, but we don't want to rush anyone. At that point the technician
instills the drops with the patient still seated in the dispensing area. We have a
tissue available and the patient simply leans his head back and it's done. The
tech can then continue to finalize the frame choice, check the fit, take
measurements, discuss lens options, enter all data needed for the order, write up
all charges and complete insurance paper work. There are plenty of duties to
use up most of the necessary dilation time. The patient is then worked back into
an available exam room for the doctor to complete the examination.
Optical dispensing is simply too important to patient satisfaction as well as
practice revenue to make frame selection a difficult process. It should be a fun
experience for the patient!
- The blur from mydriatic drops causes problems mostly for hyperopes,
although high myopes and astigmats can have problems seeing frames on
their faces with or without drops.
- A virtual dispensing video system that allows patients to see themselves
wearing various frame styles while wearing their habitual Rx glasses is a
- A magnification mirror and good lighting is beneficial.
- The use of lens flippers with trial lenses of the right Rx (or pre-made with
plus lenses) may assist when held in front of the new frames, although
they do get in the way.
- I've heard of doctors inserting trial contact lenses to assist with frame
selection in cases with a high prescription, and also as a way to introduce
contacts to patients who might not have considered it.
- If the case is routine, the dilated fundus exam can be done when the
patient returns to pick up the new glasses.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management