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 By Neil B. Gailmard, OD, MBA, FAAO, Editor June 16, 2004 - Tip #126 
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An Educational Handout and Waiver for PALs

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Additional Information

I'm not a big fan of having patients sign informed consent forms and waivers, but there are a few instances when they are very helpful. I will offer a few such forms that I use in my practice in the weeks ahead, so you might consider adapting them for your use.

While we always concentrate on presenting the positive benefits of spectacle lens options, we also have a professional duty to explain the unwanted side effects that exist. This is part of good patient education and it actually improves patient acceptance when a negative feature is experienced - it helps a lot if the patient was informed in advance and knows it's "normal".

Progressive addition lenses (PAL) represent a large majority of multifocal lenses dispensed today, and my office is no exception to that trend. We love PALs and we recommend them to nearly everyone.
For patients who are new to progressives, our opticians explain how great it is to have clear vision at all distances and how PALS are better than bifocals, because the prescription change occurs gradually through the lens. If patients seem leery of trying something new, we give them some comfort by explaining the non-adapt warranty. Very few patients don't choose PALs.

All first-time PAL wearers are given a copy of the handout below at the time of order, and asked to sign it. A copy is kept in our records. As you'll see, this form makes sure that we explained the not-so-common-anymore side effects of progressives, and it discloses the rules of our non-adapt policy. This has saved us many times from having the rare non-adapt patient from asking for refund of the difference in the cost of PALS and flat-top bifocals.
All progressive addition lenses (also called invisible or no-line multifocals) have a slight optical distortion in the outer portions of the lens, which can make some objects appear bowed or curved, or can cause a feeling of motion when the head is turned. The reading zone in progressive lenses is wide enough for most purposes, but it may be narrower than some other bifocal styles. These factors are usually minor and disappear with wear. The advantages of this lens generally far outweigh the problems. While most people are not bothered by these factors, some will find it unacceptable even after a 1 to 2 week adaptation period.

If you cannot adapt to progressive addition lenses, our office will make new lenses in any other design that you wish at no charge, within 30 days of dispensing. Since the original lenses were a custom prescription item, which must be discarded, there are no refunds of the difference in cost if the re-made pair is of lesser value.

I have read and understand this policy.

Patient's signature_________________________________________________

Date____________ Technician___________________________

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
Advertiser Disclaimer: ACUVUE® 2 COLOURSTM is a registered trademark of Johnson & Johnson Vision

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