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 By Neil B. Gailmard, OD, MBA, FAAO, Editor August 25, 2004 - Tip #136 
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Managing Established Contact Lens Patients:
It's not just about fixing problems - It's about upgrading

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Additional Information

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?
  • Changing the lens design or brand would require more service, which would result in a higher fitting fee. While that may not sound like a problem, in the real world, there is a natural resistance to this (although there shouldn't be). The doctor would then have to justify the need for the additional work and fee, and that can become uncomfortable or confrontational. It's easier to avoid it. We hate the idea of "selling", and recommending a change in lens design when the patient didn't ask for it is getting very close to selling.
  • It's easy to rationalize that no change is in the patient's best interest. From a scientific perspective, the existing lens is a proven clinical success. If there are no complaints... why change anything?
  • The doctor might recommend a change in lens type, only to have the patient prefer the old design, hurting the doc's image. While this certainly does happen, it needn't hurt your image. I tell patients in advance that this might happen and that we can always return to the old design if that's the case. That's what trial lenses are for.
Why the safe approach is not really best for the patient:
  • The patient is deprived of new and better lens materials that may meet there needs better than what they were fit with years ago. Patients don't know what they don't know! They can't ask for something they have no idea exists.
  • "No complaints" does not mean everything is perfect! In fact, in contact lens wear, it rarely is. It means patients have accepted the current status of their contacts as "the best that can be expected". Ask your next CL wearer who has "no complaints" if their lenses ever feel a little dry or gritty toward the end of the day. Her answer will be something like "oh... well yeah, of course".
  • We like to hear "no complaints" because it validates that we did a successful job in fitting this case, and it makes our current job easier. We should dig deeper.
  • Even if there are truly no complaints, we owe it to our patients to discuss convenience issues - like not ever using solutions again, or not having to insert and remove every day, or not having to put reading glasses over the contacts, and so on. Provide convenience and you'll have a very happy patient!
Why the safe approach is not really best for the practice:
  • By not bringing up new technology and new modalities in contact lenses, doctors teach their patients that the need for the routine annual exam is kind of a rubber stamp event. From the patient's point of view nothing happens - except they pay a high fee. Boring. In their view, they already knew nothing was wrong with their eyes or their lenses! Is it any wonder why patients might feel like they don't need the visit?
  • If we simply leave patients in older technology, they won't be as enthusiastic about their lenses or our practice - which hurts referrals. There will be nothing to talk about to others.
  • Fitting new lens designs results in more professional fees and possibly higher profits on materials.
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,

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

A Proud Supporter of

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

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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