The contact lens industry has made great advancements in the past few years. Silicone hydrogel lenses have proven to offer huge advantages to the wearer in terms they understand: better comfort, longer wearing time, less redness and sharper vision.

National market data shows that sales of silicone hydrogels are brisk, but are you actively converting your contact lens patients? Do you tend to think of it mostly as a rather expensive problem-solver lens? Do you still think of it only as an extended wear lens? Do you generally leave patients in the contact lens brand they are wearing if they seem perfectly happy? If so, it's time to adjust your thinking.

The tendency to leave things alone

As a practicing OD, I understand the thought process perfectly when you perform a yearly exam on a patient whom you previously fit with contacts. This is a loyal patient who puts his trust in you, pays your fees (including the extra contact lens fees), and you naturally assume the role as his advocate. You try to do the best you can with him and for him. That is just as it should be and that approach has earned valuable patient loyalty for many doctors. But I believe we are sometimes mistaken in our view of what the patient wants. If we were on target with what is best for the patient, we would earn even more loyalty and a side benefit is that we would also earn more money.

Here is how I view how patients feel about contact lens care. By selecting you as their practitioner, they are saying they want the best. There are obviously cheaper places to obtain contacts than your practice. They are willing to pay your exam fee and contact lens evaluation fee because they believe they will obtain state-of-the-art contact lens management. They don't really know what that is, but they trust you to provide it for them. Knowing that, ask yourself if you are truly delivering state-of-the-art care when you leave a patient wearing a lens material that has been around for 10 or 20 years. I suppose you can tell yourself that factors such as the increased oxygen transmission and the smoother, wetter lens surface don't matter to all patients, but I'm not so sure. I've been putting SiHy trial lenses on nearly every CL patient I see, and they notice the difference immediately.

Jeopardizing your image?

Rolled up in this approach of leaving things as they are is the comfort of knowing you won't recommend a lens that the patient won't like as well as what he had before. After all, you prescribed the contacts the patient is now wearing and he's happy - why rock the boat? I have an answer for that. I dispense a free trial pair of the new lenses for the patient to take home and I tell him that if he doesn't like them as well as his old ones for any reason, we can always switch right back. I remind him that the old contacts were still fitting fine, but that the new design may offer more comfort and better eye health and it's worth a try. If the patient wishes to return to his previous contact lens Rx, he does not need to see me or even tell me, he can just call the technician and she will take care of it.

Step by step example

Here is a typical scenario:

• After the eye exam, I tell my existing contact lens wearers that there is a new breakthrough lens material available that offers many benefits to most patients.
• I recommend that we try a pair of free trial lenses on in the office and see what they think. There is no charge to try on a pair and it only takes a few minutes.
• My technician gets the lenses and places them on the patient while I see another patient. Depending on your state law and your comfort level, you may have your technician check acuity, ask about comfort and proceed to dispense the trial pair of contacts. You may also pop back in the exam room and check the fit yourself if you wish, although in many cases the change in lens fit is minimal and you already know the lens will center and move well.
• Depending on the nature of the fitting change, you may not need any follow-up with this patient unless he notices problems, of course. I would have the technician call the patient in a few days, inquire how he is doing and make a note in the chart.

What about the refit fee?

If you charge a healthy exam fee and an additional contact lens evaluation fee, I don't think you need to charge a higher "refit fee" on these simple cases that are upgrading to newer and better materials. I simplified the process and kept the time spent to no more than any other contact lens evaluation. Upgrades are part of our service. The nice thing about higher fees is that you don't have to nickel and dime the patient every step of the way.

I like being able to tell the patient that they can try the new lens on and even take the trial pair home to test it out and there is no increase in the professional fee. That makes my motives appear in the patient's best interest - which they are! If a patient learns that the fee went up because he tried on the new lens, he will become suspicious. Of course, the new lens type will have a higher material cost, and we tell the patient about that early on in the process, but that cost is only incurred if the patient decides to buy the new lenses over his old type; it's his choice to make. Patients almost always choose the new design over the old, in spite of an increase in price.

What about ordering the boxes of lenses?

It may give you pause when you realize that if you stayed with the old brand of contacts, the patient would place an order for boxes of lenses the day of the exam. If you dispense a free trial pair, how do you handle ordering the supply? I simply assume the patient is going with the new lenses and I write up the order for the supply in the new brand. My technician asks the patient how many boxes he would like to order and recommends a full year supply. The tech discusses rebates and any other price break that might alter the decision of how many boxes to order. We don't ask if the patient wants to order any boxes, we ask how many.

In the rare case that the patient decides to return to his old contact lens brand, you simply take back the unopened boxes of lenses and order him the boxes in his old type. Issue a credit or refund of the difference in lens cost. This happens so infrequently that I don't view it as a problem. We tell our patients that the trial pair of lenses is the test pair and they should not open the boxes unless they have decided to stay with the new design.

Two final points

When we take a case history on a contact lens patient, it's easy to get a response that all is well, but there are degrees of successful lens wear. If you probe a bit more, you'll often learn that wearing time is limited because of dryness or discomfort. He wants them out. The patient may have accepted that as normal, but it means things could be better. After you've determined that all is well, ask the patient if there are any minor things he wishes were better with the contacts and ask why he removes them when he does.

Part of the role we often assume as patient advocate is to help them spend money wisely on eye care products. That effort is in the right place, but we may even become a little frugal in the process. Be careful not to prejudge and leap to the assumption that your patient wants to purchase the lowest price lens available. Many people want the best, not the cheapest.