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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
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
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
- 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
- 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.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
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Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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