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 By Neil B. Gailmard, OD, MBA, FAAO, Editor November 14, 2007 - Tip #303 
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Dilation and Frame Selection

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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.

Why care?

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 ...
  • 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.
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.

One technique

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!

Additional thoughts
  • 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 big help.
  • 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,

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.
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