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 By Neil B. Gailmard, OD, MBA, FAAO, Editor February 25, 2009 - Tip #368 
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Contact Lens Patient Conundrums

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I love the real cases that readers send me to comment on. As part of our practice management grand round series, I'll continue to give my two cents on challenging situations. I find there is excellent learning potential in reviewing actual problems that occur in the trenches. Typically, I write a private response to the reader right away (it may take me a week or so) and I save the correspondence for possible use in a future tip article. I remove any identifying information in order to encourage readers to be completely forthcoming about aspects of the practice that are not going well, but the cases are real.

A reader's email

My contact lens prescriptions are valid for one year. I allow patients up to three months after the exam to "finalize" the fitting (trials, changes, etc), then I write the Rx and they can order boxes for one year. I verbally specify this to patients and have them sign a form that specifies that. If I require a follow-up, I also specify that in both places. However, too many times patients come in six or eleven months after the exam now asking for their Rx so they can order boxes. Up to six months I charge them an office visit fee; after six months I require a new exam. Of course they whine about that, despite having been told about the policy! As an example, I saw a patient about a year and a half ago for a contact lens exam and over the next two months gave her a few trials, then never heard back from her. Yesterday she came in wanting one pair of contacts for an event. I said no, and she said she never ordered boxes because they weren't comfortable. I said that's why we have you back for follow-up, so we can make things as good as possible. I advised her that she needs a new exam. She replied that she just ordered her glasses a month ago so why does she need a new exam again? I explained again, and offered her an exam within 24 hours, but of course that was not good enough.

I understand the prescription is valid for one year once I release it, but if I release the Rx six or more months after the exam, the patient has just extended the term of the Rx!!! Do you have any ideas or suggestions?


I don't run into what you describe in my practice so we should be able to pinpoint some aspect of your procedure that could be changed to prevent this. I may not understand your process perfectly but I'll propose a couple of thoughts. Why not "finalize" the contact lens prescription sooner so the burden will be on the patient and you won't have that time lapse between the exam and the contact lens Rx? At the end of an exam, you would write a prescription for contact lenses. Until proven otherwise on follow-up - that's the contact lens Rx. If you don't need any follow-ups, you're done unless the patient calls back with a problem. If you want to do a follow-up, schedule it for one or two weeks and go from there. If the patient does not show - the prescription stands as is. If there is a problem at the follow-up visit, change the prescription as needed and you now have a new one.

For new fittings, I charge a contact lens fitting fee (in addition to the exam fee) that includes follow-up visits for two months, but if all is well I really only need one visit.

Of course, I'm very big on excellent customer service so I am very understanding if the patient comes back with a complaint - either with contacts or glasses. I'm very tolerant of people who take too long to return although I always look them in the eye and nicely ask "why did it take you so long to let me know about this problem?" Then I listen. You'll know how to proceed when you hear the response and it gets the issue out in the open so the patient knows that you know. I charge fairly high fees in the first place so it's easy for me to give excellent customer service. That's a great reason to charge high.

I do not charge for a complaint visit (contact lenses or glasses) unless it is more than six months from the exam and even then I would listen to the issues before deciding what to do. If the problem was always there from day one (based on the patient's word) then I'm more likely to fix it at no charge.

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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Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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