Article Date: 9/1/2007

Dealing with Dispensing

Dealing with Dispensing

Increase patient satisfaction and practice growth by following these tips.

BOB LEVOY, O.D., Roslyn, N.Y.

Getting more of your current patients to seek more of your services or buy more in your optical requires improved communication skills. Within this category are countless opportunities to achieve both patient satisfaction and practice growth with prescription eyewear and contact-lens dispensing.

Increase patient acceptance

Premium lens options, such as anti-reflective (AR) coating, Ultra-violet ray (UV) protection, photochromic, high-index materials, progressive lenses, polished edges and the like, greatly improve a patient's visual efficiency; comfort, safety and appearance. That's a given.

"When you discuss products in the exam room," says Dr. Michael H. Cho, director of Optical Services at the University of Alabama at Birmingham School of Optometry, "patients interpret what you say as a prescription or recommendation. This also paves the way for you to properly transfer authority to your staff." When you recommend a specific PAL in a high-index material with an AR coating, tell the patient that the optometric assistant or optician will discuss and answer any questions about these products in-depth. "By doing this, you integrate products with service, transfer authority, motivate the patient to visit the dispensary and set a proactive example for the staff to follow."

Escort the patient to the dispensary, or call the optician into the exam room and review the premium-lens recommendations in front of the patient to accomplish this all-important transfer of authority.

Document when patients refuse to accept your recommendation of polycarbonate lenses.

"Quote fees (for premium lens options) as one package instead of a series of add-ons," says Dr. Robert J. Lee, of Cerritos, Calif. Presenting features as a series of add-ons emphasizes costs over benefits and invites patients to compromise. "If a patient balks at the cost, inquire which feature(s) the patient doesn't want," suggests Dr. Lee. "Then, you can remove options and quote the total fee again."

Stress the benefits of premium lens options. For example, "AR coating isn't just for making glasses look good," says Dr. Irving Bennett, founder of the Irving Bennett Business and Practice Management Center at the Pennsylvania College of Optometry, in Elkins Park, Pa "It also improves night vision, a major advantage for senior patients."

"Any patient can benefit from lightweight, impact-resistant lenses," says Dr. Lee. "But for some patients, these characteristics are more than just a convenience. If a patient is monocular or has the potential for eye injury, make sure you discuss the importance of impact-resistant lenses."

If a patient refuses to accept your recommendation of polycarbonate lenses, document it, says, Dr. Pamela J. Miller, of Highland, Calif. Dr. Miller's practice created a form specifically for this purpose.

"When we started asking people to sign-off that they had declined impact-resistant lenses, our sales went through the roof," says Dr. Texas Smith, of Citrus Heights, Calif. "Today, we do over 70% impact-resistant lenses."

Rx for occupational and avocational needs

Some practitioners use an entrance history form that asks patients about their occupations, hobbies and interests to ascertain visual needs. Others include such questions during the case history.

The video display terminal (VDT) workplace questionnaire for example, recommended by Dr. Jeffrey Anshel, of Encinitas, Calif., includes questions about work practices, the environment (including the lighting), display screen, workstation (including viewing distances) and visual symptoms. Even the most unlikely candidates, he points out, are often avid Internet users.

  • Presbyopes. Ask progressive lens- or bifocal wearers if they ever watch TV from a recliner chair. If the answer is yes, ask: "Does the reading portion get in your line of vision; cause neck strain? Do you ever slide your glasses down your nose so you can see more easily through the distance portion?" If so, suggest the patient have his or her distance prescription mounted in an old frame to keep by his TV. Comfort is important, and patients will be delighted with their "TV glasses." It's an idea I first heard from Douglas D. McElfresh, O.D., of San Diego.
  • Golfers. Ask presbyopic golfers if their bifocal gets in the way of their swing? If so, ask whether they've ever seen a special lens just for golf? Then show them a pair of "golf glasses" that have a 10mm button segment in the temporal, lower corner of the right lens only (for a right-handed golfer). It will give them an unobstructed view of the ball, won't interfere with their swing and yet, will be fine for writing the score.
    Golfers will love the convenience of not having to take their glasses on and off, plus this unusual prescription will likely generate talk among their golfing partners and possibly referrals.
    In our surveys, only a handful of golfers had ever heard of such an idea, let alone been asked if they'd like it. Most said it sounded like a great idea and asked where they could get such lenses.
  • Every patient. Ask patients if they're bothered by the weight or thickness of their lenses; bright sunlight; their bifocal line; glare or reflections when using a computer or driving at night. And, ask high myopes if they're interested in less thick lenses at the edges than the ones they're wearing.
    By raising the issue, you'll "plant the seed" and cause patients to think about these issues. And, before long, some will return for premium lenses. I've seen it happen countless times.
    Diagnosing patients' occupational and avocational visual needs is the first step. The next: prescribe special purpose lenses and/or premium lens options.
    This in-depth consideration of patients' total vision needs benefits your practice by providing a unique, value-added service to patients, differentiates your practice and generates significant, additional revenue.
  • Begin the eyewear selection process by showing patients your top line of frames first.

    Contact lenses

    "Give patients the chance to think about contact lenses during their entire time in your office," says Dr. Gary Gerber, of Hawthorn, N.J., "instead of waiting until the last possible moment when they are already focused on leaving the office."

    "Your patient information sheet should include a line that asks if patients are interested in contact lenses that change eye color," say Drs. Janice M. Jurkus, coordinator of the contact lens service at the Illinois College of Optometry and Jeffrey Sonsino, of Vanderbilt Eye Institute in Nashville. You can then streamline fitting to the specific lens type you deem best for the patient. They add, "If your staff members wear contact lenses, suggest they wear tinted ones. Patients who see colored lenses on real people (rather than in pictures) are more likely to ask about availability."

    Don't forget patients who already wear contact lenses. "Ask patients who are perfectly content with their current contact lenses if their eyes feel as good at the end of the day as they do at the beginning," recommends Dr. Susan Resnick, of New York. If these patients answer, 'no,' Dr. Resnick explains that the increased oxygen delivery to the cornea with new, silicone-hydrogel lens materials provide many patients more comfort at the end of the day than their current lenses. "I also tell them that with silicone-hydrogel lenses, many patients experience less redness at the end of the day, presumably due to both increased oxygen and less irritation," she says.

    Our surveys indicate that significantly more color contact lenses are dispensed in offices where staff members wear the lenses than in offices where they don't. And the same is true for spectacle lenses: "If you recommend AR verbally, but don't wear it yourself," says Dr. Gary Heiting, of Hopkins, Min., "the patient receives conflicting messages and is more likely to believe the more powerful, nonverbal message."

    Premium frames and accessories

    The reason that more premium, special-purpose lenses and silicone-hydrogel contact lenses aren't dispensed isn't because of cost or lack of interest – but because staff does not show or explain them to patients. "It is good practice," says Dr. Neil Gailmard, of Munster, Ind., "to begin the dispensing visit with a discussion of the lenses before frames are considered." Dr. Gailmard suggests setting-up an in-office "lens design center," to display samples and demonstration lenses in the form of uncut lens blanks (e.g. high-index plastic vs. CR-39 in the same prescription) and mock-up glasses (e.g. right lens AR coat, left lens normal).

    Begin the eyewear selection process by showing patients something from your top line of frames first. The quality and perhaps name-recognition will be impressive and appealing. In addition, it will make more moderately-priced eyewear seem less expensive by comparison. And who knows? If primacy is indeed a factor in eyewear selection, the patient may choose the best.

    By the same token, recommend spectacle lens brands and product features that will give patients the best performance. Don't prejudge what people will spend for their vision needs.

    Prescription sunwear

    It is rare to have a patient regret the purchase of prescription sunglasses. On the contrary, what most people say is, "I wonder how I got along without them."

    Patients often buy poor-quality, ready-made sunglasses at drug- or department stores, even from street vendors and nail salons. Yet, unless they experience serious discomfort, most patients wouldn't think of bringing such sunglasses to your office. Some would see no reason to do so. Others would be embarrassed to do so.

    Provide a value-added service to such patients that also has the potential to generate considerable additional revenue. Namely, when making appointments, have your receptionist suggest that patients bring in any sunglasses they're currently using, regardless of where patients obtained them. The purpose: "To make sure you have clear, comfortable vision with them, are properly protected from the harmful rays of the sun and have a frame that fits properly and is comfortable." The gesture alone, will be appreciated.

    During the examination, place the sunglasses over the aperture of the acuity projector to determine unwanted power or distortion in the lenses. Check for visible light, infrared and ultraviolet transmittance. Be sure to check the fit of the frame as well.

    Many over-the-counter (OTC) sunglasses are fine. Others are seriously flawed. When you explain and demonstrate such shortcomings to patients, many will want quality sunwear replacements. Failure to evaluate potentially harmful OTC sunglasses is a disservice to patients. It's also a lost opportunity.

    Avoid the hard sell

    If patients are reluctant to purchase any of the above products or premium lens options, don't be over bearing and avoid at all costs, the "hard-sell."

    Patients who require a lot of persuading are likely to later have "buyer's remorse" and resent spending money for something they don't think they need or can afford. Don't sacrifice long-term relationships for short-term profits. OM

    Dr. Levoy is a well-known seminar speaker who focuses on profitability and practice growth. His newest book is "222 Secrets of Hiring, Managing and Retaining Great Employees in Healthcare Practices," published by Jones & Bartlett, 2007. You can reach him by e-mail at

    Optometric Management, Issue: September 2007