Article Date: 3/1/2008

WHEN SHOULD YOU RECOMMEND <i>Premium Lenses?</i>
premium lenses


Our special section on glasses opens with proven advice on how to keep patients' vision — and your practice — healthy.

Tifton, Ga.

Those thick CR-39, -7.00-1.00 × 090/+2.50 OU glasses with the flat top 28 you just dispensed to your banker are about to cost you money. Big money. No, he's not going to give you a Prime-Plus 20% home loan the next time you visit his office. It's much worse. His family, friends, acquaintances and business associates may discover that he got his glasses … from your office.

Dispense with the drama

The situation is not quite that dramatic. But it should be. Every pair of glasses you dispense has the potential to end up in a conversation. Thus, when people ask, "So, where did you get your glasses?" you would not want them to think, "Well, I'm certainly not going to his office for my eye examination and glasses. Those glasses are hideous."

Ben Franklin's technology

Imagine a car dealer wanted to sell you a "brand new" 1980 Dodge K-Car? Even if the dealer has kept it in his warehouse, has cranked its motor, run it for it for one hour every week and has placed new tires on it, I would bet my next optometry-school loan payment (with apologies to the Southern College of Optometry) that you wouldn't even consider purchasing that car. After all, it's more than 25 years-old. So why is it that we continue to sell our patients eyewear with technology that Benjamin Franklin invented in the 18th century? The answer: Many optometrists are so afraid of being viewed by their patients as "salesy" that half the time, they "are not even doing their job" — that is, making the proper eyewear recommendation, says my friend Thomas L. Bowen of Williams Consulting Group, a practice-management consulting firm located in Lincoln, Neb. In essence, we're not living the mission of our profession, which is to offer our patients a better quality of life.

Fear of rejection

Many of us don't recommend the best eyewear for our patients' individual vision needs because we fear the patient will think that we are trying to take advantage of him or that we're somehow robbing him of his hard-earned money.

Is this fear justified? Let's look at this question from a different perspective: Do you know what the patient-acceptance rate of anti-reflective (AR) lenses is in Japan? It's more than 90%, according to the AR Committee of the Vision Council. Eye-care practitioners in Japan usually dispense polycarbonate lenses or better yet, 1.67 high-index lenses to accompany their patient's selection of AR-coating.

Are those who wear glasses in Japan sitting on a heap of money that your patients don't have? Are the costs of goods half that of American optometric offices? I would argue that the answers to both questions are "no." Instead, I would argue that eye-care practitioners in Japan make recommendations without fear.

Steps to patient satisfaction

Let's discuss how to make the appropriate recommendations to our patients without fear. First, educate yourself on your patient's needs. Armed with this information, you'll have the confidence to educate your patients on how specific types of premium lenses can benefit them. The result: The patient won't view your recommendation as "salesy," but practical and smart.

To educate yourself on your patient's needs:

Review your patient's patient-history form. The data contained in this form should reveal the patient's vision problems and lead you to the appropriate recommendations for each patient. To obtain the best education on your patient's needs, make sure your patient-history form includes questions about lifestyle, not just ocular issues. An example of a lifestyle question: "What hobbies do you currently pursue?"

Review your patient's exam data. Armed with the results of your patient's vision exam and patient-history form, you now have all the education you need to recommend specific lenses to the patient.

Educate the patient. Now, while the patient is still in the exam chair, tell him what type(s) of lens(es) you recommend and why. Answer the "why" by outlining the specific benefit(s) the patient will receive from your recommendation(s). It's important you do this while the patient is still in your exam chair because doing so links your recommendation with the exam, placing immense importance on the correct lens selection.

Now, present a written copy of the patient's prescription to him, as Federal law requires you to do so after you've determined his refractive status. (Keep in mind that failure to do so has resulted in penalties of up to $10,000 per occurrence).

Write a prescription for the lenses you've recommended, and hand one copy to your frame stylist in front of your patient. The prescription shows the patient that your premium-lens recommendations are medical, not sales-based. Personally handing the prescription to the frame stylist, in front of the patient, reinforces this message, as you are the patient's eye-care provider.

Make sure your patient questionnaire addresses not only eye problems, but lifestyle.

Recommendation examples

Here are seven examples of lens-recommendations you may make to patients:

high-index lens. If you write prescriptions for -7.00-1.00 × 090/+2.50 OU, I suggest you recommend a 1.67 high-index lens to patients with this prescription.

The benefit for the patient: The lens is thin (cosmetically more appealing) and light. In addition, most high-index lenses have an aspheric surface, minimizing the distortion.

progressive addition lens (PAL). PALS provide presbyopic patients with distance, intermediate and near vision.

The benefit for the patient: The lens doesn't contain bifocal lines — a feature extremely appealing to many baby-boomers who may feel lined bifocals are glasses that their grandparents' wore. In other words, PALs allow presbyopes to maintain a youthful appearance.

When you explain progressive lenses, explain them in terms of function. For example, "Progressives will allow you to see clearly at all distances, from the back of the movie theater, to the computer screen and to the text in the newest John Grisham novel."

Anti-reflective lenses (AR). If your patient questionnaire doesn't address glare, then personally ask the patient. You'll be surprised to hear how many of them suffer from eyestrain as a result of glare. When patients tell me that glare is an issue, I recommend AR lenses.

To show these patients the benefit of these lenses, my optical staff employs a lunette that contains one non-AR CR-39 lens on the right side and the AR lens with the scratch resistant, dustrepelling material on the left. It's a great presentation: The opticalstaff member then taps on the lens with her pen to prove to the patient that there is a lens on the left side (it will look invisible). Then, my optical-staff member says to the patient: "I recommend the lens on the left. Can you see the difference? This anti-reflective lens will get rid of the reflection and glare in your vision that comes from light bouncing around on your lenses. As a result, when you're driving at night, for instance, you won't see all the haloes around the lights from the reflections that are typical with non-AR lenses."

My optical staff member further says: "These lenses will also benefit you in that they are made of a scratch-resistant material, making scratching them more difficult, and they repel dust, so you won't have to clean them as much as non-AR lenses."

Now, the patient may reply: "The last pair of AR lenses I had were really tough to clean." Assure the patient that these new AR lenses are much easier to clean. Tell the patient, "Simply wipe them with the cloth that we'll give you."

Photochromic lenses. If your patient's history form reveals he's light sensitive or that he regularly performs both indoor and outdoor tasks, recommend photochromic lenses.

The patient benefits: These lenses allow patients to go from indoors to outdoors and maintain comfortable vision, while keeping the sun's brightness and harmful ultraviolet (UV) rays at bay.

To educate the patient on how the lenses will benefit him, have your optical-staff member take a photochromic lens into the sun and then back into the office.

One caveat: If your patient is interested in using these lenses for driving, let him know that he may be better off with a polarized clip for his current frames or polarized sunglasses, as the UV protection auto manufacturers add to car windows precludes photochromic lenses from darkening.

Polarized lenses. For patients who spend a lot of time in environments with intense glare (on the water, at the beach, in the snow), always recommend polarized lenses.

Computer lenses. If the patient indicates that while working on a computer he experiences poor vision, eye strain, watery eyes and/or an aching forehead, he may be an excellent candidate for a pair of computer vision lenses.

Sports goggles. Patients with visual issues who participate in sports and recreational activities, such as swimming, can benefit from prescription goggles. Optimum performance at sports and recreation activities requires the proper materials and design for clear vision and eye protection. Also, note that because of safety issues, many sports in which contact among players occur (i.e. basketball and soccer), prohibit participants from wearing glasses.

The exchange

Now it is time to pass the baton to your frame stylist. I find it most effective to have this exchange in the examination room in front of the patient. Numerous pager systems are available that allow you to contact your staff from the examination room.

If you use a chairside scribe, the scribe can walk to the optical dispensary in person and notify the frame stylist that your patient has concluded his exam.

Review with your frame stylist your recommendations in detail. Explain why each recommendation is very important. This conveys to both the staff and the patient why you're prescribing your recommendations.

Now, ask the patient if he has any further questions, answer his questions, thank your patient for allowing you to be his eye doctor, and leave. Yes, leave.

Your job is not frame selection — leave that to the professionals.

Next, the frame stylist must do the following: "Doctor has recommended that your lenses have …" This needs to be done before any frame selection commences. After all, this summary brings what you have recommended to a proper conclusion.

Following these recommendations will probably not get you that great loan from your banker, but you will have a happier banker, one who might even let you have your checking for free. Now imagine what these recommendations can do for all your patients and your practice. OM

Dr. McElroy was named Georgia Optometric Association's Optometrist of the Year in 2005. He was named Georgia Optometric Association's Young Optometrist of the Year in 1997. He operates Family Eye Care in Tifton, Ga.

Optometric Management, Issue: March 2008