Article Date: 4/1/2008

Fitting Beyond The Chair
contact lenses and lifestyles

Fitting Beyond The Chair

Prescribe contact lenses that fit lifestyles and exceed patient expectations.

CHRIS H. COOPER, O.D., Memphis, TN.


ILLUSTRATION BY DAVID HITCH

Fitting contact lenses is about so much more than a prescription and a base curve — or at least it should be. Through the years, I've learned that simply asking the right questions is the best way to meet — and hopefully exceed — my patients' expectations.

What are the "right" questions? They are the questions that allow you to customize the patient's experience to his or her life outside your exam lane. The answers to the right questions add validity to assumptions about what we already know clinically and give the patient implied permission to be honest (see "Ask The Right Questions," below).

We all know that patients don't always comply with our instructions. I try to frame compliance questions in a way that gets patients to open up without them fearing that I'll be judgmental or take away their contact lenses.

For instance, when a patient tells me he wears his two-week lenses for a month or more, I view this as an opportunity to talk with him about services such as AcuMinder (AcuMinder.com), a free online reminder service that can send him an e-mail or text message when it's time to replace his lenses.

In addition, I might also consider switching him to a daily modality lens, as doing so may better suit his wearing habits.

Understanding your patients

We can't underestimate the importance of understanding vocation and avocation, and these change through time.

A patient of mine recently accepted a job as a hospital chaplain, which required her to be on call at night and to arrive at the hospital quickly. As a result, switching her from a disposable modality to an extended-wear lens made sense.

Brian Linde, O.D., a private practitioner in Billings, Mont., often makes outdoor sporting needs central to his contact-lens recommendations. Many of his patients enjoy hunting, fishing, snowmobiling, skiing and other outdoor activities that present special visual challenges.

For instance, a hunter might not want his glasses to reflect light in a duck blind. And, a fly fisherman may need bifocals to tie on his fly, but they get in the way when he's golfing.

Ask The Right Questions
Here are a sampling of questions you can use to create a personalized patient-care experience.
■ How many hours a day do you spend on the computer?
■ At what point in the workday do you notice your eyes feeling dry or burning?
■ When do your glasses get in the way? Are there times you'd rather not wear them?
■ Have you ever considered part-time contact-lens wear with a single-use lens?
■ How long do you wear your lenses? A week? A month? Three months?
■ What time do you put your lenses on in the morning? What time do you usually take them out?
■ Is Jenny still playing soccer? How is she doing in school, academically?

"As someone who enjoys many of these activities myself, I can relate to my patients' frustrations when glasses or contact lenses become a limiting factor," says Dr. Linde.

Don't underestimate the role of vocation.

Because his patients are frequently outside in dry, windy environments, they may benefit from a lens that performs well in adverse environments. Learning more about the patient's lifestyle helps to remove some of the "sales" aspect of optometry with which many doctors are uncomfortable.

"Once the patient has identified a problem, he or she is more open to your recommendation," Dr. Linde says. "Now I'm solving a problem, rather than selling a product."

Some doctors are very comfortable gleaning information about work and hobbies through casual conversation. For others, a written questionnaire or intake form is a better way to discover the patient's needs. Staff can also be a valuable asset in screening some of these lifestyle questions, so that you can walk into the exam room, continue the conversation and then quickly and efficiently make patient-specific recommendations.

The younger set

When you work with children, it's especially important to be tuned in to their ever-changing needs. Increasing involvement in sports is often what brings children to my office seeking contact lenses. Parents are very motivated to help their children excel in sports, and they understand intuitively that new activities demand new equipment.

"My patients aren't just a pair of eyes," says Mary Lou French, O.D., a pediatric optometrist in Orland Park, Ill. "I want to know a little about their personality, what sports they play, and how they're doing in school."

If a child is struggling in school, Dr. French says she's more likely to prescribe vision correction and to suggest contact lens wear early.

"Kids sometimes don't wear their glasses because they don't like how they look in them," she says. "This is an opportunity to prescribe contact lenses, so that vanity doesn't get in the way of academic performance."

The Contact Lens in Pediatrics Study (CLIP) showed that teenagers and children ages eight to 12 derive a number of quality-of-life benefits from contact lenses, such as an increased confidence in their ability to participate in sports.

"I want kids to see their best and look their best," says Dr. French. "I have seen firsthand what a positive impact contact lenses can have on a child's self-esteem."

Vision in the real world

Unfortunately, 20/20 vision in the office doesn't necessarily translate to 20/20 vision in real life. The classic example is the prism-ballast astigmatic lens wearer. In the exam chair, the lens works great. But when a wearer changes his head or eye position quickly, the lens may rotate, compromising vision.

I recently re-fit a patient of mine for this very reason. He had been wearing prism-ballast lenses and thought they were "OK." When I asked him whether he was dissatisfied with his lenses during specific times, he replied that his vision would get blurry when he watched television while lying down. Also, he said he enjoyed doing projects around the house, but the need to adjust wiring above his head or twist his head under a cabinet "wreaked havoc" with his vision. I re-fit this patient with a soft-toric accelerated stabilization design (Acuvue Advance for Astigmatism, Vistakon).

In a follow-up visit, the patient reported a "much better wearing experience."

You can educate patients on the many ways they can try contact lenses in their own real-world environments. In a retail setting, offer the patient the opportunity to walk around the store for a while in their new lenses, so he can determine how well he can read price labels or see someone across the room.

Dr. Linde offers a "Guaranteed Contact Lens Success Program," in which patients can return lenses to the practice within 30 days for a full refund.

"We want them [patients] to find out whether the lenses work for them when they are skiing or hunting or working late at the computer," he says.

Because the guarantee program eliminates barriers to trying contact lenses, Dr. Linde says it has helped his practice reach out to many new wearers, from eight-year-olds in their first pair, to 55-year-olds who are trying them again after two decades of spectacle-wear.

"Silicone hydrogel and new material technologies allow us to address some of the dryness issues now that may have caused these patients to drop out in the past," Dr. Linde says.

I find that patients often bring their real world with them to the office. It's not unusual to find patients checking messages on their cell phones or flipping through some reading material. Ask about the use of these things to assess how well the contact lens you prescribed is working.

It doesn't take a lot of time to learn more about patients' wearing habits, hobbies and visual needs. When you take all these lifestyle factors into consideration, it instills patient value in your service and makes your practice stand out from others.

Learning about your patients' needs creates a personalized patient-care experience that truly drives patient satisfaction. OM

Dr. Cooper is Professional Affairs manager with Johnson & Johnson Vision Care, Inc., and a principle partner in West Tennessee Eye, LLC, in Memphis, Tenn. Contact him at (901) 872-2020 or chrishcooper@hotmail.com.


Optometric Management, Issue: April 2008