Article Date: 2/1/2010

Eyeglasses And…
contact lens

Eyeglasses And…

Use these four steps to identify contact lens candidates and turn them into happy contact lens wearers.

LEE ANN MURPHY, Stratford, Conn.

If you think everyone who wants to wear contact lenses is already wearing them or that people who want contact lenses will ask you for them, you may be missing an opportunity to increase your patients' satisfaction level.

“I've never seen a successfully fit contact lens patient who wasn't enthusiastic when he left our office,” says Kenneth Young, O.D., Primary Eyecare Group in Brentwood, Tenn. “If you have an enthusiastic patient, you have somebody who's going to send you referrals.”

How do you generate this enthusiasm and generate new opportunities? We interviewed several optometrists who are successfully adding new contact lens wearers to their practices and learned four simple steps you can adapt to your practice.

● Given the technologies available today, just about everyone who needs vision correction is a candidate for contact lenses, including the young, the old and the discouraged.

“We sometimes pigeonhole our patients, which can be detrimental,” says Mile Brujic, O.D., Premier Vision Group, Bowling Green, Ohio. “For example, take the 8-year-old child who's been wearing eyeglasses since he was 4 years old, and they're always banged up. His parents believe he's not ready for contact lenses because he can't take care of his glasses. In fact, he may be a great candidate for contact lenses. Those eyeglasses are always mangled because they're in the way.”

Daily disposable contact lenses may be the ideal solution for these young patients, says Michael P. Lange, O.D., C.N.S., founder and CEO of Lange Eye Care and Associates with eight offices in Florida. How early can patients wear contact lenses?

“Some parents still think their children should be at least 13 and able to take out the trash and do their own homework before they can wear contact lenses,” Dr. Lange says, “but I have 4-year-olds who wear contact lenses successfully. With daily disposables, lens care is not an issue. You wear them for a day and then throw them away.”

Dr. Lange also fits patients at the other end of the age spectrum — some as old as 85 — and maintenance-free daily disposables are his preference for these patients, as well.

One of the biggest opportunities for new contact lens wearers can be found in those who have tried contact lenses unsuccessfully in the past or who think they aren't candidates because they have astigmatism or corneal irregularities.

“Studies consistently show about 50% of the people who drop out of contact lenses do so because of discomfort,” Dr. Brujic says. “I always tell patients that contact lenses today are significantly different from those they may have tried in the past, even if they tried them only a year or two ago. There is a constant evolution in the materials and the modalities.”

● Education begins before the patient enters your examination room. Brochures, posters and videos describing the latest contact lenses can be great conversation starters and should be prominently displayed in your reception area. Your staff can reinforce this message by simply asking every patient if he is interested in contact lenses. Be sure to promote multifocal and toric contact lenses because many candidates for them are unaware they exist.

Victoria L. Dzurinko, O.D., F.A.A.O., in Billerica, Mass., says contact lens wear is one of a whole spectrum of topics that should be discussed in an eye examination. “Once I see a patient's prescription and have an idea of his options, I tell him about the latest contact lenses that are more breathable, easier to handle and easier to take care of than ever before.”

Dr. Brujic links those benefits to a individual patient's interests and needs, as revealed by his patient questionnaire. If a patient plays golf, for example, Dr. Brujic mentions the improved field of vision offered by contact lenses as compared with eyeglasses. If a patient wears progressive eyeglasses or bifocals and works at a computer, he explains how multifocal contact lenses can improve mid-range vision.

● Even after a personalized education, some patients will still be reluctant to try contact lenses. If you feel the patient is a good candidate, there are several strategies you can use to help patients experience contact lens wear. First, however, be sure you have a variety of trial lenses available.

“Having a good inventory is important to me because I offer everyone the chance to try on lenses on the spot,” Dr. Young says. “There is a huge benefit to being able to say, ‘While you're here, let's try on a pair and see what you think.’ If I can put a patient in a lens right away, then 9 times out of 10, that patient is going to want contact lenses.”

With comfort — or lack of it — being an issue for many patients, the in-office trial can be an important revelation.

“The biggest hurdle with people is comfort, especially if they've been unsuccessful in the past,” Dr. Dzurinko says. “If I can put a lens on a patient's eye and he can experience the comfort firsthand, it usually sells itself.”

Even if patients are not interested in a trial, Dr. Lange lets them experience the benefits of contact lens wear by offering them some added convenience after their eye examination. “We'll fit them in a multifocal contact lens after the exam because their eyes are dilated and they can't see up close,” he says. “That way they can see how their eyeglasses look when they're out front shopping for frames. That allows patients to experience contact lens wear.”

When patients are not ready to say yes to contact lenses, it's important not to become discouraged or oversell them. “If they're adamant they're not interested, I make sure they leave with all the information and let them know they have a three-month window from their eye exam to return for a contact lens fitting,” Dr. Dzurinko says.

Dr. Brujic says practitioners should not become discouraged when a patient says no. “We shouldn't alter our recommendation if we think it's in the patient's best interest,” he says. Even if a patient decides against contact lenses, he is likely to think about them every time he does something where contact lenses would be beneficial, such as shooting hoops or jogging — any of the activities you discussed during his visit. “Patients will have these environmental triggers if your discussion focused on their interests and lifestyle,” Dr. Brujic says.

In Dr. Brujic's practice, patients who say no to contact lenses initially often call back before their next appointment a year later, asking for a contact lens fitting. What accounts for the change of heart? “Having the conversation means the seed is planted for future follow-up visits,” he says.

● Once a patient has agreed to try contact lenses, make sure the lenses are comfortable. This means fitting them in the proper lens from the start, even if it is a specialty lens.

Some doctors resist fitting specialty lenses — even toric lenses — and Dr. Lange thinks that is a missed opportunity. “Prescribing specialty lenses can be a huge practice-builder because these are patients who have never been satisfied with their vision and, all of a sudden, the optometrist says, ‘Let's put you in this specialty contact lens,’ and they get 20/20 vision. They're going to be patients for life,” he says.

Invest in technology

Dr. Lange suggests investing in the technology that will help uncover irregular corneas as part of building a specialty lens practice. “Without Orbscan or corneal topography capabilities, practitioners will miss a lot of patients with irregular corneas,” he says.

With specialty lens fittings, taking sufficient time with each patient is imperative. “We're a big contact lens practice and part of the reason why is that we will take the time to fit the difficult patient,” Dr. Young says. That is time well-spent because those are the patients who are likely to generate referrals, more so than a patient who felt rushed during his examination.

For straightforward cases where spherical lenses will produce good vision, it's important to make sure patients are truly comfortable by asking the right questions.

For instance, when patients return for a follow-up visit after a trial, Dr. Brujic doesn't simply ask how the lenses felt. He asks what time of day they started feeling their lenses during the trial period. Sometimes, when properly prompted, a patient who said his trial lenses were great also says he started to feel them toward the end of the day and needed to remove them as soon as he got home from work. At that point, Dr. Brujic talks to the patient about a different material or design that may improve the patient's end-of-day comfort.

Nonverbal cues also can signal contact lens discomfort. At follow-up appointments, Dr. Brujic has both new and longtime contact lens patients bring their lens cases, cleaning and disinfecting solutions, and any related products they've been using. He examines the case for soil and debris and checks to make sure the patient is still using the solution he recommended. If a patient is using artificial tears, that is a sign there may be a comfort issue. “If a patient's lenses are always comfortable, he'll never have to use supplementary eye drops, so I get an insight into the real comfort of the patient when I see what else he's using.”

New contact lens wearers need to know they don't have to experience discomfort at any time. “Everyone feels a little dryness while wearing contact lenses from time to time, but it doesn't necessarily have to be that way,” Dr. Brujic says. “By asking more detailed questions, I get more detailed answers and then I can make changes and feel confident it will correct the problem.”

When vision and comfort are acceptable, Dr. Dzurinko looks for one more sign that the lenses are right for her patient: enthusiasm. “I want patients to leave excited,” she says. “If they're saying the lenses are OK, I ask them what isn't OK about them. That will sometimes lead me to a different material or modality. I like to make sure they're very happy before they purchase any lenses.”

Freedom and comfort build loyalty

As the optometrists we interviewed can attest, contact lenses can be a rewarding and profitable part of an optometric practice. “A lot of people think optical is where you make all of your money, and you do make a big chunk there,” Dr. Young says. “But contact lens patients also buy eyeglasses.” What's more, successful contact lens patients are happy patients who often credit their newfound freedom and comfort to you.

“New contact lens wearers can be some of your most grateful patients,” Dr. Dzurinko says. “They come in tied to glasses, and they leave seeing well without them. It's one of the most rewarding things about what we get to do every day.” OM

Ms. Murphy is a freelance writer and editor based in Fairfield County, Conn.

Optometric Management, Issue: February 2010