Article Date: 9/1/2010

Reduce Spectacle Remakes
in-office labs

Reduce Spectacle Remakes

Follow these steps to reap the benefits of providing an optimum pair of glasses

Jim O. Davis, III, O.D., Batesville, Ark.

Imagine this: A patient enters your practice, and exclaims, "I can't see a thing out of these glasses you made me! I want a refund!" Your practice is full of other patients either waiting for eye exams or perusing and selecting eyewear from your dispensary. As a result, in addition to one very dissatisfied patient, the patients waiting for an eye exam are now wondering about the caliber of your clinical skills. And, those in your dispensary are now re-thinking their plan to buy their eyewear from you.

Having an in-office optical lab offers you the advantages of cost savings (in-office equipment return on investment vs. lab bill) and patient loyalty, but only if you and your staff can provide patient satisfaction with the eyewear you produce. The primary way to do this is to minimize spectacle remakes.

Here, I provide the five steps I've used to accomplish this.


ILLUSTRATION BY JOHN SCHREINER

1. Double check the refraction

Personally, I rarely change a prescription more than +/−0.75D. So, when a patient's prescription has changed more than that amount, I've found that our number of spectacle remakes increases. Therefore, I've made it a point to examine the patient's previous refractions or auto-refraction values to ensure I haven't made any mistakes prior to recording the patient's new refraction.

Another method of doublechecking the refraction: Show the patient his current prescription vs. the new prescription he selected from the phoropter, and each time, ask him whether the latter prescription provides him with the best vision. This reduces spectacle remakes as well.

2. Manage patient expectations

If the patient's prescription has indeed significantly changed, educate him on what, specifically, he can expect with the new prescription. For instance, if a patient's astigmatism correction has undergone a major change, show him the difference between his old prescription and his new prescription, and explain that the world will likely look slanted to him for a day or so while his eyes adapt to the new prescription.

In addition, take the time to educate first-time progressivelens wearers that they may experience intermittent peripheral image blurring or unsteadiness with these lenses, so they're not surprised, or dissatisfied, with their lenses.

Managing patient expectations not only precludes spectacle remakes, it also instills patient loyalty. This is because by taking the time to educate patients, you've shown them you genuinely care about their vision. And, not all patients encounter the aforementioned issues. Either way, you're a hero in patients' eyes, and this often leads to patient referrals.

3. Have a well-educated optical staff

Your optical staff must have the education to transform the prescription you've written into a satisfactory pair of spectacles. Specifically, your optical staff should possess the following skills:

Appropriate frame selection. Suitable frame selection is essential to prevent spectacle remakes, as the proper alignment of lenses in the frame reduces the chances of distortion and the prismatic effect of the lens. In addition, it allows for the adjustment of the lens up or down in case the outside lens lab makes the lens' optical center slightly too high or too low. Further, your optical staff should know to inform patients who decide to switch to a smaller frame than they had before of the vision they can expect as a result. This is a way your optical staff can manage the patient's expectations.

Pupillary distance and segment (seg) height lens measurements. Your optical staff must know how to read the millimeter ruler or use the pupillometer. After all, if they don't record the proper pupillary distance or seg height, prism will be induced, and the patient is more likely to experience eye muscle strain.

In addition, your optical staff must know to always adjust the patient's frame prior to measuring the seg height of the lens. This is especially important with progressive lenses that must be fit within a 2mm margin of error in the frame and along the patient's visual axis. Also, this is helpful in patients who have high power single vision prescriptions.

Proper patient positioning. Patient complaints of near or distance blur often result from the patient positioning himself upright for the aforementioned measurements, even though this is not his normal sitting position. To prevent this, your optical staff should know to tell the patient to sit and hold his head in his normal manner during the measurement process.

In addition to the aforementioned skills, you should require your staff to attend local/regional eyecare meetings at least annually. (Most of my staff attends more than one meeting, and several have obtained certified fitting licenses.)

Further, you should invite ophthalmic lens manufacturing laboratory representatives to give presentations on the intricacies of the new lenses they offer. This way, your optical staff will be up to date on the latest offerings and how to best fit them. Doing this in my practice has definitely resulted in a reduction of spectacle remakes. The outcome has also been an increase in revenue, as these presentations include effective dispensing tips as well. (See "The Latest Lab Equipment," below.)

4. Always check lens powers

Another way to prevent spectacle remakes is to always check the lenses your off-site lens laboratory delivers as soon as they arrive. In fact, I recommend you have a written agreement about re-makes with the lens lab you use. For instance, the lab we work with offers a free re-make within 30 days for any reason, with no charge other than shipping and staff labor costs. (I don't typically charge the patient for any of these services.). Almost all lens labs have a one-time re-make policy within a certain number of days of making lenses. Some labs, however, will charge for any re-make at a much lower rate than other labs — sometimes at half price.

As a brief, yet important aside, never contact the patient to tell him his lenses have arrived before you or your optical staff checks the lens power. Having patients present to your optical only to be told that the lens powers aren't what they should be is highly aggravating for them — especially for those who made that long drive to get to your practice. Further, this occurrence can have a negative affect on the patient's perception of your optical, prompting him to purchase his next pair of spectacles elsewhere. If, however, this circumstance should occur, consider giving the patient a gift card to a local restaurant to make up for their time and travel.

5. Provide a written policy

Give your patients a written policy on re-makes before they leave the office with their new spectacles. I place my policy in a packet that contains information on the cleaning and care of the patient's new eyewear. Also, our staff reviews the warrantee information on lenses and frames with the patient. Each lens has a specific warrantee. Even within one brand of lens, certain lenses will have a better (or worse) warrantee. Most of the lenses I use have either a one- or two-year replacement, but the lens company usually limits the number of replacement times to one. Keep in mind, however, that even the best-written policy sometimes does not address rare exceptions. If a patient's glasses have been destroyed in a fire, for instance, we often replace their glasses, even if they aren't under warrantee. In these cases, what is right for the patient is what is right. (See "Handling Complaints: A Step-by-Step Protocol," below.)

Although completely avoiding spectacle remakes is impossible, the five aforementioned tips can reduce them and result in more patients presenting to your office exclaiming, "I want another pair of these great glasses you made me!," rather than "I can't see a thing out of these glasses you made me!" OM

THE LATEST LAB EQUIPMENT
AIT Industries' Maxima Evolution patternless edging system features wrap edging technology, an automatic 4D groover that angles from 0° to 15°, automatic, program-guided, manual and flat internal and external safety bevel programs (B dimension, minimum 18mm on rimless and 19.6mm) and a mini-bevel to fit all mountings in thin metal frames. Other attributes: automatic polishing of all plastic lenses, such as Trivex and polycarbonate (an optional hi-luster wheel is available), a specialized roughing process for lenses that have slick coatings, such as super hydrophobic coatings. The device operates as a system with the company's Combimax Tracer/Blocker or the CNC-3D Tracer/Blocker. Visit www.aitindustries.com.
Briot's Alta Pro edger features a Tilted Bevel System (TBS) so you can angle the edging wheel to match the frame groove's angle and adjust the back facet up to 3mm. The device consists of four automatic bevels to accommodate an array of lens and frame characteristics. For instance, the finesse safety bevel control provides surgical accuracy on the front and back surfaces of any lens thickness, the company says. In addition, the device enables you to drill at angles from 0° to 30° with a 0.1mm accuracy rate, and the grooving is synchronized to adjust automatically to lens curvature and thickness. Finally, the edger's screen shows 3D pictograms to guide you through each step, and you can customize screen icons based on your most frequent jobs. Visit www.briot-usa.com.
Gerber Coburn's Mr. Blue Edger features simultaneous tracing of the front and back surfaces of the lens and a standard, milling and an edging- assisted system cycle. In addition, it finishes with 3D bevel profiling, offers groove width and depth settings (steps of 0.05mm) automatic or customized adjustment of the drilling angle through holes, non-through holes and notches with a maximum number of 12 holes per lens. (It provides flat-edge finish and polishing — B dimension minimum: 17mm on flat edge, 18.5mm on bevel.) Other attributes: a counter bevel for front and/or back surfaces and a three-to-four wheel speed variator, depending on the lens material (e.g. glass, plastic and composite edging, such as medium and high-index, polycarbonate polishing). Visit www.gerbercoburn.com.
National Optronics' Axiom Surface Generator provides complete lens processing, including generating, cribbing and pin beveling. In addition, it includes integrated smart software, such as worker-friendly touch-screen procedures, maintenance and part manuals that can be accessed via the touch of a button. Also, the software processes plastic or foam laps to match any surfaceable lens curve, the company says. The device is able to cut curves from +6.00D to −30.00D. Visit www.nationaloptronics.com.
Optical Dynamics' nanoCLEAR AR 5.1 anti-reflective coating machine, which runs on the company's newest version of nanoCLEAR chemistry, works exclusively in conjunction with the company's Q-2100R Digital Lens System. The Q-2100R creates the patient's lens from a liquid plastic, using an in-mold process. Prior to creating the lens, you place the nanoCLEAR AR stack on the molds. The end result: an AR lens with a hydrophobic top coat, in about an hour, the company says. Visit www.opticaldynamics.com.
Santinelli International's ME-1200 lens edger features a Click Mode, which processes Chemistrie Sunlenses as well as three-piece drill mounts; step-beveling technology, which allows the edging of prescription lenses for any high-wrap frame; and a polishing function, which eliminates knurl-mark edges. Other attributes: a diamond grooving wheel; a radius measurement unit, which measures the lens' radius for proper cut-out and orients the lens for quick processing speed, and the company's proprietary Self-Adjusting System (SAS) "Wizard" technology, which provides self-calibration and auto adjustment. Visit www.santinelli.com.
Super Systems Optical Technologies' Surfacing for Dummies is a new version of the company's Fast Grind 2200 System. It requires no prior surfacing experience. Via a video you can learn to run the computerguided device in about one hour, the company says. Specifically, it features a three-pad process that produces fine and polish prescription progressive, single vision and bifocal lenses (ranging from +6.00D to −9.00D in up to a 3.00D cylinder) using tap water and standard electricity. Visit www.superoptical.com
Visionix's VL3000 Lensmeter/Mapper uses wavefront technology to objectively measure any frame and lens type via the push of a button. It features real-time power mapping of various lens types, such as single vision, automatically measures the addition and far vision of any progressive lens and presents a schematic representation of frame fitting and pupillary distance measurement. Other features: a diagram representation of the progressive addition channel, automatic progressive addition measurement and right and left fitting heights. Visit www.visionix.com.
Tomey USA's TL-3000C auto lensmeter measures standard and high index, bifocal, trifocal, progressive and prism ophthalmic lenses as well as both hard and soft contact lenses. Once you set the device's nose piece for measuring contact lenses, it automatically switches to the contact lens measurement mode. In addition, the TL-3000C measures interpupillary distance with automatic right/left detection and can measure UV transmittance, while also measuring the lens' power. Visit www.tomeyusa.com.

Handling Complaints: a Step-by-Step Protocol
To handle patient complaints, design a set protocol for your optical staff to follow.
In my practice, I have my optical staff measure the patient's pupillary distance and use a black marker to mark where the patient looks through the lenses. In addition, I have my optical staff measure the power of the lenses at the point the patient looks through them and compare this power with my written prescription.
If the measured power matches with my prescription, I have the optical staff look through the lenses at an Amsler-type grid to determine whether the lenses contain any obvious distortions or imperfections. If distortion is noted near the visual axis, we order new lenses. Depending on the lens and lens manufacturer, the lab typically doesn't charge us, but if they do, we incur the costs.
If, however, the correctly powered lenses don't contain any obvious distortions or imperfections, my staff dot the optical centers of the lenses to observe whether the patient is looking through the right part of the lens. If he is and still reports a visual problem, we re-check the patient's refraction that day.
During this process, we measure the patient's vision with their new lenses and check it against the pre-determined refraction. We conduct a pinhole acuity test to see what vision the patient is capable of and compare it with his previous bestcorrected vision. To determine the specific culprit, we ask the patient following:

► How long have you noticed the vision changes? (If the patient notices an immediate vision problem upon receiving his glasses, typically a refractive mistake has been made. If, however, the prescription was fine upon receiving their glasses, but later got blurry, typically, the patient has experienced either a change in his eye health and/or medication.
► Have you had any recent health changes?
► Have you been taking any new medications? (Often if a new medication, such as metformin [to treat type 2 diabetes] or amiodarone [an antiarrhythmic agent], has been started, or was started close to the time of the examination, that could be the cause of the problem.)
► Are you diabetic or hypoglycemic?
► Are you experiencing any other problem I didn't mention? (This is a great question in that some folks who are experiencing financial trouble will admit that they really just need their money back and don't really have a problem with their vision.)

If all the above doesn't solve the problem, conduct a thorough eye health evaluation that is comprised of Amsler grids, confrontation fields, pupil analysis, color vision testing, biomicroscopy and a thorough evaluation of the retina and optic nerve. The results will likely indicate the need for a referral to either their primary-care physician or appropriate specialist for further evaluation.
Realize that having a visual problem with a new pair of glasses can be very distressing. As a result, try to make this into an opportunity to show the patient how much you really care about him and his visual needs. Practices grow by word of mouth (close to 90% of our patients are referred by established patients). Some of our problem patients have become our best source of referrals.

Dr. Davis practices in Batesville, Ark. with one of his sons, and his wife, who is executive director of his practice. He is currently on the advisory board of OOGP, a buying group. E-mail him at icgreat@yahoo.com, or send your comments to optometricmanagement@gmail.com.


Optometric Management, Issue: September 2010