Article Date: 9/1/2011

How to Prescribe High-Prescription Spectacles

How to Prescribe High-Prescription Spectacles

Consider these steps to satisfy patients who require high-prescription correction.

Diane Donofrio Angelucci
Clarksboro, N.J.

High-prescription patients often carry a long history of coping with cumbersome eyewear. Although this struggle may lead to their misconceptions about lens technology, it also can open the door to a valuable conversation at which you educate patients and ultimately provide them with spectacles that offer the highest quality of vision, comfort and style.

Begin this conversation by listening to the patient's story, says Donna Suter, a practice management consultant and business coach in Chattanooga, Tenn. You may learn that a high-prescription patient's perception of eyewear hasn't changed since his spectacles broke during a baseball game or since adolescence when he wore “Coke-bottle” spectacles.

“When you acknowledge feelings and let them tell their story, it allows patients to be open to education,” Ms. Suter says.

Beyond this opening conversation, this article describes other steps to meet the challenges of providing optimal vision for the high-prescription patient.

Get an early start

Ask staff to check patients' prescriptions on file before they arrive for an exam. This way, they can provide relevant lens brochures at check-in, say those interviewed. Also, during pre-testing, have technicians ask patients about their lifestyle and vision challenges and be prepared to discuss brochure information. Further, consider asking patients to complete a lifestyle questionnaire, say those interviewed. An example of a question: “What sports, if any, do you participate in?”

To prepare staff for these discussions, scripting is key, says Richard S. Kattouf, O.D., D.O.S., optometric consultant, Bonita Springs, Fla., and OM's “Fix This Practice” columnist. Staff also should provide demonstrations of lenses and frames as well as written handouts to help patients remember what was said, he explains.

Prescribe based on needs

Once patients are in the exam chair, O.D.s must use the “power of the doctor,” Dr. Kattouf says.

“Power of the doctor simply means that the doctor should sit with the patient eye-to-eye, knee-to-knee, and should order, direct and prescribe everything the patient needs,” he says.

This includes lens material and design, lens enhancements and additional spectacle pairs based on the patient's lifestyle, Dr. Kattouf explains. Having the doctor, or expert, do these things conveys the importance of them to the patient.

Emphasize “24/7 vision,” Ms. Suter says. “We're saying that our goal is to help you achieve 24/7 vision and to do this in a fashion that protects your eyes and gives you the clarity you're looking for,” she says.

You want to educate patients that with 24/7 vision, they'll have spectacles that provide clear vision for every activity and occasion, whether enjoying their favorite sport, working on a computer or even if they break their primary pair, Dr. Suter explains.

Michael Rosenblatt, O.D., who practices in Washington, D.C., says he offers discounts on additional spectacle pairs and informs patients about these discounts in the exam room. This enables him to immediately plant the seed regarding the benefits of additional pairs.

Have staff educate

After you write the prescription, opticians and frame stylists must continue the conversation, providing detailed explanations and lens demonstrations, those interviewed say.

Opticians caring for high-prescription patients must be well-versed in presenting the newest and thinnest lenses, specifically for presbyopic patients, as not every progressive lens is available in all materials. Opticians also play a key role in helping patients achieve the look they desire, says Carolyn Rikje, ABOC, optician supervisor at Optique of DuPage Medical Center in Glen Ellyn, Ill.

“There are lots of smoke-and-mirror techniques that you can use to disguise a higher prescription,” she says. Helping the patient choose the right frame, in addition to offering the thinnest lens possible, makes a huge difference in appearance, Ms. Rikje explains.

“When it comes to high prescriptions, just a few millimeters too big or too small can really change the whole look of the glasses,” she says.

Ruth Ann Ham, LDO, ABOC, NCLEC, independent consultant and optical trainer in Jacksonville, Fla., explains that for the best correction, high-prescription lens-wearing patients need frames that are symmetrical with rounded corners and centered well over the eyes.

“The frame also needs to be pre-adjusted to each patient to ensure optimal fit. Panto, faceform, bridge and temple adjustments create the as-worn placement of the frame and will affect the measurements and the performance of the lenses,” she says. “Panto is also essential to help eliminate chromatic aberration.”

Several of those interviewed recommend prescribing premium lenses that take into account higher-order aberrations. Prescribing these lenses requires a LASIK-surgery-grade aberrometer analysis, which identifies high aberrations and is used to fabricate custom spectacles that maximize vision, Ms. Suter says.

Explain enhancements

Explain to patients that in addition to an accurate prescription, clear vision and comfort also depend on lens enhancements. For example, high-prescription patients must understand that AR coatings improve the appearance of their glasses while allowing them to achieve optimal vision. AR coatings are particularly important in reducing the inherent reflections of hi-index lenses, Dr. Rosenblatt says. “There seems to be more reflected light at night from the higher-index materials, so putting that coating on seems to help improve a patient's nighttime vision,” he says.

Scratch protection is important in keeping vision clear and crisp, adds Ms. Rikje.

“The anti-reflective is the outer most coating, so you really want to choose a multi-layer anti-reflective treatment that has scratch resistance built into it,” she says.

Unlike older generation CR-39 lenses, hi-index and polycarbonate lenses contain ultraviolet protection. However, for outdoor activities and driving in bright sunlight, patients still require sunglasses and can take advantage of a variety of options, including polarized lenses, hi-index, or polycarbonate polarized photochromic lenses, Ms. Ham says.

Another option for outdoor wear: magnetic clip-on sun lenses, adds Ms. Ham. For the correct fit, “you have to be sure that they'll accommodate the curvature and thickness of your higher plus or minus lens,” she says.

Sports enthusiasts need a knowledgeable optician to provide sports glasses and goggles, says Ms. Rikje. “[These products] do have some prescription limitations, especially when we're talking about a patient with a high prescription,” she says.

Make frame selection easy

Because many high-prescription patients can't see themselves once they remove their glasses, some practices use cell phones, webcams or tablet computers to snap photos of patients wearing frames so patients can view the photos later when they are wearing their glasses.

Other practices ask patients to try a pair of contact lenses so that they can see themselves in frames, says Dr. Rosenblatt. “If they're not contact lens wearers, it opens the door for potentially converting that person to at least a part-time contact lens wearer,” he adds.

Some practices offer imaging technology that enables patients to see themselves in different frames and compare lens materials, those interviewed say. In addition, frame company websites often offer a virtual try-on, Ms. Ham says.

Invite company for support

Dr. Kattouf recommends you have high-prescription patients bring an adult family member to appointments to help reinforce messages. “Many high prescriptions require that the patient hold reading material in a certain way, at a certain distance. The light has to be behind the head,” he explains. “ … We need that adult family member to support our educational process with the patient in the use of these high-prescription lenses.”

After appointments, Dr. Rosenblatt says his staff sends e-mails to the patient to reinforce the messages delivered during the visit and to provide supplemental information.

Reap the rewards

Although high-prescription patients have unique needs, they will appreciate your efforts to help them achieve optimal visual results, say those interviewed. “Today you can really give them the ‘wow’ factor of what's available,” Ms. Ham says. “When you do that and they understand the time you took with them to give them personal service, plus the effort you made to give them quality, they're very appreciative of it and will tell their friends, family and co-workers.”

Providing services to high-prescription patients also sets your practice apart, say those interviewed. “When you're doing this kind of specialty care, we find that practices have patients coming from neighboring counties to this specialty office because, as they cross the county line, they're not passing anybody who performs these types of specialties,” says Dr. Kattouf. “So it does increase your radius of draw—no question about that.” OM

Ms. Donofrio Angelucci is a freelance writer based in Clarksboro, N.J. She regularly covers optometry and other medical specialties. E-mail comments to

Optometric Management, Issue: September 2011