Article Date: 9/1/2006

How Do We Upgrade Patients?

Hands-on advice for switching patients to silicone hydrogels, from discussions to fees to annual supplies.

Dr. Quinn: Here's a scenario many of us see every day. There's a patient in your chair, and you're thinking of switching him to silicone hydrogels. What happens next? Do you ask probing questions to uncover the patient's needs?

Dr. Sorrenson: If a patient's eyes look red, I mention it, or I ask, "Do your eyes get a little red by the end of the day?" Next, I tell the patient, "There's a new contact lens that lets much more oxygen through to your eyes than the lenses you're wearing. Let's try that and see if your eyes start to look better and maybe feel a little bit more comfortable." Patients are so excited that they definitely want to give it a try.

Dr. Quinn: Dr. Szczotka-Flynn, how do you present the new contact lenses to patients?

Dr. Szczotka-Flynn: We have a lot of eye-catching brochures in the reception area, which is beneficial. Often, by the time patients see me, they're ready to find out more. They'll ask me, "What's up with this contact lens? Can I wear this?" Even if they don't ask, I tell all my patients about the newer modalities every time I see them. 

Dr. Miller: I really try to probe about a patient's existing lens-wearing habits. I used to ask, "Do you sleep in your lenses?" Now I ask, "How often do you sleep in your lenses?" We know they're all doing it, at least for naps, and this question encourages them to discuss it. Then I explain the benefits of the new generation of contact lenses.

Dr. Kaminski: I compare new contact lenses to new pharmaceuticals. I tell patients, "Your family doctor wouldn't prescribe the same blood pressure medicine year after year if he knew there was a newer, safer, more effective drug for you."

Next, I talk about the paradigm shift in contact lenses — doctors like silicone hydrogels, patients like them and they're best for your eye health. I want patients to have a smoother contact lens with better wetting, less hypoxia and greater comfort.


Dr. Quinn: How does your staff support you in introducing silicone hydrogel contact lenses?

Dr. Miller: In many practices, patients spend more time talking to the staff than they do to the doctor, and the staff often can find out what problems patients are having. Patients might even talk more openly with the staff, so they're an important communication link for us.

Dr. Lapple: My staff teaches lens application, removal and care, but they don't use a script. What also helps is having staff members wear the lenses. That way, they can discuss their own experiences with specific lenses.

Dr. Miller: It's important for my staff to start talking about advances and new lenses and prepare the patient for my discussion. A lot of the direct-to-patient advertising has them ready to consider new modalities, including the ACUVUE® OASYS™ Brand Contact Lenses.


Dr. Quinn: Do most of you do a trial fitting? What's your procedure?

Dr. Sorrenson: If a patient has been wearing hydrogel lenses successfully, I examine his eyes and apply a silicone hydrogel lens. If it feels good, fits well, and the patient sees well, I teach him how to remove the lens and send him home for a trial.

I have patients e-mail me to tell me how they're doing with the lenses. If they're doing well, we place an order. If not, we have them come back to try another lens, or we order their previous lenses.

Dr. Miller: I bring all my patients back 2 weeks after the diagnostic fitting, even if that means giving them two pairs of diagnostic lenses. I like to get them past that 1-week "something-is-different" feeling. Since I started the 2-week schedule, our success rate for silicone hydrogel transitions has increased significantly.

Dr. Quinn: How do you prepare patients for the transition?

Dr. Miller: I don't make promises about comfort. I do explain that silicone hydrogel contact lenses will feel different at first, but gradually they'll become more familiar, like wearing a ring on a different hand. Adaptation takes some time. Thankfully, the newer generation of silicone hydrogels has been giving us almost instant comfort in a lot of cases, so adaptation isn't taking as long.

Dr. Szczotka-Flynn: I also schedule a 2-week follow-up visit. If a patient doesn't like the new lens, he can call or e-mail to get a prescription for the previous lenses, but I'd rather see the patient. When patients make the effort to come in, I say, "Let's not just discount this entire modality. Let's try another contact lens." It's another opportunity to provide them with the contact lens they want.


Dr. Quinn: One issue we all face is being compensated for any additional chair time required to refit a patient for silicone hydrogels. Are you assessing a fee to refit?

Dr. Kaminski: We have to get paid for our time. I explain the refitting fee to my patients within the context of the benefits these lenses offer. I can always judiciously waive a refitting fee if I think it's best.

Dr. Lapple: In my practice, we have a 2-month fitting fee period, and we see a patient as often as needed within that period. But when I'm asking a happy hydrogel wearer to change contact lenses, I don't charge an additional fee, even if there are follow-up visits and phone calls.

Dr. Sorrenson: My approach is a little different. I charge an annual contact lens analysis fee for every contact lens patient. I have several levels of annual contact lens analysis fees, so that I can charge a higher level for tougher cases where I'll be doing more follow-up or the initial exam takes longer.

Dr. Szczotka-Flynn: Our fee schedule is similar. Patients pay a contact lens assessment fee for every annual visit, even if we are reevaluating and represcribing the same lenses. Patients deserve advice on their current lenses or other options during their annual assessment. They realize they are paying for this advice, and they usually opt to try silicone hydrogels.

ACUVUE® Brand Contact Lenses are indicated for vision correction. Eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from VISTAKON®, Division of Johnson & Johnson Vision Care, Inc., by calling (800) 843-2020 or by visiting

ACUVUE® OASYS™ is a trademark of Johnson & Johnson Vision Care, Inc.

©Johnson & Johnson Vision Care, Inc. 2006

Contact Lens Spectrum, Issue: September 2006