According to optometrists interviewed by Optometric Management, practices realize substantial advantages when they recommend solutions. Chief among these is a healthy base of loyal wearers. "I want my patient to have the best chance for success," says David Seibel, O.D., St. Louis. "There are differences on how solutions perform on a given patient's eyes. By not recommending a solution, you risk yet another contact lens drop out."

Frank Fontana, O.D., St. Louis, agrees, adding that personally prescribing a contact lens solution is responsible for "trouble-free wear in 95% of our patients."

The solution recommendation strengthens the doctor-patient bond. It reinforces the individuality of a patient's care and lenses, as well as "educates them in the proper care and feeling of their lenses," says Pamela Miller, O.D., Highland, Calif.

In the few cases where a contact lens patient has symptoms, the patient will be better managed because the doctor "always knows what was dispensed," says Richard S. Kattouf, O.D., D.O.D., Warren, Ohio.

These patient care advantages create tangible practice management benefits. "Improved outcomes reduce chair time and costs per patient," says Robert Davis, O.D., Oak Lawn, Ill. "It eliminates office visits, which allows more schedule opportunities for full examinations. It also improves referrals and promotes practice growth."

The recommendation "shows the patient that you have a clue and positions your recommended brand as right for the patient," says Gary Gerber, O.D., Franklin Lakes, N.J.

Choose the solutions

1. Chemistry

Before you recommend solutions, select the right ones for your practice. Sheldon Kreda, O.D., Lauderhill, Fla., says "clinical performance and feedback" guide his recommendations.

Optometrists will consider a number of criteria when selecting a solution, including:

Optometrists typically avoid solutions with benzalkonium chloride, thimerosal and other preservatives. "Preservatives not only kill pathogens but can also become toxic to the corneal epithelium," says Dr. Davis.

Dr. Fontana says he pays "particular attention to the preservative, cleaner, buffer and re-wetting components that are included in any solution" that he prescribes.

2. Lens Modality

Dr. Davis recommends no-rub solutions only for disposable lenses — those that are replaced monthly or more frequently — and a peroxide system for reusable lenses.

3. Patient Health

The right solution system allows healthy, comfortable lens wear, even for those who wouldn't be optimal candidates for contact lenses. For example, Dr. Davis dispenses surfactants and enzymatic cleaners for those patients who exhibit giant papillary conjunctivitis or other debris-producing entities. He also recommends a more rigorous disinfecting/cleaning system for patients who are prone to infections.

4. Patient Compliance

"Patients will rarely follow instructions to the letter," says Dr. Kreda. "For this reason, I recommend the simplest system with the least amount of bottles and steps, even if it's not the best system. I'd rather have them use a good system right than a great system wrong."

Dr. Miller adds, "the more complicated the regimen, the less likely we will have compliance."

What happens when a practice finds two solutions equally as effective? According to Dr. Seibel, "If two solutions are absolutely equivalent choices, the decision may be which company supplies you with product samples or other support to educate your patients and grow your practice."

Now educate

The most careful choices in solution selection become useless without proper patient communication and education. From verbal instructions to live demonstrations to educational DVDs, the emphasis on proper lens care must start with the patient's first lenses and continue with each subsequent visit. "Do not assume that long-time contact lens wearers were instructed properly," says Dr. Seibel. "Some have been given a box of lenses, a box of sample solutions and a blessing out the door," he says. "Others may have just fallen into some bad habits that need to be corrected."

You can uncover noncompliance by interviewing patients. They may be using the wrong solution, often substituting the recommended brand with a low-price alternative. (Compliance also includes timely replacement of the lens case.) It's important at that point to reinforce the proper contact lens care regimen, discuss the practice's reason for the recommendation and, if necessary, provide a demonstration.

Any number of educational aids can be effective. Dr. Fontana advises practices build relationships with solution companies to take advantage of all the resources available. "There are really four Os," he says, "the ophthalmologist, the optometrist, the optician-technician and ophthalmic companies."

With the recommendation

After the verbal recommendation, O.D.s agree that it's most effective to hand the patient a sample, a new lens case and a written recommendation. Writing the solution name on a prescription pad further emphasizes the impor- tance of the recommendation.

Samples are "critical," says Dr. Gerber, because "O.D.s like giving away free things — it's a genetically programmed, ingrained O.D. thing." But the giveaway must be consistent with the recommendation. "After all, why would an O.D. recommend something they can't hand a patient?"

Should you sell?

While all practices inventory starter kits and samples, some take the next step and dispense solutions. These practices typically sell contact lens solutions in three-month, six-month or annual supplies. This provides the patient with convenience: They can reorder the solution when they order contact lenses. Solutions sales also provide the practice with an indication of patient compliance. "If done properly, the optometrist can develop a profit center from the solution and prevent patient erosion," says Dr. Kattouf, whose office dispenses solutions.

If inventory is an issue, there are contact lens solution companies that will process orders from practices and ship the solutions directly to patients.

The bottom line

Are there any excuses for not recommending a contact lens solution? According to these practitioners, a better question might be: Are there any excuses for not providing contact lens patients with the best care possible?