practice fits patients with contact lenses, provides them with instructions on lens
care and schedules follow-up visits. But if you don't prescribe a specific contact
lens solution, you might be ignoring a critical step in the care of your patients
and the growth of your practice.
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.,
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
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
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
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.
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.
"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."
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
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?