How Do We Upgrade Patients?
advice for switching patients to silicone hydrogels, from discussions to fees to
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?
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.
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
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
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.
FEES AND INCENTIVES
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.
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
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 ecp.acuvue.com.
OASYS™ is a trademark of Johnson
& Johnson Vision Care, Inc.
©Johnson & Johnson Vision
Care, Inc. 2006
Optometric Management, Issue: September 2006