Q: How do you answer the burning practice questions?


A: The planning for this issue started with a simple question: What if we revisited the “Question & Answer” issue we ran in 2016, and invited our readers to once again submit their most pressing practice questions? The answer to this question has ultimately become this, the second OM “Question & Answer” (Q&A) issue.

To learn of the top questions, in April OM emailed subscribers a link to a survey where we asked subscribers to provide us with their most critical practice questions. Respondents could answer with whatever questions they chose. We also offered a number of categories as prompts, for example ocular disease (diagnosis and treatment), contact lenses, the optical (spectacle lenses and frames) and practice management (finance, technology, staff management, etc.). Additionally, we included a general category for other “big issues.” In all, we received about 400 questions. We are grateful to you, our readers, for such a generous response.


Before we tallied up the most popular questions, we did a bit of editing. For example, to help maintain balance in the content, we removed questions that would garner a focus on only specific name-brand companies, products or services.

The OM editorial team also eliminated questions in which the answers would be practice specific, such as, “I own x, y and z. What piece of equipment should I acquire next?” At the other end of the spectrum, we dropped those questions that we felt were too general and, therefore, would likely require a lengthy answer, such as, “What are the best treatment approaches for eye-related diseases?”

Finally, we set aside those questions that were answered in recent issues of OM and those that will be answered in upcoming issues. (See “A Nod to Future Answers,” p.15.)


With our final list of questions, we enlisted the help of our contributors to provide answers. Here, our authors deserve a big “thank you” for enthusiastically lending their expertise and unique perspectives to the Q&A format. You’ll notice that many of the regular columns and departments, such as “Dry Eye,” “Cornea,” “Retina” and “Business Strategies,” appear this month as “Q&A features” rather than in their usual format.


As mentioned earlier, the answers to several of the top questions can be found in recent issues of OM. Others can be found in the e-newsletter, “Optometric Management Tip of the Week.” Here is a sampling:

Q: How do I help patients get the right glaucoma medication when cost is an issue?

In his article, “When Price Is a Concern” ( ), Justin C. Holt, O.D., explains to patients why he is prescribing a particular course of treatment. He does not “let cost dictate” treatment. He does, however, take steps when the patient expresses a cost concern. These may include offering a sample, a smaller bottle, a discount card, information on websites that offer price comparisons/discounts or an assistance program provided by a foundation or drug manufacturer: “By addressing the patient’s cost concerns, we improve medication compliance while offering the best medicine,” Dr. Holt says.

Q: What diagnostic tools should we consider to intervene in AMD earlier?

It might take volumes to answer this, but the OM “Practicing Medical Optometry” (PMO) series that covers AMD — in May of both 2018 ( ) and 2019 ( ) — can provide a foundation. In addition to the round-up of AMD diagnostic tools by Jessica Steen, O.D., (May 2018, p.16, ), Laurie Sorrenson, O.D., offers scripts for patient education, so that patients understand the importance of both diagnosis and treatment regimens (May 2019, p. 21, ). Both authors emphasize the importance of structural and functional testing.

Q: Should we recommend omega-3 supplements to dry eye disease patients?

In 2018, the Dry Eye Assessment and Management (DREAM) Study concluded that omega-3 fatty acid supplements did not offer significantly better outcomes than the study’s placebo, olive oil. Yet in her analysis, Laurie Capogna, O.D., concludes there is a role for omegas: “O.D.s should consider supplementing with omega-3 fatty acids or a supplement that contains omega-3 fatty acids and GLA (an omega-6 fatty acid), as research clearly shows they have an important role in the management of this chronic condition.” (OM July 2019, p.50, ).

A Nod To Future Answers


How can I integrate OCT into a general optometry practice?

See next month’s “Clinical Technology” issue for tips on how to make OCT a larger part of the optometric practice.

How do I get patients to be more cooperative during diagnostic testing?

OM will cover the topic “How to Improve the Diagnostic Testing Experience for Patients” in the October 2019 issue.

What is the best way to sell my practice?

Watch for “Understanding the Options for Transitioning a Practice” in the December issue.

Q: How do you manage and motivate staff?

“Managing employees is an art unto itself, as each is unique with different personalities, motivations and needs,” writes Trudi Charest, R.O., in “Manage by Personality.” (Nov. 2018, p.42, ). However, most employees fall into one of four basic personality types: controller, announcer, intellect or insider. By first recognizing the personality, managers can then tailor their approach. For example, the controller will likely respond to competitive situations and recognition.

Q: How do I respond to a patient who walks with his prescription, purchases glasses elsewhere and then returns with a complaint about them?

This answer comes from a 2013 “Management Tip of the Week” e-newsletter ( ). Neil Gailmard, O.D., recommends first listening to the complaint and then identifying the problem, which could be an issue with the prescription, PD, seg height or frames. The problem will usually dictate the response. For example, a, “frame problem is really not your problem because you did not sell this frame,” writes Dr. Gailmard.

The payoff of this effort? The doctor gets recognized “as the true expert in visual science.” In addition, “Building goodwill with the patient that converts to loyalty and referrals is worth some time and effort,” notes Dr. Gailmard.


We hope this issue inspires you to view practice challenges with a fresh perspective. As a final point, please note that OM welcomes questions anytime. The August issue is a starting point. OM