The conclusion of the refractive portion of a comprehensive ocular health and vision exam presents an interesting challenge, not for the patient but for the doctor. We spend so much of our training on disease management, OCT and VF interpretation, sleuthing out whether we’re looking at a 3rd or 4th nerve palsy, figuring out whether that pigment epithelial detachment has a choroidal neovascular membrane, that it seems so non-medical to talk about prescriptions. Additionally, I think many of us fear being perceived by patients as salesmen, and not doctors, when faced with discussing refraction results. But here’s the thing: At the end of the day, our patients want to see clearly, which is why they see us. So, we are not doing them or our practices any favors by failing to explain how we can enable them to maximize their vision.
Here are some action steps to overcome our discomfort when it comes to explaining refraction results.
1 CREATE THE EXPECTATION
In my practice, patients are asked at the time of scheduling their yearly ocular health and vision exam to “bring indoor glasses, outdoor glasses and computer glasses to the appointment,” to get them in the mind set that they’ll likely be purchasing glasses and/or contact lenses (the right tools in their toolbox) “to help them see the best they possibly can in all situations.” This step also sets the expectation that most people have multiple pairs of glasses for multiple needs.
Later, this gives us the opportunity to discuss their refractive options and lens coating and filtration options to best suit their needs.
2 CONSIDER NEW TECHNOLOGY
With the incorporation or addition of automated phoropters, I gained the ability to flip between patients’ old prescriptions and new prescriptions with the press of a button. The result: On patients who had a small 0.25 D or 5° axis change, I receive dramatic positive responses to the new prescription, giving me confidence in prescribing.
Also, this technology has enabled me to adapt lengthy and, sometimes, confusing descriptions of compound hyperopic astigmatism to: “This is your current prescription, and this is your new prescription.” Simplification is a beautiful thing!
3 BE SENSITIVE
A strong emotional dynamic is at play as refractive errors increase, particularly as presbyopia sets in. An acceptance of our own mortality and the slipping away of our perceived invincible youth is hard.
For example, haven’t we all had that 55-year-old emmetrope who proudly proclaims he doesn’t need reading glasses, just a little more light? It is truly hard to accept refractive change, even when we, as optometrists, fully understand the optics. But remember, our patients do not, they understand their emotions. Sadness, “I feel old” and fear are all parts of the emotional roller coaster these patients experience in response to their refractive changes.
I learned this very early on in my career, in my twenties. Specifically, I was at lunch one day when I overheard a patient talking about the recent exam I’d performed on her. She went on and on about how I told her she was getting old and how her aging eyes were changing. This patient was in her early 40s and, thus, in the early stages of presbyopia. I hurt her emotionally. Now, in all fairness, I would not have called her old, but perhaps I did say that, “as our eyes age,” which she heard as, “you are old.” She never returned.
With these emotions in mind, we should consider treading lightly, realizing that these patients may feel that presbyopia won’t happen to them. To that end I say: “Many people will experience a mild increase in difficulties reading. This might possibly happen to you. If it does, I want you to know that we have lots of options through both glasses and contact lenses to easily deal with the challenge.” Additionally, the three letter words “old” and age” are not allowed to be uttered by my staff when educating patients about presbyopia. We now say: “As you grow up. . .”
4 SHARE PERSONAL EXPERIENCES
There is nothing more powerful than sharing personal experiences with patients. So, when I start talking to presbyopic patients about computer use, for example, I tell them that as my personal presbyopia has now firmly set in, I find myself lost if I forget to wear my computer glasses and that I find them the most useful tool in my box. I add that it is the only prescription I write that results in patients stopping me in the grocery store to tell me how much they love their new prescription, and it is a very true statement.
Sharing these personal experiences provides patients with a personal endorsement and connection with a group who has similar problems, incentivizing them to try out a new tool for work.
BRINGING IT ALL TOGETHER
To overcome our discomfort at being perceived as salesmen vs. doctors by patients who have a new prescription, let’s try creating the expectation for prescription eyewear prior to the appointment, considering new technology, being sensitive during the refraction explanation — remember there is a strong emotional side of vision changes — and sharing personal experiences.
My philosophy is to give them something through their office experience that many fail to give them. That is, give them a story to tell. Do so by exceeding patients expectations and focusing on what is best for them. I’ve employed all these previously mentioned action steps and have found the result is both patient loyalty to me, my practice and my optical. OM