We have all had a disappointing experience when our expectations were not met: Maybe a restaurant brought out food that wasn’t the correct temperature, something you ordered did not arrive on time or you felt your business wasn’t appreciated. Think back on the times you have been disappointed as a patient or a consumer — the common thread of these experiences is likely that the reality did not live up to what you expected.
In clinical care, managing and setting patient expectations is a crucial piece of the puzzle to create or maintain a successful contact lens patient. It sounds simple enough to let the patient know what to expect, but under the surface it is more complex.
As contact lens technology has evolved, each of us has gained more tools to aid our patients in finding the best contact lenses for them. How we position and present technology to each patient can make or break the experience, so setting expectations in a personalized way for each patient is critical. The good news: It doesn’t have to take a lot of chair time to set patient expectations and maximize success. Here are the steps I like to walk through with my patients:
SET THE FOUNDATION
In my experience, patients frequently under report struggles or concerns they have with their contact lenses. So, how can we uncover their true wearing experience? I have experimented with different ways to obtain this information from patients. What has worked best for me is asking two simple questions: (1) “Tell me how things are going with your contact lenses?” This gives me an idea of how the patient perceives her wearing experience. I typically hear responses, such as “They are fine,” or “They are okay.”
My next question: “What time each day do your lenses start to feel uncomfortable?” This is something each patient can answer quickly and succinctly, as it is part of their daily routines. I gather an incredible amount of valuable information from this simple question, and it opens the door for a more honest conversation about aspects of the patient’s wearing experience that need improvement. It also serves to reveal where patients are making compromises, often unknowingly.
For example, one of my patient’s answers surprised me. He had been refit from a frequent replacement lens to a single use, daily disposable lens at his previous exam. When I asked him how things were going with his lenses, he was enthusiastic and said, “I love these lenses; they are great.” He seemed so happy with his contact lenses, I briefly thought about skipping my second question. I am glad I didn’t. When I followed up and asked him what time of day his lenses become uncomfortable, he hesitated for a moment and reached in to his pocket. He pulled out another pair of his daily disposable lenses and said, “Every day at 3 p.m., I have to change into a new set of lenses because they are dry.” I was blown away that he seemed so happy with his lenses, yet was going through the trouble (and expense) of carrying around a second pair to change lenses midday. This gave me the perfect reason to introduce him to a different lens.
Once I have a picture of where patients are at with their current lens, I can better discuss with them the specifics of how my recommendations will benefit them and enhance their wearing experiences. Moving into setting expectations, I like to touch on three aspects with the patient: vision, comfort and fitting process.
COMMUNICATE THE GOAL FOR VISION
Clear, comfortable vision is, of course, the goal. When I set expectations around vision in contact lenses, I compare the patient’s current correction to what I am prescribing for her. Many times, this is a quick demonstration in the phoropter of showing patients their current prescriptions in comparison to their new prescriptions. However, for a patient trying multifocal contact lenses for the first time, a short conversation on visual adaptation can go a long way to coaching the patient to wearing success. For these patients, I let them know that their visual system needs three to four days to adapt to the new optics of their contact lenses. Patients, like all of us, make very quick assessments of the performance of a new lens, so it is imperative to give them a timeline before they place the lenses on the eye.
One of the challenges, specific to vision, of setting patient expectations is conveying enthusiasm for the recommended lens without overpromising. In fitting multifocal lenses, I avoid using terms, such as “compromise,” that have negative connotations and, instead, say the lens provides “a good range of focus.” I also let patients know that my goal for them is to be glasses-free 85% of the time, so that they understand there will be some tasks for which glasses may be needed.
This is similar for patients who have been masking their astigmatism with spherical lenses. First, I show the patient the difference between the spherical equivalent and the astigmatic prescription in the phoropter. The vast majority of my patients appreciate better clarity with the astigmatism correction, and it quickly demonstrates to them the value in trying something new. Before they even place the lens on the eye, I ask them to allow time to adapt to the new optics.
2018 Contact Lens Practice Metrics
PERSONALIZE THE COMFORT CONVERSATION
In discussing comfort with patients, I let them know about the benefits of the specific contact lens I am prescribing and why I think it is the best option for them. During this time, I like to use something specific from their case history to illustrate why I think my recommendation will work better for them and improve their wearing experience. For the patient I mentioned earlier, I briefly let him know the difference in technology of his habitual lens vs. what I was prescribing. I then let him know I felt the lens I was prescribing would free him from having to switch his contact lenses out in the middle of each day, by providing a unique surface technology. In giving patients a specific and personalized reason I am prescribing a contact lens, I demonstrate to them that I am listening to their needs, and I help them to understand that contact lenses are not all the same.
DISCUSS THE FITTING PROCESS
We live in a world of immediate gratification and same-day shipping, so all of us are used to results delivered quickly. It is often possible to deliver an immediate result to a contact lens patient, but sometimes extra time can go a long way. I find this to be most common among patients new to multifocal contact lenses, patients who are new to wearing contact lenses and astigmatic patients who have high prescriptions.
Patients who are new to multifocal contact lenses, but longtime contact lens wearers, are typically accustomed to coming in for their exam, having their contact lens prescriptions finalized that day and ordering their annual supplies. I explain to new multifocal wearers that it takes time for their visual system to adapt to the different optics of the lens. I let them know that I want them to experience the lenses during their daily tasks, setting the stage for feedback at follow-up from real-life situations in which their vision could be optimized. I have found that if I don’t mention the importance of the follow-up visit to patients, they may believe the lens is not performing because they need to return to the office for a recheck. Letting them know up-front that the follow-up visit is an important piece of the process gives them a mental roadmap of what to expect.
For neophyte contact lens wearers, I walk them through the fitting process step by step and let them know that, at subsequent exams, their fitting process will be shorter. I explain to them the importance of insertion and removal training and compare it to learning to ride a bike; it seems challenging at first, but once it clicks you never forget.
We have all had hyperopic astigmatic patients who end up waiting a few weeks for their trial lenses to arrive. This can be frustrating and disappointing if patients are unaware that their lenses may take more time to arrive. For these patients, I let them know that their lenses may take a few weeks to come in and that it may take a follow up or two to perfect the prescription. I reassure these patients that the time will be well invested in obtaining their best lens and vision.
INVEST YOUR TIME IN COMMUNICATION
Setting expectations is an opportunity to connect with each patient and guide them to contact lens success. Investing a minute or two of chair time in patient education will often have the payoff we each strive for: a happy and loyal patient. OM