Every practitioner has been faced with a patient who has worn contact lenses for a time, expresses satisfaction with their lens brand and modality, and is successful with wear because they understand the value they get from their lenses. When they are happy and satisfied, their only question is, “Have my eyes changed?” When further questioned during the exam by the doctor and staff, they'll respond that their contact lenses are "fine."
In this article, let’s explore that patient comment. When we get the “fine” answer in my practice, we always try to probe further. We understand that most patients’ only experience with contact lens wear and vision is what they are experiencing currently. Many will believe that their experience is typical of all patients. Some may ask friends, coworkers, family, or the internet what other patients are experiencing, but wearing contact lenses is a deeply personal experience. Some patients are so comfortable with their lens modality—daily, biweekly, or monthly—that they don’t know enough about other lenses to think about changing. Other patients worry that complaining about their current lenses would require their eyecare practitioner to make a change, which is even more of an unknown than what a patient knows about the contact lenses they already have.
So, when our practice hears that a patient’s contact lenses are “fine,” we take that as a challenge. We convert “fine” into an acronym for “Features I Never knew Existed!”
What the patient is really saying is, “I only know what I know about contact lenses. I am the most inexperienced person here when compared to my eyecare practitioner and their staff. I hope they will explore deeper what my life is really like when I wear contact lenses.” We have used that knowledge to develop our most effective probing questions that help us gauge our patients’ ability to wear their contact lenses successfully:
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How long do you wear your contact lenses in a typical day? Would you like to wear them longer?
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On a scale of 1 to 10, with 10 being the highest, how do they feel when you apply them? With the same scale, how do they feel when you remove them? What time of day is that?
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Can you wear your lenses comfortably for as long in a day as you need them to last?
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Is there anything about your lenses you would like to change? (Note, be careful of this one. We’ve had patients say, “Yes, make them free!” Oops!)
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What if a different lens could give you a more breathable, healthier option?
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Have you ever thought about wearing a daily disposable lens?
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If I had a magic wand, what would you want me to change about your contact lenses?
As the exam proceeds, patients give us permission to evaluate their eye health, refraction status, and their contact lens modality. Then at the conclusion of the exam, we can explain whether we think their lenses are working as well as the patient believes they are performing, from our clinical perspective. Any determination that their lenses are inadequate gives the eyecare practitioner the chance to explain the patient’s current vision and eye health, both internal and external. By educating the patient, we can share our knowledge and experience about their eyes.
We are experts in determining the best lens for our patients. When we ask a patient, “Do you want to try a new contact lens?” we instantly lose our opportunity as prescribers. If we are the most knowledgeable, why would we give patients the chance to decide the best contact lens for their eyes? We can be confident that as eyecare experts, we know more about available contact lenses than our patients and we should prescribe them the best lens option. Our consultation allows patients to experience the difference between their current lenses and an upgrade to another contact lens. Manufacturers continue to provide lenses that provide more end-of-day comfort, higher DK/T, and improved vision. Depending on the patient’s exam findings and their expressed needs for their contact lenses, we have many options to improve a patient’s ability to successfully wear contact lenses.
Our office does not ask patients if they want to “try” a new contact lens; we “prescribe” the lenses that the patient’s eyes require. For example, we often prescribe a higher DK/T lens when a patient shows corneal neovascularization. To improve vision, we prescribe astigmatic lenses instead of a spherical equivalent lens. When dryness is a complaint, we prescribe a lens that retains more moisture to last the entire day. This decision is critical because dryness and discomfort are the primary reasons that patients discontinue contact lens wear. We will prescribe a daily wear, single-use lens when we learn that a frequent replacement lens is not performing as well as before. When a patient has been wearing monovision, we prescribe a multifocal lens that returns binocular vision as well as intermediate focusing. Although the patient does need to neuroadapt to the multifocal optics, the benefits are worth the time to adjust. As eyecare providers, we need to educate patients on the reasons for an upgrade and the amount of time this process will take, but the benefits to the practice and to the patient are worth it.
When patients come for an exam and contact lens fitting without complaints, they will resist a change in lenses. Giving them a no-risk trial with diagnostic lenses will allow them to see and feel the difference from their current, older lenses and the upgraded lenses. Patients can be called several days later or scheduled for a follow-up visit if there has been a drastic change in prescription or lens fitting. When patients question a price change for the new lenses, we offer to let them experience the difference with their eyes before they shop with their wallet. We always try to find a way for patients to afford their upgraded lenses by explaining vision plan allowances and rebates to lower the final prices of the upgraded lenses. If the patient ultimately decides to return to their current lenses, the provider is still perceived as the practitioner who cares about the patient and their contact lens success. Many times, the process of prescribing an upgrade at this visit provides a future path for your patient’s contact lens experience.
So, remember: When a patient tells you their lenses are “fine,” they are really saying, tell me more about contact lens Features I Never knew Existed!
