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I've received quite a few emails from readers in recent months about how to manage patients who wish to take their prescription so they can purchase eyeglasses online. Prescription eyeglasses from Internet sources are a new and growing form of competition that's creating some concern among eye care professionals (ECPs). It's not so much that we mind patients taking their Rx to go (although I'm certainly not ashamed to say I'm happy to have the business when they purchase glasses in my office). It's really that most traditional ECPs feel that Internet eyeglass vendors aren't competing on a level playing field.
We know that optical dispensing requires critical measurements that must be taken in person by a professional. And eyeglasses must be properly fitted and adjusted to the wearers face for optimum performance. Additionally, there is a considerable amount of patient education necessary before glasses are ordered and at the time of delivery. Since a web-only vendor can't perform these one-on-one services, they must take the position that a) the services aren't important or b) the ECP will perform the duties. I don't agree with the former and the latter is obviously not fair.
What information to provide
ECPs today happily release eyeglass prescriptions, not simply because it's required by federal law, but because it's the right thing to do. If we charge an appropriate professional fee for our services, the work of examining the eye is rightfully separated from the buying of glasses. But exactly what is included in an eyeglass Rx? The near and far PD? A seg height? And what about other information like eye size, bridge size, temple length, frame make and model, lens material, lens options, and other special instructions?
In my opinion, the only bit of extra information that one could make a case for is the PD. It may not be legally required (although you could check your state law), but it is a simple measurement that is often included in a spectacle Rx and it is usually in your patient records. I provide this information upon request by my patients in the interest of goodwill. To withhold this basic data would create a perception that the ECP was trying to block the patient from purchasing glasses elsewhere. That would be extremely damaging to the long term doctor-patient relationship.
I feel no obligation to provide any other information or measurements about frame or lenses when purchased elsewhere. I do recommend certain types of lenses in the interest of good eye care, but that would be the same if the patient went to a local bricks and mortar optician or online. If asked to supply a seg height or other measurements, my staff would simply and politely decline. We would explain that those measurements should be taken by the person ordering and fitting the glasses and that it would require the exact frame on the patient's face.
Interestingly, many online eyeglass sellers provide instructions for patients to take their own PD using a ruler and a mirror. What about parallax? These vendors are not too concerned with segment heights either; one site I visited said they have a formula based on the frame size and it is extremely successful. How odd. My experience has always been that the seg height was very critical for progressive lens success. I find practices like this to be quite telling about the level of quality that can be expected.
Learning from our past
We have some recent history we can learn from for competing with Internet commerce, namely contact lens sales. It was not so long ago that some ECPs resisted releasing contact lens prescriptions in various creative ways. While some of the reasons for the slow release or no release were noble, in the end it turned out that it was best to give the patient what he wants as long it did not threaten eye health. A few years later, most ECPs have found that most patients still prefer to purchase contacts from their practice and Internet sales have not been such a huge factor.
We can also look back at LASIK, which was at one time imagined to be a category killer for eyeglasses, but it has not turned out to be so. Embracing new technology and assisting the patient in getting what they want while helping them avoid pitfalls, has proven to be the best strategy.
Patients are very smart consumers and they are very sensitive to what can appear to be a ploy to stop them from exercising their rights. Even if your motives are truly looking out for the patient's best interest, use caution in your response to questions about buying glasses online. Don't take it personally – you're the eye doctor and you can continue with that role. Nothing will end a relationship faster than appearing to be mostly interested in financial profit.
Set your professional fees at a high enough level so that you're compensated fairly without the sale of glasses and then compete for the eyeglass sale by offering the best service and value. One good point for vision plans is that online eyeglass vendors are not providers, so the vision plan exam fee is not a factor here.
I want patients to buy glasses from me because they want to; not because they have to.
Optical services after the sale
Consider how you will handle requests for optical dispensing services from your patients who obtain their glasses over the Internet.
Initial frame adjustment and fitting
Instructions on how to use a progressive lens
Troubleshooting common adaptive symptoms to a new eyeglass Rx
Verification of your prescription in the glasses, including PD and optical centers
Adjusting nose pads for optimum seg height placement
Education about cleaning antireflective lenses, darkening properties of photochromic lenses and other questions about optical products
Routine adjustments for the life of the glasses
Frame repairs, nose pad replacement, restringing semi-rimless lenses, replacing temples, etc.
Even though there are some logical arguments to the contrary, I believe rechecking a refraction based on a complaint should be done at no charge, assuming it is requested soon after new glasses are made. This is a widely accepted convention in eye care and it's good customer service. Mistakes can happen and I want to be responsible if that's the case and I should not stand to make a profit by making mistakes.
The no charge complaint follow-up visit is available to my patients no matter where they buy glasses, but if they obtained the hardware from my office, my trouble shooting effort will include an exhaustive check on the glasses. If the glasses were dispensed by others, my recheck is limited to the refraction and a basic Rx verification. If the refraction is correct, I send the patient back to where they got the glasses for remediation, possibly with a short handwritten note if I see what the problem is. I will not take over the eyeglass dispensing unless the patient asks me too, and then they would be charged our usual fees for new eyeglasses. They may be able to obtain a refund from the previous dispenser.
Charging dispensing fees
Here is how I would handle it in a nutshell. Right now, as long as Internet eyeglass purchases by my patients is a very small number, I won't charge for optical dispensing services like simple adjustments and I don't bother to check if a patient purchased glasses in my office or not. I am still a believer that these services are a valuable marketing effort that results in future business. We do charge for parts if repairs are needed, of course. But I'm monitoring Internet eyeglass sales closely and I think the day will come when we charge for dispensing services rendered on eyeglasses not purchased from our office.
Those optical services would still be available at no charge on all glasses purchased in my office, so charging a fee to others would actually raise the perceived value of buying glasses from us.
Even if I begin to charge for adjustments, I would still not charge for a PD measurement and I would still not charge for a complaint office visit to troubleshoot the refraction. Detailed troubleshooting of the specifications on glasses made elsewhere and recommending solutions for eyeglass problems could require a professional fee. I'll explore this when the time comes because I don't want to seem like I'm nickel and diming people. One advantage of owning the practice is you can try new tactics and evaluate the response.
The key to charging a fee for dispensing service is to always notify the patient in advance. The patient should have the right to decline the service if they wish after hearing the price (or a good faith estimate).
The smart thing to do is develop your office policies now on how to handle requests for special information and requests for services when you don't provide the glasses. Decide on your philosophy about eyeglasses obtained over the Internet without measurements by an optical professional. Be prepared to share your thoughts and concerns with patients who ask about buying glasses online, but do so in a way that does not seem defensive or antagonistic.
Once you've made some decisions about your stance, meet with your staff and ask their views. It's great to obtain different points of view on the subject. Then train your staff thoroughly on how to respond to requests related to Internet purchases and how to help patients understand the pros and cons.
A handout sheet to give patients about Internet buying would be a smart tool to have available. I'll provide some ideas for that next week.