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Last week’s tip focused on resolving the inevitable eyeglass complaints that
occur in any practice that has an optical dispensary, but there is actually a
problem more damaging than a single episode of patient dissatisfaction. And
that’s dissatisfaction over an issue that was attempted to be resolved, but is
not. This happens more than you might think and it’s worth working hard to
Here is the scenario
It always seems to happen to one of your best patients who spends a lot of money
in your office and brings the whole family regularly. Mr. Jones is that guy. He
had his annual exam two weeks ago, picked up his new progressive Rx ($550) one
week ago and he drops into your office and tells your receptionist that
something does not seem right – he feels blurry. She smartly summons your
optician, Mary, who takes Mr. Jones to optical. Mary recalls your last staff
meeting when you spoke about the importance of patient satisfaction. You
instructed all employees that they should try to handle eyeglass complaints on
their own and that they are empowered to fix the problem – whatever it is. Don’t
worry about the cost. Mary also remembers that you seemed a little annoyed the
last time she put a patient with “Rx trouble” in your schedule and you commented
that these no charge visits are not good for the practice.
As any good optician would do, Mary verifies the lens powers and parameters with
the doctor’s Rx in the file. She finds the invisible progressive lens markings
and outlines the segs and major reference points with a felt pen. She checks the
Lens material as ordered
Quality of the optics
Monocular distance PD
Base curves (compared to the patient’s previous lenses)
Frame fit, vertex distance and pantoscopic tilt
Mary did a commendable job and she, indeed finds one of the parameters is
incorrect. She apologizes to Mr. Jones and explains that the lenses were not
made correctly, but she will have them remade right away. Mr. Jones is quite
nice about the whole matter and he understands that mistakes happen. He leaves
the new glasses with Mary and will wear his old ones in the meantime. Mary
writes up the re-order and sends it off to the lab.
Is the problem the right problem?
Let’s suppose Mary found any one of the following things wrong (not all of
The PD was 2 mm off.
The base curve was .50 mm different than the old Rx.
The seg heights were made as ordered, but in checking it on the patient,
Mary feels they should be 2 mm lower.
The cylinder was off axis in the right lens by 3 degrees.
The sphere power in the left eye was .25 diopter too much plus.
The question is, are we sure that the problem noted above was the real cause
of Mr. Jones’ complaint?
It’s hard to know, but with a lot of experience and knowledge, most eye care
practitioners in all three Os are pretty good at putting all the factors
together and coming up with a conclusion. We know when the complaint matches the
finding. Does Mary know? Are all your staff at a high enough level to really
I don’t mean this to be a contest in ophthalmic optics; the options above are
simply examples of errors that a tech could encounter that are not likely to be
the true cause of a vision complaint. I suppose some of these items could be
responsible for symptoms, but it’s certainly not a sure thing. The PD being off
on a progressive looks like a problem, but what if it was found to be 2mm off
from a tech’s measurement and the measurement was incorrect in the first place
and the error was in the right direction? Or what if the PD error was on a
single vision Rx and the power in one eye was plano?
Credibility is destroyed
My point is that a well-meaning optician could be led astray in an earnest
attempt to fix a problem. No matter how it happens, I’m sure that Mr. Jones
won’t be so nice about it when he returns to get the new glasses and finds the
blurred vision is still there. His opinion of his favorite eye care practice
will surely drop like a rock. He must wonder if those people know what their
Hopefully, the problem now finds its way into the doctor’s exam chair, and
without having to wait for an opening in the schedule that’s 10 days out. But
what if another staff member tries to take one more crack at fixing the problem?
Maybe something like, let’s change the frame because it looks a little small.
Anyway, let’s assume in our case that the doctor rechecks the refraction and
finds that he transposed a number incorrectly. That cylinder axis was not
supposed to be 18 but 118. It happens.
What to do
I’m not saying that your staff should not troubleshoot optical problems first
and solve them independently whenever possible. That’s the protocol in my
practice. But we have had staff meetings about “problem attempted- not solved”.
My staff is aware of it and often gets a second opinion from a coworker. I don’t
think the doctor should recheck every complaint case, but he or she should be
happy to do so whenever the complaint is one that could be refractive.
Please don’t take my comments about opticians or technicians as demeaning of
their skills. I know many opticians who can run rings around me in
troubleshooting optical problems. But I stand on the point that the title of
optician is used broadly to mean one who fits glasses, and many skill levels
exist in practices. Resolving a complaint on the first try may take a team
approach using all the skills available.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.