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I was pleased to get such a nice response from readers on the last tip article, which advocated a new, simpler approach to letting many patients try on contact lenses in the office, and postponing the actual fitting work until later. At the end of that article, I asked readers to let me know of problems with the quick try-on technique and how those problems could be overcome. This week, I'll present some quotes from readers and explore the quick try-on approach in more depth.
Problem with dilation
The blurry vision associated with pupil dilation can certainly cause difficulties as we try to demonstrate any vision care product. We've all had patients decide to postpone an eyeglass purchase because they can't see themselves well enough to try on frames. Dilation will also adversely affect the contact lens experience. Here is how one reader put it: “The only problem I see with this is many patients are being dilated at this point in the exam so multifocal contact lenses won't exactly wow the patient. Even contacts for distance may seem blurry during dilation. So, it might "spoil" the experience and turn the patient off.”
I don't see a perfect answer to this issue, but here are some thoughts:
Most ECPs don't dilate every patient, every year. Even if you just use the quick try-on technique for patients who are not dilated, you will likely increase your contact lens productivity.
There are many techniques to minimize the blur effect of dilation. We all use our professional judgment in evaluating if these are appropriate, but if you think creatively, there are good ways to reduce the problem.
We may be speculating to some degree and dilation may not be as big of an issue as we think. I admit that a dilated pupil and lack of accommodation is not a perfect way to test one's vision, but the basic experience of wearing contact lenses is not lost. The patient can still tell how comfortable the lenses are. And if the correct distance Rx is used, distance vision should still be fine. We can explain that the dilating drops cause some blur.
The use of trial contact lenses could actually help overcome the common problem that people have when they can't see up close well enough to try on frames. You could use a simple formula for the contact lens power to help cancel the mild cycloplegic effect. If we want the patient to see in the mirror and at intermediate distances, you could simply add +1.00 D to the patient's distance Rx. Maybe in monovision.
The idea is to just let the patient have a brief experience with contact lenses to whet their appetite. You could fit them properly on a separate visit.
Use contacts as an aid to frame selection
A colleague from England wrote: “We quite often place contact lenses on the patient's eyes in order that they can choose spectacle frames!” This is a fascinating marketing technique that seems to be more common in the United Kingdom, although I've heard of it here in the states as well. There was even an article published in the June 2009 Contact Lens & Anterior Eye, a publication of the British Contact Lens Association, that described a clinical study using this approach. The article, authored by Nick Atkins, Sarah Morgan and Philip Morgan, is titled “Enhancing the Approach to Selecting Eyewear (EASE): A multi-centre, practice based study into the effect of applying contact lenses prior to spectacle dispensing.” It is very nice to see actual data on a management related topic and one the findings was that subjects who had the trial contacts on for frame selection were more likely to purchase contact lenses and they also spent more money on eyeglasses than the control group.
This is a great way to introduce contact lenses and I would love to hear feedback from more ECPs who try it.
Takes too long
I often hear from eye care practitioners in other countries and a reader in Stockholm, Sweden wrote, “I always try to recommend contacts to everyone, sometimes though I just don't feel like I have the time to do so.” An OD in the U.S. wrote that patients are too tired after the exam. These are good points and we should be aware and sensitive when our clinical process takes a long time and the patient has had enough.
Of course, every patient is different, but from a marketing standpoint I try to design my clinical testing to be quick and efficient with little wasted time in the reception area or exam rooms. This results in fresher patients who have an interest in learning about optical and contact lens products. The more time patients spend in the exam areas, the less time they will spend in optical.
I use a clinical technician as a scribe and at the end of my exam I simply tell the technician what trial contact lenses to apply. I leave the entire process of getting the lenses and placing them on the corneas to the tech. Since this is not an actual contact lens fitting, the tech walks the patient to the optical area and lets them look around and experience the contacts. The technician asks the patient for feedback and if there is any interest in being fitted with contact lenses. We follow up from there. I will often prescribe, fit and dispense contact lenses on the same day of the initial exam. I believe patients are more impressed with simplicity and efficiency than with complex procedures.
Some readers had questions about fees; one wrote: “How do you explain a contact lens fitting fee to a patient if you have given them a trial pair of lenses to try in the waiting room?” Another wrote that a patient might say: “Why is the fee so high? The doctor just put them on me and I see great. We're done, no? It shouldn't cost so much just to teach me to take them in and out and clean them.”
I would not get into much of a discussion about fees; at least not to the point of trying to justify them. We are happy to quote our fees and explain what they are for, but if the patient does not see the value in our services, then we just move on. Take the high road. The fee is what it is and it covers a high level of skill. It seems obvious that a technician placed a trial pair of contacts on the patient's eyes, but the doctor did not evaluate the fit or test the prescription. We did not perform corneal topography yet, or lens care, insertion/removal training and we need some follow-up exams. We include a fitting period which covers the patient for lens exchanges and additional office visits. The fee for that contact lens service should be high and in addition to the comprehensive eye exam, which was already received.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
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