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The contact lens manufacturers should be commended for the many advancements we've all seen in the past year or so. Improvements in silicone hydrogel materials have resulted in unprecedented all day comfort, reduction of dry eye symptoms and even UV protection. Exciting new designs are available or soon to be released for astigmatism and presbyopia, with sharper visual acuity as a result.
It's natural for us to prescribe the newest and best designs for new fittings, but how aggressive should we be in changing a lens design or brand for established contact lens patients, especially if the patient is happy? As contact lens practitioners, we all face this decision numerous times every day. We see successful contact lens patients who are in the office for a routine yearly exam and to renew their prescription so they can buy a new supply of lenses.
The majority of these folks report that they are doing fine with their current lenses and our examination confirms there are no problems. The patient is often wearing a lens design that has been around for a few years, but acuity is good and the slit lamp exam is normal. Maybe you find a slight adjustment in lens power, but no big deal. Do you continue with the current lens brand or do you recommend refitting with a new design in the latest technology?
I have found there are two major factors that discourage us from trying the newest technology on these patients, which we'll explore below. I'll also explain how my approach leads me to recommend the newest lens technology in all these cases and dispense a trial pair of lenses in the new design.
One of the biggest obstacles to presenting the newest contact lens to an existing happy wearer is the potential for the patient to not like the new lens as well as the old one. I admit that is not real likely with many of the new lenses because comfort is so good, but we've all had patients who love their old brand of lenses and any attempt to update them meets with rejection. When that happens, it reflects poorly on the eye care practitioner (ECP) to some degree. After all, trying the new lens was the ECP's idea. You brought it up and said the new lens would be better and it ended up a failure. Time, energy and possibly money was spent in an effort that, in the end, was not successful. The experience is not good and it causes many ECPs to be cautious and conservative about changing happy patients.
The refit fee
Another major roadblock to trying new contact lenses is the fitting fee. Of course a fitting fee should be charged; there is more work involved when the ECP changes the lens design. Diagnostic lenses must be evaluated for fit and for vision. Patient education is provided. In some cases, a follow-up visit may be needed and lens Rx adjustments may occur. Professional fitting fees are the best way to maximize contact lens profitability and I recommend that ECPs always charge for their services.
An ethical dilemma can be created, however, when you recommend additional services that the patient does not perceive any need for and then proceed to charge an additional fee for those services. This dilemma is compounded if the additional service (the contact lens refitting in this case) is unsuccessful and the patient returns to the lens type they wore originally.
It would be so easy to recommend the newest technology in contact lenses if we were not charging an additional fee; the ECP's motives would not be questioned.
Overcoming the obstacles
I would like to overcome the factors stated above because I inherently want to provide the newest and best technology to all my patients. That's part of the mission of my practice. Here is how I approach it.
I simplified the contact lens refitting process and I reassessed my need for follow-up care. Of course, every practitioner has to decide his own comfort level with clinical procedures, but the contact lens field has evolved in many ways and our procedures should keep up to date. I find no advantage in making clinical procedures more complex than they need to be in order to impress a patient. Patients are more impressed when things are easy and fast.
I use my technician staff to assist with trial lens application and vision assessment and I check the fit. The process can be very quick.
Many patients don't need a follow-up visit; if they have a problem with discomfort or vision or redness they call my office and we have them come in.
I charge all patients a significant contact lens evaluation fee. I set this fee high enough that I can make a simple lens change, such as the material, and not have to charge a higher fee. I make simple lens upgrades part of the normal routine at annual exams and it's built into the evaluation fee, so there is no increase in the fee for trying the newest technology.
I simply tell established contact lens patients that there have been some advancements in contact lenses and I want to be sure they have the best lens possible for their eyes. I describe the benefits of the new lens (better comfort, resistance to dryness, better oxygen transmission, UV blocking, etc.) and I say I'd like to give them a free trial pair of contacts for evaluation. I stress that the previous contacts they've been wearing are also very good and if they end up preferring the old ones; that's fine. We will simply stay with them if that's the case. But, there is no cost to trying the newest technology so why not? Many patients who had no complaints are thrilled with the increased comfort of the new lenses. They just didn't know it could be any better.
I tell the patient to wear the new lenses for a few days and then call my technician back and let us know which lens is preferred, the old or the new. We typically order the supply of lenses at that time and have them direct-shipped (assuming the patient agrees). I'm generally not involved at all after the exam; the technician updates the patient record with the patient's choice.
There are some strong practice building benefits to taking the proactive approach with contact lens technology.
There are degrees of happy. Patients don't know what they don't know. Even patients who do not report a complaint may have improved end of day comfort with a new lens material. The monovision patient who says all is well may be amazed at how much better vision can be with a new multifocal design. Patients had to accept some compromises at times in order to wear contacts and they may still think there are no better options. It's our job to give them those better options.
Even if a new lens design is not preferred, you get points for trying with the system I described above. The patient realizes that you are on the cutting edge of technology and that you care enough to try to improve his contact lens experience. Offering the latest technology makes a routine, boring visit to the eye doctor more interesting and fun! It gets the patient talking about you.
Moving the patient into more advanced lenses often increases the profit margin on the materials. It may be a small increase but it's ongoing.
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.