Making Your Contact Lens Practice A Mecca For Presbyopes

BY ROBERT A. KOETTING, O.D.
FEBRUARY 1998

By knowing how to communicate with presbyopes, you can entice more of them to make the pilgrimage to your office and into contact lens wear.

Your contact lens practice ought to be bulging with presbyopes. Since 1987, there have been more Americans over age 40 than under. Almost all are presbyopic, and 98 percent of them don't wear contact lenses. But you can bet it's not because they want to wear eyeglasses. From face lifts and hair coloring to Nordic Tracks and vitamins, they are obsessed with holding on to youth, so why do so many refuse to consider contact lenses? Ask around and you'll find the answers are surprisingly consistent -- "It wasn't worth the hassle!" They haven't even tried contact lenses. Some of their friends have, though, and they may have given contact lenses a bad rap. Published studies clearly illustrate that at least half of the gray market could easily be wearing the contact lens designs now available.

Price is No Object When it Comes to Satisfying Presbyopes

The presbyope is a different kind of contact lens patient. Price is not usually very important. They want service and special attention. They don't want to spend precious time without assurance that the lenses will work. Above all, they want quality. Keep in mind that the quality of professional service is often judged by the surroundings in which it is offered. Your practice must exude quality, from chairs and carpets to assistants' career apparel. Be sure that your instruments are state-of-the-art, and pay attention to every detail. Do it with class because as a group, presbyopes can afford it.

Baby-boomers, especially, tend to indulge themselves with the best. Take a "you deserve it" attitude and recommend contact lenses to anyone who might not have considered them before. Try saying: "I know your health plan doesn't provide for these lenses, but you will certainly enjoy wearing them. You deserve it!" Then, when your patients begin to feel as though they are entitled to the very best, be sure they get it!

My favorite telephone reply to the following two common questions goes something like this:

Patient: "How much are your contact lenses?"

Staff: "How are your eyes troubling you?"

Patient: "I need reading glasses and I don't want to spend time and money on contact lenses unless I'm sure they will work."

Staff: "I'm certain that Dr. Jones will be able to tell whether they will work for you after a complete examination, for which the customary charge is $xxx. I hope you don't mind my asking, but will you be in a position to spend an additional $xxx for the lenses, handling instructions and follow up care?"

If the answer is yes, you have answered the questions and gotten a comittment.

Remember too, that at least part of your basic examination is most likely covered by a vision care plan. Explain to patients how you provide contact lens care as an adjunct to these pre-paid services. Back up your presentation with a personalized mailing. Never downplay contact lenses because they are not covered under some managed care delivery system. Be thankful for this opportunity to set your own fees for a change.

Their Time is Precious Too

See patients promptly and show them how you value their precious minutes. No one really believes that the meteoric success of one-hour eye wear operations came about because all these consumers were facing optical emergencies. Advertising has reached those who honestly feel that they no longer have time to wait for anything. Patients welcome convenient hours, planed replacement programs that deliver lenses by mail, packs of lenses and solutions on hand in the office and anything else that fits our modern-day lifestyle.

Patients must also realize that time is a precious commodity for doctors too and that the extra time required for presbyopic contact lens care must be factored into the fee for contact lens service.

Have Faith in Monovision

We refractionists, schooled in the fundamentals of binocularity, find it hard to believe that reading with one eye does not result in headaches and a life-threatening loss of depth perception. Have faith in the system. Monovision doesn't seriously inhibit the ability to judge distances. It is friendly to computer screens, and many golfers report that the system works better than bifocals. Doctors who have never had the patience to give monovision a fair personal trial tend to lack credibility when discussing it with prospective wearers.

No one wants to wear contact lenses. Keep in mind that some people want to be rid of eyeglasses so badly they elect to have surgery based entirely on the hope that their vision will be acceptable afterward. In this world of compromise and trade-off, some patients will prefer crisp, clear near or distance seeing, while others will feel that personal appearance is more important.

The Challenge of Adaptation

A few patients may accept monovision or bifocals with expressions of delight after the first few moments, but most do not. You must be willing to try to convince patients that the inconvenience of an adaptation period is worth the trouble. Once convinced that there's no simple way to get used to their new bifocal or monovision contact lenses, they will wear them and sometimes even recommend them to their friends. Understand that a social wear schedule generally negates any hope of adaptation to presbyopic corrections. In my experience with more than 10,000 presbyopes, part-time wearers were rarely successful.

Patients crave reinforcement. Can you imagine going to a health club where your decision to continue was based on how you liked it after the first time you tried to lift a barbell? The first try may be discouraging, but the blurring, especially with monovision, is not really as bad as most people expect. If you aren't wearing monovision yourself, please take my word for it. Careful screening for monovision candidates can prevent a great deal of disappointment, but in those cases where patients seem particularly disturbed by a specific task, an additional spectacle correction can help. A pair of unbalanced reading glasses for an accountant or an extra distance lens for a frequent driver usually provides the emergency crutch that saves the system. Tennis players and other athletes are especially pleased with prescription sunglasses incorporating a compensating distance correction. A third lens set for some intermediate distance (instead of near) can be a problem-solver for musicians and many athletes.

You can use the following dialogue to screen for acceptable vision at the presbyopic examination:

"How does that look to you? Do you think you could do your job, play tennis or cook dinner this way? Would you feel safe driving? Would you accept your vision as it is now for six weeks to two months? Please understand, I don't mean two months of ownership, I mean wearing them for everything you do for a couple of months. If you can do that, I'll promise you'll be delighted with them from then on."

Lens Handling is the Presbyope's Greatest Turn-off

One-step chemical disinfection and frequent replacement schedules have eliminated almost every concern but the big one -- presbyopes don't want to handle contact lenses. They like the idea of extended wear, so give them that option if possible. "You can't learn to swim by reading a book about it" applies to contact lenses as well. The process cannot be hurried. Even experienced wearers have considerable difficulty learning to handle large, thin lenses.

Since educating patients in lens handling can take hours in some cases, select a secluded area in your office. Expecting anyone to grasp lens handling techniques at a dispensing table in a busy frame bar is simply an invitation to disaster. No phones, no interruptions, no audience ... and no doctor! Hire a middle-aged assistant (they relate best) to work with patients. Schedule the task for someone who will give your patients unhurried, undivided attention for however long it may take. You have other things to do and so does the rest of your staff, so can you afford to pay someone to baby-sit your presbyopes? Why not? These are your most affluent patients and higher fees will not drive them away.

If patients cannot successfully apply and remove contact lenses three times in your office, there's little reason to believe they will go home and learn to do it on their own. Handing someone a boiler plate instruction book and hoping for the best puts the professional in a league with mail-order and discount houses. When patients can't get the hang of it on a fitting visit, have them come back another time. They also need reassurance that no serious harm will result from leaving a soft lens on overnight if they are unable to remove it.

Telephone new patients after a day or two. Ask if they are having trouble handling the lenses, and by all means, talk to them about lens handling at the first post-dispensing visit. If there is any doubt, simply ask the patient to remove and reapply a lens there in your office. Be suspicious immediately if the case history indicates that lenses are not being worn on a regular schedule. "I didn't have time to put them on yesterday" is a sure sign that handling has become a hassle. Handling difficulties rarely go away if you ignore them.

Appealing to Presbyopes of All Ages and Genders

How do you establish a planned replacement program that will appeal to everyone between 45 and 65 years of age? Both ends of the spectrum have nothing in common but their presbyopia. "Cognitive age" refers to how old we think we are, and if you ask most people, the answer will be substantially less than their actual number of years. Young presbyopes want to be treated as though they are younger still. Effective communication with mature patients depends upon also treating them as though they are younger, but there are some special considerations. Keep messages simple, concrete and familiar. Take it point-by-point, and remember that repeated exposure to any information reduces the effort required to interpret it. Print media enables older consumers set their own pace. Though they watch a lot of television, these messages may be less effective than those they see in print. Older adults don't organize or recall facts as readily, so it's a good idea to supply memory aids when you write copy. They like ads that emphasize youth and show them relating to younger people. They love to hear you compare ways you used to provide eye care with the way it is done today. When you trigger memories, the difference between young and old disappears.

Contact lenses are worn by a lot of young women, but women do not have a monopoly on vanity. An advertising executive once came up with a plan for our practice to reach a huge untapped segment of the market. "No one encourages middle-age males to wear contact lenses," he said, so we launched a campaign to do just that. We called them "Executives," and advertised in trade journals and the business pages of local papers. We emphasized better vision, sports, ease of viewing a computer screen and, discreetly, appearance. The results were phenomenal.

As part of our "Contact Lenses for Executives" campaign, we ran commercials on drive-time radio spots using a mature voice, and we ran a modest size advertisement in an airline in-flight magazine. The latter technique brought in some new patients, but the unexpeted bonus came from reinforcing the folks we already knew. "I was flying from Paris to Cairo," one patient told us, "when I saw your ad and was glad to learn that I have been seeing a very important doctor."

Back to the Basics

Compliance, Dk and planned replacement programs are topics that have recently gotten their share of attention, but it seems like we need to return to the fundamentals. Consider how many more people would be wearing contact lenses now if more practitioners had suggested them or if they could have learned how to handle them without the hassel?

What have I found to be the single most effective way to make a contact lens practice a Mecca for presbyopes? Set a good example by wearing contact lenses yourself. It starts conversations at parties and enhances the credibility of your office.