CL PRESCRIBING
Proactively Prescribing Contact Lenses
The why and how of following this practice.
By Stephen Cohen, OD

When we consider why patients perceive that they can't wear contact lenses, a couple of plausible reasons quickly come to mind: they think their eyes are too dry or that they have that "stigma" thing. However, the primary reason why patients believe that they can't wear contact lenses is because their doctor never told them they could. We all know that what we say (and how we say it) has an impact on our patients. Now we learn that what we don't say has an impact as well.

Take a Different Perspective

With mass merchandising, mail order, Internet sales and federal contact lens prescription legislation, the contact lens market has changed dramatically. We can no longer defend our position that "we've always done it that way," nor live by the adage that "if it ain't broke, don't fix it." We need to constantly re-evaluate our prescribing practices. Perhaps a simple way to accomplish this task is to look at our practice through the eyes of our patients. If, like a virtual tour, we follow patients through the entire experience they have in our office, it could provide insight into how contact lenses fit into our practice, as well as the potential benefit of proactively discussing contact lens options.

Revealing Moments

The Disney Company spends considerable time and resources analyzing the direct encounters its employees have with its "guests" at its theme parks, beginning even before the guests enter the property. The company refers to these encounters as "moments of truth." As we proceed, we'll borrow this phrase to address many of the contact lens "moments of truth" (opportunities and missed opportunities) that exist in our practices.

With that in mind, and for the rest of the article, we'll refer to Stephanie Noble, a pleasant, 40-year-old "virtual" patient new to our practice.

Moment of Truth #1

You need to make sure you're letting your prospective patient, or in our case, Stephanie Noble, know that you offer contact lens services. To illustrate, many years ago, a retail optical chain boastfully advertised on TV that its doctors "do a phoropter exam." It didn't matter that we all routinely provide this service -- they were the ones touting it. When it comes to contact lens services, moment of truth number one is that Stephanie will likely function under the assumption that if you don't mention it, then you don't offer it.

When Stephanie calls your office, your receptionist might ask whether the exam is "for glasses or contact lenses." Whereas this statement indicates that contact lens services are offered in your office, it also sends a message that this is an "either/or" decision. When the question is, "Is this exam for glasses, or for contact lenses and glasses," it sends the message that people who wear contact lenses also need glasses (keep in mind that none of us owns only one pair of shoes), and for those who wear glasses, contact lenses might also be an option.

There's a simple business axiom that to stay in business you need to make a profit. In the eyecare industry, you can either see more patients each day or meet more of each of your patients' needs and increase your revenue for each patient (the proverbial "working smarter, not harder"). Lastly (if applicable), you should tell Stephanie to write down or bring in her current contact lens information and her contact lens solutions, as well as any glasses she has, including nonprescription sunglasses. (This last item will allow you to check the optics of the lenses and the degree of UV protection and to open the discussion of the value of wearing quality sunglasses over contact lenses.) As about five out of six contact lens patients will purchase nonprescription sunglasses within 48 hours of the fitting, this represents another moment of truth (and another way to increase per-patient revenue).

Moment of Truth #2

The next contact lens moment of truth comes when Stephanie Noble arrives at your office. Most contact lens companies provide point-of-purchase educational and marketing materials. When you walk into your own office, do you notice whether you use these or other vehicles to let patients know that you offer contact lens services? Also, take a look at your patient information form. A more forward-thinking practitioner may include a list of services with a question asking whether Stephanie is interested, for example, in wearing contact lenses. However, if she answers in the negative, there's nowhere to easily go with this discussion. Perhaps a better question to include might be "What are the times that you'd like to see without your glasses?" This general open-ended question literally opens the door to the contact lens arena, from occasional use daily disposable contact lenses ("when I play sports"), to multifocal contact lenses ("when I read").

Such notation provides an opportunity for follow-up discussion, whether by your optometric assistant or contact lens technician, or an even more novel thought: by you in the exam room! The common refrain here is that with the premium placed on time, we can't afford to spend much of it in the exam room going over all of the vision correction options at our disposal. Whereas so many advances in eye care help us delegate more of our responsibilities to others, we run the risk of diluting what's perhaps the greatest tool we have: the trust that our patients place in us to help them determine what will best meet their needs. There's a clear delineation in our patients' perceptions depending on where they receive information. Patients who hear about options from a member of our staff often perceive it as "selling." When they hear about it from us, it's typically perceived as "prescribing." Clearly, they'll be more likely to proceed with what we prescribe for them rather than what others sell to them. On a business level, if we spent a little more time discussing these options, then we could potentially see an increase in our per-patient revenue, which could ultimately allow us to see less patients each day and remain profitable.

Moment of Truth #3

Let's get back to our virtual patient, Stephanie Noble. For the remainder of the discussion, we'll look at the "moment of truth" opportunity that we (the doctors) have to proactively recommend contact lenses. First, we need to resolve an issue of semantics. Many of us are reticent to discuss contact lens options for fear that patients will perceive us as "selling." If, however, we saw our role as "educating" our patients about available vision correction options, then we'll view the process differently. We would agree that whereas selling is often uncomfortable, educating is an opportunity as well as a responsibility.

First, let's look at the general education process, which we can break down into two categories:

1. The education about contact lenses

2. The education about the fitting of the lenses

We can quickly and efficiently present the plethora of contact lens options in just a few statements. We can use any one, or combination of the following statements as an educational tool. When it comes to contact lens modalities, we don't have to list every option; we can merely tell Stephanie that "we can offer contact lenses that she can replace every day on up." Another quick education statement is to tell her that "contact lenses that block up to 99 percent of UV radiation are available," and that "we now have bifocal contact lenses that can address reading and computer needs." Lastly, we can educate her about a "nonsurgical option to correct nearsightedness and astigmatism with the FDA-approved 'corneal refractive therapy.'" Even presenting all of these educational statements to her will require little time. The benefits of taking such an approach are several. For one thing, Stephanie will leave our office knowing more than when she came in, which will increase her perceived value of the experience and will help to reinforce three important practice goals:

1. Retention

2. Recalls

3. Referrals

When we educate Stephanie about these options, we're more likely to retain her as our patient. This education process will also reinforce our recall efforts, as Stephanie will see her recall card as a reminder to not only get her eyes checked, but also to come in to learn about what's new in eye care for her. Lastly, when she leaves our office more educated, she's more likely to tell someone else about the services we provide and the contact lens options that exist. Briefly, let's expand on the topics of UV protection and bifocal contact lenses.

UV Protection Without question, Stephanie will see value in UV protection. One survey showed that although about 90 percent of patients expressed an interest and perceived value in UV protection in contact lenses, only about 10 percent heard about this option from their doctor.

Bifocal Contact Lenses When it comes to bifocal contact lenses, merely consider these statistics: For people older than 40, the need for vision correction doubles, but the percent of people wearing contact lenses cuts in half. Additionally, whereas about one-half of our patients younger than 40 (who require vision correction) wear contact lenses, 10 "presbyopic" years later, less than three percent are still wearing contact lenses as their primary vision correction. The opportunity in these two areas speaks for itself.

Moment of Truth #4

Again, with the change in the contact lens marketplace, we've had to emphasize the value of the professional services we provide over the supply of the materials. The words we use here will have an impact on Stephanie's perception of that value.

For example, most of us refer to the fitting of contact lenses as "a trial fitting;" it's more powerful to change the term to "diagnostic fitting." (When was the last time your physician sent you out for "trial blood tests?") "Diagnostic" connotates that valuable information is coming from the fitting of the lenses. As a result, we should never again perform a "trial" fitting with "trial" lenses, but rather a "diagnostic" fitting with "diagnostic" contact lenses.

Lastly, we should describe the fitting as a "process." This simple word lets the patient know that, as a process, "the fitting may involve several steps to help us achieve optimal results." We also need to advise her about the specific contact lens care products that she's to use and the benefit of doing so. Failing to do so will increase the likelihood that she'll subsequently purchase the wrong solution or one that's the cheapest, leading to possible lens-intolerance issues, possible unanticipated contact lens follow-up visits and ultimately, contact lens drop out.

As we proceed with those steps, we need to again pay attention to the words we use. When it comes to making contact lens changes, we can "modify," "enhance" or "adjust," but "thou shall not 'tweak!'" We may "tweak" the tension on the strings of a tennis racket or "tweak" the hem of a pair of pants, but we should never "tweak" a contact lens prescription and expect Stephanie to value the skills we bring to the process. As national optometric lecturer, Ann Hoscheit, OD, of Gastonia, NC, likes to point out, "With all the training and expertise we bring to our patients, we better be able to do more than 'tweak.'" So keep in mind that the words we use have power.

Once you've successfully completed the diagnostic fitting process, it's time to order Stephanie's contact lenses. In this case, let's use a two-week disposable lens. What role can we play in the exam room? We don't need to talk about the price of contact lenses, but we should talk about the value of annual supplies. Doing so reaps several direct benefits:

• We can tell Stephanie that a one-year supply will give her all the lenses she needs "between now and next year's exam," which will passively reinforce our recall efforts.
• Without quoting prices, we can tell her that a one-year supply can save money (rebates, free shipping, volume discounts).
• At the same time, this will increase profitability to the practice and save tremendous staff time (one-time annual order shipped to the patient vs. two boxes at a time, which takes approximately 20 minutes for each order [ordering, checking in, calling the patient, dispensing]). While we might calculate that a one-year supply is eight boxes of these lenses, industry statistics show that Stephanie will ultimately order about five boxes in the course of the year. The reason for this is simple: When Stephanie has fewer lenses, she's more likely to extend her replacement schedule beyond two weeks. A one-year supply decreases this "commoditization," thereby increasing her compliance to the replacement schedule.

Share Your Knowledge

This leads to the last part of our virtual tour, and what might be the two most powerful words we can use: "I recommend..." Although most people have become more informed consumers, Stephanie isn't supposed to be an eyecare expert when she comes to us. As an illustration, when Stephanie sees her primary care physician because of an upper respiratory condition, he doesn't offer her all of the treatment options for her consideration. Rather, he educates her about her condition and prescribes a specific course of treatment.

We can approach our discussion of contact lens options in much the same way. While we might educate Stephanie about a variety of options, we ultimately have to make a specific recommendation. Consider, for example, that we decide to tell her about each of the presbyopic contact lens options (reading glasses over contact lenses, monovision, multifocal lenses), including a detailed explanation of the pros and cons of each.

For one thing, proceeding in this manner is a poor use of our precious "chair time." Additionally, if the first question she asks is "Which do you think is best for me?" then we've proven that this detailed explanation basically wasted our time. Rather than offer this dissertation, we could simply state that "More options are available than ever before to address your particular vision needs. I recommend that we start with...." Such a simple statement can provide a well-thought rationale for our initial approach (without "bad mouthing" one of the other options that we might later need to revisit), while alerting Stephanie to the fact that other options exist, and that, based on the results, we might change directions as we proceed.

The Final Moment of Truth

Consider this final moment of truth: We can complain about the ills of the contact lens industry or we can take a proactive approach that will enhance the perceived value of the services we provide; increase patient compliance; support retention, recalls and referrals; and increase practice satisfaction and profitability. So what are you waiting for? The "moment" is here and Stephanie is waiting.

Dr. Cohen has been in private practice in Scottsdale, AZ, since 1985. He's a past president of the Arizona Optometric Association and has been a national and international lecturer on topics including contact lenses, practice management and ocular surface disease. Dr. Cohen has been involved in several FDA investigative studies for the treatment of dry eyes and is on the faculty at "The Vision Care Institute" at Vistakon headquarters in Jacksonville, FL.