Presbyopes in Your Practice

- Robert A. Davis O.D.

As I travel around the country and speak to eye care professionals, I keep hearing the same thing. "Fitting contact lenses is not as profitable as it once was." This statement is far from the truth, especially when fitting specialty lenses like multifocals. On average, contact lens patients visit the office every sixteen months, while eyeglass patients visit the office every twenty-five months. Most contact lens patients also select some form of eyewear as a backup to their contact lenses. Contact lens patients are more loyal and refer more patients to the office. Building a profitable practice all hinges on relationship building and relationships are easier to build with contact lens patients especially when you prescribe something out of the ordinary like specialty contact lenses.

Why are some doctors more successful than others? First, they recognize new opportunities early. Second, they are willing to try new things. Third, they involve the entire staff. Fourth, they listen to their patient's wants and desires and ask questions of them.

Many of the contact lens companies are giving eye care professionals new materials and designs that enable them to easily fit specialty lenses. Silicone Hydrogel materials allow for great comfort, greater wearing time, outstanding vision, and healthier eyes.

Our office recommends new multifocal contact lenses to every patient who we think will benefit from them. We try to present something new to the patient every time they'll come in for a visit. This makes them look forward to their regular visit and provides justification for a higher evaluation fee for a contact lens analysis.

It's been said that as many as 40% of presbyopes are still being fit with monovision. Multifocals give my patients better depth perception. Should we ask our monovision patients to wear spectacles over their contact lenses when driving? In my office, when I must fit monovision, I insist on spectacles to be worn over contact lenses while driving.

Prescribing multifocal lenses does not take much more time when you develop the right presentation skills in the examining room and throughout the entire office. Involve the entire staff. Our staff discusses specialty contact lenses with patients in the pre-test area. They are trained to praise the doctor's skills in fitting specialty lenses. They always mention how important it is for these visits. Once I determine what lens I want to use, a technician is there to place the lenses in the patient's eyes so that I can go on to my next patient while the lenses settle. The staff will go over insertion and removal techniques and the proper use of solutions.

The doctor's presentation to the patient in the examining room is the key to successful specialty lens fitting. Your recommendation is mandatory. Patients are in the office because they trust you and presenting too many options may cause confusion. I have heard some doctors tell patients that we have the option of eyeglasses, contact lenses for distance and reading glasses, monovision, bifocal contact lenses or lasik surgery. Which do you want? Doesn't it make more sense to recommend multifocal contact lenses as a lens choice with a back up pair of progressive glasses? Never make just "suggestions" to patients. Don't suggest - recommend or prescribe. Take the word "but" out of your presentation. It's human nature that everything before the "but" is usually forgotten. As an example, "I think multifocal lenses would be best for you Mrs. Jones. They will give you the best vision in both eyes, but they are more expensive than monovision." The patient will come away with the thought that multifocals are more expensive instead of the thought that she's getting the best possible vision.

When discussing multifocal lenses talk about features but "sell" benefits. As an example, a feature of multifocal lenses is distance and near vision in both eyes and better contrast sensitivity.

Now, get a pair of multifocals on the eye. Before you do, set proper expectations. Talk about comfortable vision but don't over promise. Explain that there will be a learning curve and it might take a little time or some lens changes to achieve success. Bring your patient back for a recheck before ordering their year supply. We like to pre-appoint all contact lens patients. Once the patient and I am satisfied with the result, I pre-appoint the patient for a six-month visit. During that visit I try not to just pat the patient on the back and say "you are doing great." When I look at the patient with our biomicroscope I explain what I am looking at and why. I always explain that besides visual acuity, I look for lens centration, good lens movement, and health of the cornea. I make sure there is no swelling or new vessel growth in the cornea. Those few short words mean so much to the patient, and now they understand why progress visits are so important. At the six-month visit, I then pre-appoint for the yearly comprehensive exam.