By Sarah Galt, OD, FAAO
June 26, 2019
Pediatric patients can present special challenges at dispensing, requiring help from the prescribing doctor and additional training of opticians.
Here are three difficult scenarios your practice may experience when prescribing and selling eyewear for children, and how to handle each.
Effectively managing these situations will lead to satisfied patients who return to the practice for care and refer friends and family.
Parent Expresses Negative Feelings About Glasses
Sometimes a parent makes remarks during the exam that make it apparent that they view a need for glasses as a negative, such as: “If you don’t sit still, they are going to give you glasses,” “Are you going to be a four eyes?” Or sighing and being overtly upset at the announcement that glasses will be needed to improve vision.
Why this is so challenging: This parental attitude sets the doctor up for a negative patient response when announcing the need for glasses, as children often look to their parent for cues on how to react. The doctor must get ahead of these negative feelings from the parent, and ensure the patient can create a positive attitude toward their diagnosis and treatment to have a hope at good compliance.
What the doctor and/or optician should do: The doctor and optician must increase the amount of positivity when educating the patient and the parent that they need glasses. They can do this by focusing on improved functionality, and discussing specific benefits, such as sports performance or driving. Noting specific benefits to wearing glasses goes a long way to making the patient enthusiastic, despite their parents’ stance on spectacle correction.
Impact of handling this situation well: This important conversation, which can take place at the exam, and again at dispensing, can give the patient a confidence independent from their parents’ opinion. This will increase the chances of glasses-wearing compliance.
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The parent will also be educated on the benefit of spectacles for their child, and may change their opinion about spectacle wear in general. This often happens once the parent sees their child’s improvement in quality of life and functionality in activities of daily living after the glasses are worn.
Predicting these specific improvements at the time of the exam can increase the parents’ trust in your expertise, and encourage them to mention these improvements to other parents. A compliant patient with a well-fitted frame is a walking billboard for your practice. A thoroughly educated parent who feels that the doctor and optician took their time to ensure compliance will be enthusiastic about telling many other parents about your practice.
Parent Isn’t Enforcing Glasses-Wear Due to Misunderstanding
In this scenario, the parent arrives for follow-up with the patient, but the patient is not wearing their correction. The parent says that the reason for this is: “The prescription is too strong.” After further digging, you discover that the parent tried on the glasses, and could not see through them, then refused to let their child wear them.
Why this is so challenging: This situation is difficult because while we consider refractive understanding to be second nature at this point in our careers, the general public has little knowledge of refractive error, optics and what glasses do. (This is apparent by how many times we all hear “I am legally blind without my contacts” as soon as you tell people you are an optometrist.) It can be difficult to phrase your explanation of the need for glasses without being condescending or using phrases that imply “Because I’m the doctor and I said so.”
What the doctor and/or optician should do: In this situation it is important to find the right depth of education to provide a parent when prescribing and dispensing glasses. The amount of information you choose to share will dictate your conversation and further education at follow-ups. It can be helpful to casually ask the parent what their day-to-day activities are, including employment, caring for loved ones and hobbies. This gives the doctor a way to draw parallels from the parent’s life that may improve their understanding of the need for their child to wear glasses. It is also important to reiterate that glasses are never prescribed unless they are needed.
Impact of handling this situation well: If a parent understands that, while certain aspects of refractive error can be inherited, their child’s prescription is unique to their eye shape and size, they will understand the care that was put into getting the best prescription for the child, and why wearing the glasses is important. This slower-paced conversation can improve their trust in your prescribing skills and ensure them that you have their child’s best interest at heart.
A parent must understand that if they give their child time to adapt thoroughly and encourage full-time wear, the patient is much more likely to be compliant, have improved best-corrected visual acuity and best possible functionality. Peers and other parents who observe these benefits will be more likely to approach the child and their parent and inquire about their spectacle success, and your office’s services.
Child Impeded From Wearing Glasses Due to Peer Pressure
Peer pressure, an ever-present aspect of growing up, can adversely affect glasses wearing. There are phases during elementary, middle and high school in which glasses wear is revered, and phases in which it is a source for ridicule. I have not been able to pinpoint any specific grade levels yet, as popularity of glasses will vary by school and classroom based on who is wearing them.
Why this is so challenging: This is a difficult aspect of compliance to anticipate in the exam room. Sometimes it is clear that a patient cannot wait to get glasses. In these cases the confidence the glasses give the patient will carry over into their classroom setting, and any negative peer pressure has a more minimal impact. In other cases, children may be reluctant about their new accessory. To the doctor’s chagrin, sometimes peer pressure wins out over the improved function a patient gains from spectacle correction.
What the doctor and/or optician should do: An emphasis on specific task improvement, such as reading, catching a ball, seeing a movie screen or scores at a sporting event can reduce the likelihood of non-compliance based on negative peer attention. Find the patient’s “carrot” and they will then be able to respond to any negativity from a peer with an example of how their glasses benefit them. In these cases, as in all cases, it is important that a parent also know exactly why glasses were prescribed, how often they should be worn, and that they are not prescribed without a specific need. The parent can keep an eye out to ensure the patient leaves home and returns from school wearing correction, and can inform teachers of the recommended wear time to ensure compliance throughout the day.
Impact of handling this situation well: If a patient and their parent know that glasses are going to provide long-term benefit, and are necessary for academic and athletic success, they are less likely to heed the potential negative attention from peers regarding their new specs.
Improved compliance leads to improved vision. When a patient is able to appreciate the improvement in their vision after adapting to their specs, they will continue to return for follow-up appointments, and trust you as a prescribing doctor.
When you anticipate a patient’s hurdles to compliance, and give them the confidence and trust to continue with wear despite these hurdles, they will be a patient for a long time, and are likely to bring in family members and friends to your practice.
Sarah Galt, OD, is an associate at Bright Eyes Vision Clinic–All About Kids Vision. To contact her: firstname.lastname@example.org