By ROB Editors
A number of studies confirm what eyecare practitioners have long believed: That a contact lens patient is more valuable to a practice over time than is an eyeglasses-only patient. Keeping a patient in contact lenses is inevitably tied to good lens care compliance, and here an OD can promote good compliance and lens comfort by prescribing branded lens care solutions.
EyeCare Professionals Inc.
45 percent CL patients
40 percent of revenues
Each CL patient
CL Prescribing is a Process
Patients are told their contact lens prescription and fitting is a process rather than a one-time event at EyeCare Professionals, Inc., says Jason Miller, OD, who also presents patients with a contact lens agreement outlining his responsibility as doctor and their responsibility as wearer. The agreement includes, for instance, a description of the difference between a new contact lens fit and a re-evaluation for current contact lens wearers. It also has the practice’s emergency contact phone numbers, along with the cost of the patient’s annual supply of contact lenses, his or her wearing schedule and which solution was prescribed specifically for that patient’s lenses.
In addition, patients are told in the agreement of their responsibility to adhere to the doctor’s prescribed wearing schedule and choice of solution.”I usually grab that form, thank them for coming in and ask them for a few seconds to go over what we expect from contact lens wearers,” Dr. Miller says. “I’ll tell them they were given two-week lenses and that I don’t recommend they sleep in them, or maybe that their contacts are approved for daily wear, and then I’ll explain that with those contacts, I recommend this particular solution.” He says he explains to patients why the solution he is recommending is the best choice for the kind of lens he has prescribed. The reason why, he says to the patient, is because the recommended solution will maximize the safety and comfort of their contact lenses.
Rather than simply providing patients with a sample, Dr. Miller concentrates on making a firm recommendation. “I find it most useful to provide them a specific recommendation and educate the patient why,” he says. “Studies have shown patients respond better to a recommendation than to just a ‘soft’ recommendation by handing them a sample, though it is helpful and reinforces our recommendation when we provide them a sample and a case. We will take that opportunity to encourage them to change their case on a regular basis, as well.”
Coupons for recommended solutions are available in the office, though Dr. Miller doesn’t hand them to the patient when making his recommendation. “Coupons are not a useful way to prescribe something,” he says, “but we place them in our contact lens room, which is strategically located up front in our office. Patients often will ask, or stop by, for a coupon on their way to the grocery store. If nothing else, it gives them another reason to come by and see us.”
Dr. Miller says he acknowledges to the patient that they have other solution options, but that a branded solution will maximize their vision and comfort. He estimates, based on his practice’s patient surveys, 75 percent of his patients are compliant in contact lens wear, including recommended solution use.
Decide on an Alternate Preferred Solution
Different solutions are prescribed for different lenses, Dr. Miller explains. “There are specific solutions that are specifically formulated for silicone hydrogels versus traditional hydrogels,” he says. “I look at the research and see which solutions have the broadest level of microbial coverage. I look at it as minimizing risk. I want to provide the best recommendation which will minimize my patient’s risk of infection.”
Dr. Miller says he deviates from multi-purpose solutions if a patient has an allergy or sensitivity that will not allow them to comfortably use that kind of solution. In that case, he will make use of hydrogen peroxide as an alternative. “There are a small percent of patients who have a sensitivity to just about any multi-purpose solution,” he says. “When trying to filter through the many possible causes of contact lens complications, from my experience it is most often an undiagnosed underlying ocular condition that is complicating the issue.” To narrow down the cause of lens discomfort, Dr. Miller often will switch the patient to hydrogen peroxide to ensure the problem isn’t related to a problem with the multipurpose solution prescribed.
When all else fails, Dr. Miller switches the patient to one-day disposable lenses, which do not require the use of any solution.
Educate Patients on Value of Solutions
Before patients leave the exam room, explain your preferred contact lens use regimen if they’re a new patient, and if they’re an existing contact lens patient, ask about how they care for their lenses, including the solution they use, advises Jeanmarie Davis, OD. “I instruct them as to the proper care and proper use of solution, and will specifically tell them which solution to use and how to use it,” she says. “And I will go so far as to tell them not to alter the use of that particular solution.” Dr. Davis says she gives patients these instructions because she believes all solutions are not equally effective. Her research, and feedback from patients, led her to adopt OPTI-FREE RepleniSH as her solution of choice around five years ago.
Off Generic Solutions
Educate your patients about the benefits of sticking with brand-label solutions rather than the less-expensive generic labels, Drs. Davis and Miller advise.
Create Value in Brand Name
“It’s not necessarily about cost,” says Dr. Davis. “It’s more that the patient perceives no value in the name brand. They believe it’s like a pharmaceutical that’s out for a few years, and then the generic comes out. Explain that it’s not the same formulation, and that it will potentially cause adverse effects for them. Create value in the brand-name solution. People are willing to pay more if they feel they are getting something for their money.”
Focus on the Science
“It is a fine line when making specific recommendations and prescribing specific products versus making the patient feel bad for being a bad patient,” says Dr. Miller. “They often do not realize they have done something wrong. I focus on the science and let them know I have made a specific recommendation to maximize their contact lens comfort and minimize their risk of infection.”
Dr. Davis says doctors should do research and get patient feedback, and make a decision about which contact lens solution works best, and then stick to that decision. She recommends her patients use OPTI-FREE RepleniSH because she believes it is the best solution available for silicone hydrogel contact lens wearers. “I always tell patients it is the only solution available for the particular material their lens is made of, and that it will address dryness and irritation.”
Does not sell CL
of practice revenues
95 percent of patients
To reinforce her recommendation, she writes her preferred solution down on a prescription pad, or gives the patient a sample of the solution with a contact lens case.
Doctors should take the same approach to prescribing contact lens solution that they would to prescribe a medication. “I’ve found a lot of doctors take an over-the-counter approach that is different from prescribing medication. Consider it the same as medication,” she says.
If the patient doesn’t take the doctor’s recommendation seriously, and experiences discomfort, the doctor is the one who will be blamed, Dr. Davis notes. “I believe it impacts the practice financially,” she says, explaining that a patient using the wrong solution won’t be as comfortable, and is liable to leave the practice in search of a new doctor who can keep them comfortable in contacts. “The patient doesn’t know what’s causing the discomfort, so they blame the doctor. ‘I was doing fine until you put me in these new contacts,’ they’ll tell you. It gives the doctor credibility to make the proper recommendation.”
Only “a half of a half of 1 percent” of her patients are non-compliant in contact lens solution use, Dr. Davis estimates, based on patient interviews during office visits. “If one of my patients drops out of contact lenses, usually it’s not because of the solution; it’s usually just because they have difficulty messing with their eyes.”