By Brian Chou, OD, FAAO
Recently, a patient with ugly glasses–which I’m sure were from the 1980s–asked one of my former opticians, “Has my prescription changed?” “No, not much,” replied the optician. Based on that, the patient promptly left without getting new glasses. Sadly, the short verbal exchange exposed a shortcoming in the patient’s understanding. You could also argue that the optician did not serve the patient’s best interests.
The larger issue, which isn’t often articulated, is why patients should get new eyewear. It seems so elementary, but in my formal optometric training this was never discussed! This isn’t about selling unnecessary product which doesn’t benefit the patient. If a patient truly doesn’t need new eyewear, I’m the first to say this since I believe honesty and integrity are foremost in the doctor-patient relationship. That said, below, are reasons I believe are important:
1) A significant change in the eyeglass prescription. The reality is that there is always some type of change in prescription. What’s relevant is whether it’s significant such that an update would tangibly benefit the patient. For many, the just-noticeable difference is equivalent to 0.25 diopters sphere. Yet some patients have reduced visual sensitivity, where even a 0.50D sphere change would not be perceptible. This could be due to elevated higher-order aberrations, such as cataract or keratoconus, or other factors that overwhelm the usual level of sensitivity. On the other end of the spectrum, there are patients that swear that even an 1/8th diopter change offers a huge perceptible improvement. Unfortunately, the optician often is not in a position of knowing the patient’s level of visual sensitivity. For example, an optician might not realize that a 2.00D shift actually would not lead to a perceptible visual improvement, without understanding that the patient has strabismic amblyopia with suppression in that eye. Therefore, I feel that the prescribing doctor should proactively let the patient know what to expect with a new eyeglass prescription.
2) Improved lens technology. Clinicians will routinely come across patients with older lens technology. As an example, patients coming in with Transitions VI are easy to get into the improved Transitions Signature VII–even where there is no significant prescriptive change–since they’ll notice that Transitions VII provides a more neutral gray color when activated. There are patients in molded lenses that would do better in digitally-surfaced designs. Another example is a -7.00D myope wearing polycarbonate lenses who would have improved vision by moving into high-index lenses with a higher Abbe value, even with no change in the dioptric power.
3) Back-up glasses. All too often, patients who are visually dependent on corrective eyewear do not have back-up glasses. I always recommend back-up glasses, even for full-time contact lens wearers. I remind contact lens wearers that they need updated glasses in the unexpected case they develop an eye infection and cannot wear contact lenses. It is often helpful for these patients to also realize that one-hour eyeglass service may not be available to them, and even when it is, there can be a significant cost premium with limitations on lens material and options.
4) Glasses are scratched or in disrepair. I always inspect the patient’s existing glasses. When the lenses are scratched or about to fail and the patient seems oblivious to it, I will point this out and recommend new glasses prior to refracting. At the same time, I will educate the patient on any absent lens features which would benefit the patient, such as anti-reflective treatment, or polarization for sunglasses.
5) Glasses are old and ugly. I do not shy away from letting my patients know that their glasses are old or unattractive. Sometimes it’s adequate to intimate that the glasses are ancient by asking, “How old are your glasses?” If the patient’s glasses are ugly, sometimes I will gently convey this by saying, “You’ll be happy to get new glasses that are up-to-date in style.” In situations where there is something wrong with how their frame sits on their face, I will directly demonstrate to the patient what’s wrong. Examples include if their PDs are not matched well to the frame PD, or if their frames are not supported properly over their flat nose bridge, or if the frame temple bend is inappropriate.
6) Glasses for different purposes. In situations where the patient’s prescription isn’t significantly different from before, there are often still opportunities to fulfill the patient’s needs and lifestyle with athletic eyewear, near-variable focus lenses and sunglasses. My practice has a large number of presbyopic engineers and programmers, and near-variable focus glasses often make an excellent second pair of glasses, in addition to general progressive glasses. Contact lens patients in monovision or with significant residual astigmatism often appreciate eyewear for periodic use over their contacts to obtain the very best vision.
7) Full vision plan eligibility. Even when a patient’s prescription is similar, patients should take advantage of any lens and frame allowances from a funded vision plan. If these allowances are not used, the patients lose the value whether they are paying, directly or indirectly, for the plan. Additionally, patients who do not use their vision plan are effectively subsidizing the members who do use their plan to get their eyewear. When explained in this fashion, patients are more apt to get eyewear. Even when there isn’t full frame or lens eligibility, I’ve found that these patients prefer knowing that they can still purchase eyewear at a savings off the usual, customary fee. Perhaps the worst thing staff can convey is telling the patients that they are “ineligible” to purchase eyewear. In truth, these patients are still free to purchase eyewear without the vision plan dictating what is in their best interest.