An elderly patient presents for an eye exam. She just wants new frames, so after you check her vision and she selects the frames she likes, you set her up with the same type of lenses that she currently has. After all, she should know what she wants by now, right? Not necessarily. If you havent told her about the lens coatings and treatments that you offer, she may not know that theyre available to her.

Doctors need to make patients aware, or else patients wont even know what they dont know, says Robert M. Cole III, O.D., of Bridgeton, N.J. In other words, if you dont tell your patients what add-ons you can provide, such as a lens tint for better visibility or anti-reflective coating (AR) for better night driving, chances are high that they wont know to ask for it.

But, if you want to teach patients how their lenses can help them even more, consider the following lens treatments and coatings.

Start from Scratch

Scratch-resistant coatings are basic fare for an optical practice, with many O.D.s dispensing scratch coats on nearly all spectacles. I didnt want to have to sell a scratch coat. So, when I present lenses, they start at a price that includes the scratch coat, says Chet Steinmetz, O.D., of Chicago.

Other doctors choose to limit the spectacles they make without it. We have what we call a budget line, in case a patient wants spare or backup glasses, Dr. Cole says. Otherwise, all of our lenses come scratch-coated.

Why should you consider making scratch coatings part of your offerings? Palmer Cook, O.D., director of education for Diversified Ophthalmics, Cincinnati, offers this analogy: They can extend the useful life of the lens. Its like using this kind of oil to get an extra 25,000 miles on your car before the engine gives out, he says.

More specifically, a scratch coat minimizes the effects of everyday wear on the lenses. The optics of the glasses are destroyed once you have superficial scratches on the lens surface, Dr. Cole says. To get the best out of vision, you want to avoid those scratches.

Spectacle lenses, when protected by a scratch-resistant coating, may still have a few scratches, but these wont affect the integrity of the lens as badly as they would if it lacked the scratch coat entirely. Patients need to be told that a few hairline scratches arent that important, but that they need to avoid a buildup of these scratches, Dr. Cook says.

To help patients, its important to determine the cause of the scratches, Dr. Cook adds. For example, curved scratches on both the front and back surfaces, especially when the curves are parallel, are cleaning scratches. This means the patient isnt flushing the lens with water before using a cleaner. Straight-line scratches usually result from sliding the glasses into a case with grit on the lining. Scratches grouped in the center of the front surface are from laying the lenses down. Scratches in the corners generally come from using clip-ons.


Crazy About AR

With advances in anti-reflective (AR) coating technology, AR coatings do not crack and craze as they did as recently as 10 years ago. AR is now fully integrated and more scratch-resistant, yet sales in America are sluggish.1 Americans have had such a poor experience with glare coatings that they are reluctant to purchase them againin contrast to the international marketplace, which has been dispensing superior lenses for many years, says Denise Whittam, O.D., of New York.

Survey: Patients Dont Choose AR on Looks Alone

In the year ending March 2007, more than 20% of all lenses sold were anti-reflective lenses, according to VisionWatch, a study conducted by Jobson/VCA.2 But, the survey also found that most of the patients who select AR do so for its visual benefitsnot its looks.

Of those who wear AR lenses, nearly 27% of responders knew or were told that AR lenses would improve their overall vision, and 52% of responders knew or were told that reflections on the back of the lens would be prevented. Only 8% of respondents purchased AR for its aesthetic appeal.

 Today, AR is applied to a lens in layers, or stacks. These generally include a scratch-resistant coating, the anti-reflective coating and layers in between to ensure the proper adhesion. Premium coatings may also include oleophobic, static-repellent, and hydrophobic layers to extend the life of the lenses.

Ironically, in earlier incarnations of AR, the problems actually began with these layers. Specifically, when the layers reacted at different rates to temperature changes, they wore down and cracked.1

Current technology has overcome this flaw, though. Todays AR lenses address this issue through improved technology unique to each manufacturer, Dr. Cook says.

Dr. Steinmetz has offered AR coating to his patients since he first opened his practice 17 years ago. Once people see the difference and appreciate the difference, thats it, he says. I have a sample of plano lenses in a frame side-by-side, with one lens coated and one thats not coated. Until people see [AR] for themselves, it means nothing.

Heres what he tells his patients:  Everyone has to know that it improves the quality of view. You dont have to look through reflections, and everyones view of you [improves] because they dont look through reflections at you.

By letting your patients know the full spectrum of benefits a particular lens or lens coating provides, you may help them decide which theyd be most comfortable with. Some patients select AR because of cosmetic appeal alone, while others prefer its abilities. AR has benefits for vision as well as cosmetics, and I always present it that way, Dr. Steinmetz says. The impression has been that its only good for cosmesis, and people dont realize how beneficial that it is for vision as well.

Dr. Whittam has also had to re-educate patients who had bad experiences with poor-quality AR lenses. Its up to you to advise them about caring for the health of their eyes as well as their eyeglasses, she says. Im very honest, and tell them that the optical field has learned from its mistakes, and that through scientific and technological advancement, we have succeeded in producing a superior optical product with peak performance.

We came to the realization that if we didnt explain it, no one else was going to, Dr. Cole contends.

How successful was Dr. Cole? We were at 15%, and are now at nearly 85% [adding] AR, he says. Many patients complaints can be addressed by a good AR coating. For example, a cataract patient will complain of glare, and an AR coating will minimize that.

When dispensing lenses with AR coating, consider what patients will use their glasses for, what environment they work in and what needs they have, such as glare reduction. Something is only an advantage if its in the best interest of the patient, Dr. Cole says.


Dark Side of the Lens

Photochromic lenses, which bridge the gap between prescription spectacles and sunglasses, provide the respite of dark tints to spectacle wearers. Like AR, photochromic lenses needed a maturation period; the first variable-tint lenses changed quite slowly until the lens darkened or lightened as needed. Also, the lenses always had a slight gray tint to them.

A Rainbow of Photochromics

In the year ending March 2007, 15.2% of all lenses purchased were photochromic lenses, according to VisionWatch, a study conducted by Jobson/VCA.2 Men were more willing to purchase photochromic lenses than women57.8% of respondents who wear photochromic lenses were male, while women only made up 42.2% of the total group.

Of all the photochromic lens tints available, brown and gray were the most sought after. Of the lenses purchased, 52% were gray, and 23.9% were brown. Green photochromic lenses made up 2.4% of the total amount of lenses purchased, while 4.3% of the lenses sold were blue. And, 3.9% of the lenses chosen by patients were pink. All together, yellow, red, violet and orange made up 3.3% of the total amount of lenses sold.

Most photochromic lenses cannot act as a sun lens inside of a car because the windshield absorbs the UV. Be up-front about this fact. I call photochromic lenses adjustable comfort tint lenses; if a patient wants the best full-time sun protection, then he or she would be better off with a true polarized sunglass, Dr. Cole says.

To counter this potential disadvantage, Drs. Steinmetz and Dr. Cole both recommend clips to provide full-time sun coverage.

When presenting photochromic lenses, Dr. Cole uses plain and personal language. At the end of every one of my exams, he says, I will say to my patient: There is a lot of evidence of the harmful effects of sunlight. It can damage your skin, your eyes, and there is clear evidence that cataracts are closely associated with ultraviolet exposure. So, we recommend to every patient to have sun protection all the time. I personally had a bout with skin cancer, so it puts it in perspective. We recommend either a second pair of sunglasses, a clip-on or photochromic lenses.


Dispensing Happily Ever After

When dispensing new lenses, keep three rules in mind:

Know the product. Know the strengths and limits of what you recommend, Dr. Cook says. If you dont understand the technology, you need to find out the truth about it. Look in the various journals for articles that deal with the productnot as an advertisement, but where there is an analysis of performance, he says.

Know your patients. Dr. Whittam was a certified ophthalmic dispenser before he became an O.D., so shes familiar with both sides of a practice. There are three things each patient wantsquality, performance, and value for their moneyand they generally want them yesterday, she says.

However, knowing your patients does not mean judging what they want pre-emptively. If you dont present options, you lose a lot, Dr. Steinmetz says. For example, it doesnt look like your patients can afford [a particular lens], then they may turn around and say, I didnt know that existed. Sure, Ill take it, no matter the cost.

We have an obligation to educate our patients on what things are available to them, Dr. Cole adds. If patients want a rock bottom pair of glasses, then you can tell them what theyre not getting if they want to pay that price. You should present the options to them and educate them on the benefits, and then let them make the decision.

Dr. Whittams approach: Discuss lens options in the exam room and then have the optician reinforce the information. My approach is to teach my patients, she says. I show them examples of glare vs. no glare, the harmful effects of UV or poor-quality lens coatings, and do comparisons using visual aids, pictures or other props. I feel that ocular health really impacts the whole package, and Ill prescribe accordingly.

Enlist your staff. Although your word may carry weight with the patients, your employees spend more time with them selecting frames and discussing the specifics. Dispensing new lenses or lens add-ons requires a team effort to be successful. We have staff meetings where we demonstrate and explain the difference [between lens coatings], and we empower them to provide it to patients, says Dr. Cole.

Also, if patients see that you and your staff use the product, they will have more faith in it, Dr. Cook says.

There are two additional ways to involve your staff. If you have a patient come back in and comment how much they like their new glasses, let your staff know, Dr. Cook says.

Second, whenever a problem occurs, analyze it privately with your staff.Its always a no-fault discussion; just try to figure out what went wrong and what could have been done about it, Dr. Cook says.

She also suggests a phone or brief in-office follow-up with patients to be sure their new spectacles effectively meet their needs. Then analyze cases with your staff, including what worked well for a patient and what could have been more effective.


Educating patients about additional lens options, such as AR coatings or photochromic treatment, may sometimes be challenging. However, your patients will appreciate your commitment to providing them additional options for improved vision. Says Dr. Whittam, Not only do they know you care, but they know that you want to dispense a quality product to them.

1. Haseldine J. Whats New in AR? Rev Optom 2003 Oct;140(10):37-8.

2. Jobson Research.. March 2007 VisionWatch Survey.

Vol. No: 144:09Issue: 9/15/2007