When it comes to ophthalmic lenses, its no surprise that you influence your patients decisions. The power of the white coat (even if you dont actually wear one) is pretty pervasive in an optometric practice.

But, theres a proper way to use this influenceand a fine line between recommending and selling that can seem very blurry at times.

Heres how to make sure that you form the professional opinion that most benefits your patients and that you present lens options to them properly.


AR Lenses Clear Up Confusion

Lenses that are not anti-reflective may allow halos or ghost images to interfere with your patients vision. When it comes to situations such as nighttime driving or working at a computer, these reflections can be distracting. But, anti-reflective (AR) lenses help to clear these problems up. If face time is a major component of your patients career, if they drive often at nighttime, or if they spend long hours in front of a computer monitor, AR lenses may help these patients both see better and feel better about how they look, because the visibility of the lens is reduced.

For example, the Teflon Clear Coat Lens (Carl Zeiss Meditec) is designed to deliver clear, crisp vision through lenses that feature high rates of scratch resistance and a hydrophobic topcoat.

The Right Mindset

Some optometrists just dont talk about lens options, period, says Neil Gailmard, O.D., of Munster, Ind. Our profession has shifted toward medical eye care, and lenses are left out of the exam room and out of the discussion. We need to make time during the exam for this discussion.

Lenses should take on the same level of importance as a medication, says Dr. Gailmard. By discussing them with this level of seriousness and regard, you can convey to your patients that specialized lenses provide a definite visual benefit.

Make a point of discussing something about lenses with every patient, Dr. Gailmard says. This way, youll create a habit. Decide at which point during the exam it would make the most sense for you, and remember to do it. But, be flexible. If a patient asks about lenses or about something that could be corrected by different lenses, dont wait until later to discuss itanswer the patients concern, and tell him or her that you can talk about that more at the end of the exam. This way, the patient knows theres a lens that can help him or her, but youre not stopping the flow of the examand youve laid the groundwork for further discussion of specialized lenses.


Hit the Ground Running

The patient history, right at the beginning of the exam, can provide some vital clues in a situation where the patient may need a different style of lens.

Photochromic Lenses Keep It Light

Photochromic lenses are perfect for patients who dont want to switch from glasses to sunglasses, or for those who spend a lot of time outdoors. The lenses darken in the sunlight, and fade indoors.

For example, the new Transitions VI (Transitions Optical), the latest generation of Transition lenses, darken quickly outdoors in any temperature, and fade back to clear more quickly indoors as well, says the company. These lenses block 100% of both UV-A and UV-B rays and provide UV 400 protection.

Ask questions, suggests Dr. Gailmard. Find out about the patients occupation, avocation, previous glasses, ocular health status and eyeglass prescription. Some lens options are based on these factors, he says. For example, if the patient says, Im having trouble with night driving, and you can see that his or her lenses arent anti-reflective, thats the perfect time to bring it up quickly with more discussion later.

That later time can fit very neatly into the end of the patient visit, as a session that Dr. Gailmard calls the patient consultation.

At the end, after all the data has been gathered and Ive formulated my treatment plan, thats the absolute best time to discuss the patients lens options, he says. During that last consult, were summarizing the vision problems and formulation a treatment plan, which includes a discussion of lens options. Anything weve mentioned earlier will lead into this conversation.

You, as the doctor, should be the one to initiate this discussion. Dont leave it to your staffers. Theres a certain amount of authority that the doctor has, in the patients eyes, that the staff simply dont, Dr. Gailmard says. The doctor ought to at least highlight what goes into these lenses.

But, presenting lenses is more than just listing them off to patients. The doctor should not simply give a list of options, says Dr. Gailmard. Patients need and deserve more than that. They want the professionals advicewhats the best thing, whats the most important thing, what you would do if it were your eyes, etc. Its fine to give options, but it should include recommendations. Youll end up customizing a lens solution for each patient that you see, and that will have an impact on his or her perception of the importance of the proper lens.


Polarized Lenses Sharpen Any Situation

Polarized lenses are great for outdoor usethey reduce glare, enhance colors, and block UV rays. For patients who spend time in the great outdoors, these lenses can be very valuable.

For example, the newly-released Xperio lens (Essilor of America) blocks 100% of both UV-A and UV-B rays, provides superior glare reduction and color enhancement, and resists scratching, says the company.

These lenses can improve contrast sensitivity by as much as 75%, and the Xperio gray lens allows for natural color enhancement outdoors.

Mutual Respect

Though it should go without saying, make sure to show your staff the proper respectespecially in front of your patients. If you havent really taken an active role in the discussion of which lens would best suit your patient until now, this step is especially crucial. Dont accidentally belittle your staff members capability by making it seem that youre removing their duties from them.

Doctors need to make sure that the staff maintains the perception of being expert in optical design and dispensing, Dr. Gailmard notes. The doctor can do this in how he or she treats the staff members, refers to them and shows them respect.

For example, says Dr. Gailmard, dont call the optician a girl. Youve just dropped the patients perception of that staffer from an eye-care professional to a girl. Instead, use careful language, and include that staff members title in the introduction.

Or, suggests Dr. Gailmard, Ask that staff member a questionfor example: Mary, I have recommended to Mrs. Jones a high-index lens. Is that available in her prescription? Youve just painted the picture that the optician is a knowledgeable expert as well. This careful handoff from you to the staff member is very important.

But, this isnt the only aspect of your manner that has to be professional. Dont cross the line between recommending and selling, either. Its not a sales technique, says Dr. Gailmard. Its an educational approach. There is a very fine line between educating and selling, and you dont want to make the patient feel as if you are pushing him or her toward a certain choice.

Hi-Index LensesSlimming Down!

A hi-index lens is great for those patients with high prescriptionsrather than offer the patient a pair of frames with thick lenses, the hi-index lens allows you to incorporate a strong prescription into a thin, lightweight lens that allows the patient to wear nearly any frame he or she chooses.

For example, the Hoya EYNOA 1.67 lens features a monomer structure that allows the lens to be thin, flat, durable and light, with significantly less magnification and distortion than patients expect from a lens with a strong prescription.

Also, part of our responsibility is to talk about not only the benefits, but also the drawbacks of each lens, Dr. Gailmard says, and I certainly want to bring them up. For some patients, they are minor, and I can again give my advice if they are or notbut, we need to give a balanced and complete approach to explaining lens options.


Presentation of Features

Sometimes, patients understand the features of each lens better with a physical demonstration. So, suggests Dr. Gailmard, the judicious use of props may help patients to be more fully aware of the aspects of each lens type. Each lens offers its own sets of benefits and drawbacks, and such items will help patients visualize what it would be like to see through them.

Usually, when educating a patient, Ill use my own eyeglasses as a demonstration item, notes Dr. Gailmard. They are a great prop because I, the doctor, am wearing them myself.

Also, if the type of lens you recommend for the patient isnt what you wear yourself, have some spare frames made with different lenses in each eyefor example, one lens can be anti-reflective (AR) and one can be normal. Similarly, you can do a frame with one high-index lens and one standard lens. The patient can see that one is quite a bit thicker than the other, explains Dr. Gailmard.

Progressive Lenses Make it Smooth

Progressive lenses help presbyopic patients focus at different distancesfrom near zones for reading, to intermediate zones for computer work to distance zones for driving, progressive lenses have a big job to do, and each pair of lenses has be to be carefully made for each patient.

For example, the Autograph II family of lenses from Shamir includes five lifestyle designs to fit a range of patients. And, these frames have a fitting height as little as 11mm, so the patients need for a multifocal lens wont inhibit his or her frame choice.
Also, the lenses feature Shamirs As Worn Technology, which takes three measurements to match the prescription to the patient and his or her wearing preferences exactly: vertex distance, pantoscopic tilt and panoramic angle.

This technique may be able to demonstrate a lens to your patients more effectively than anything you say about it. Here, the patient can see for him or herself the difference between a normal lens and a more specialized lens.

Or, if you want to take all possible pressure off of the patient, and youre that certain that a specific lens will help him or her, offer to guarantee the lens.

Look at the situation from the patients point of view, Dr. Gailmard says. Ill ask if he or she has tried this lens before, and depending how he or she answers, Ill say, There have been some excellent advances recently, and I encourage you to try this lens again. If youre not satisfied, well remake the lenses. Actually, most optometrists give guarantees like this alreadyif a patient isnt satisfied, who isnt going to remake the lenses for him or her?

This extra motivation for the patient to try a different lens, if you truly believe that it will help them, may provide a comfort zone for patients and allow them to feel that they may safely try the new lens. Make a point of presenting this guarantee as such during the patient consultation, says Dr. Gailmard.


The patients perception of ophthalmic lenses depends mostly on your presentation of them. Not only that, but you influence the decisions that will help patients achieve the best possible corrected vision. Dont minimize the importance of the patients lenses by giving them less than your full, professional consideration.



Bringing Tomorrow into Focus

In the pipeline is the dynamic electronic focusing eyeglass, by PixelOptics. Currently, the glasses are in limited, controlled wearer trials. The eyeglasses use no moving parts to focus between distance and near, says the company.

Currently, the companys first static composite lens, AtLast!, is on the market. If all goes well with trials, the company hopes for a 2010 launch.

Vol. No: 146:03Issue: 3/15/2009