Dr. Mile Brujic and Dr. Jason Miller debate the need for contact lens follow-ups.
Follow-up visits benefit the patient and practitioner
Here are 3 reasons why
Jason Miller, OD, MBA, FAAO
Contact lens follow-up appointments can be a useful tool to complete the contact lens fitting, but they can also be an adventure of never ending, non-revenue producing follow-up appointments. Take the time to educate your patients how the follow-up process works in your office and outline the reasons for these appointments in order to minimize the number of appointments. These appointments are critical to the success of contact lens wearers within your practice and can lead to a strong contact lens profit center.
Although there certainly is a balance in respecting your patient’s time and providing the best possible eye care to each and every patient, this follow-up is critical to success with many patients. There are three major reasons this appointment will increase success with contact lens wearers and prevent potential dropouts.
1. Education and patient accountability
If the patient is overusing or overwearing his diagnostic lenses, this is an opportunity to remind him of proper wearing habits.
Compliance is a major concern with contact lens wearers. Contact lens complications, such as red eyes, infiltrative keratitis, corneal ulcers, giant papillary conjunctivitis (GPC), and more could potentially damage the patient’s ability to wear contact lenses. Communication is really the opportunity for the eyecare practitioner to educate the patient on the way that we feel it is in his best interest to care for the lenses. This is the critical moment during a patient encounter in which we incorporate all of the findings and combine them with our knowledge base and experience to give the patient the best recommendation.
Patients don’t want to cause harm to their eyes, but they get mixed messages about proper wearing habits. I once had a gas permeable (GP) wearer who stored his lenses in his mouth while he slept. He had had multiple visits to other eye doctors and was never told that is a bad idea.
Patients can become passive about contact lens wear if their eyecare professional is passive about providing comprehensive wear instructions. As clinicians, we can use this follow-up to further solidify our patients’ wearing instructions and provide them with the healthiest lens, the cleanest lens, and the lens with the least risk of infection.
2. Opportunity to wear the prescribed lenses in their normal, everyday environment
Like a test drive, this short wearing period may expose potential comfort problems. Discomfort is the number one reason for contact lens dropouts.
The key here is to listen to your patients and understand what they are looking for in a contact lens. Make sure to prescribe a specific lens that meets those needs and capture that excitement. Individualize your contact lens prescribing habits to best meet each patient’s lifestyle and to maximize comfort.
I tell patients this: "I'm going to focus on providing you with the best vision, and contact lenses can offer you that opportunity. In addition, I want to make sure you contact lenses are the most comfortable you have ever worn." Set the expectations up front. I want thepatient involved in the lens fitting process and providing feedback to me all along this journey.
Additionally, having an opportunity to wear the prescribed lenses will potentially preventing future returns and “buyers remorse.”
3. Maximize vision
The optometric oath states that, “I will advise my patients fully and honestly of all which may serve to restore, maintain or enhance their vision and general health.”1
After the patient adjusts to her new medical devices, we have an opportunity to fine-tune her prescription and maximize her vision in all situations-distance, near, computer, low-light situations, night driving, etc. Utilize this time to make sure the patient has maximized her vision with her contact lenses.
As you and your staff become more efficient with this process, the office will be able to streamline the contact lens fits and maximize success. Ultimately, the key to success for choosing the best modality is listening to your patients in order to understand what they are looking for in a contact lens. It’s best to make specific recommendations based on patients’ preferences and their ocular health, which will ultimately lead to improved compliance and maximize success with contact lenses.
Next: Dr. Mile Brujic says contact lens follow-ups aren't necessary
Today, contact lens follow-ups aren’t necessary
Disposable lenses add even more convenience by eliminating these appointments
Mile Brujic, OD, FAAO
Conventional soft contact lenses required careful and diligent follow-up by eyecare practitioners. These lenses were designed to be kept for a year before they were replaced with a new pair, so care had to be taken to make sure that compliance with cleaning regimens was upheld. Even with the highest level of compliance, keeping contact lenses for a year meant that the solutions that supported these lenses had to be compatible with the lenses, which, at times, proved to be difficult.
So under these circumstances, it was critical to follow up with patients regarding their contact lens wear-not only to monitor compliance but also to monitor ocular health and biocompatibility with the contact lenses and the care systems utilized with the lenses.
Now fast-forward four decades, during which we are practicing in the era of disposable contact lenses. We now reach for lenses that are much more frequently replaced. The most common replacement modalities utilized are the daily, two-week, and monthly disposable lenses.
Two-week or one-month lenses can feel and look very different at the end of their wearing schedule compared to the beginning of the wear schedule. It’s one of the reasons that a number of us, if fitting either of these modalities, will schedule a follow-up visit toward the end of the wearing schedule. Typically, we’ll assess the lens characteristics including deposition, the contact-ocular surface relationship, and ocular health after the same lens has been worn on the eye for a given period of time.
Daily disposables eliminate follow-up need
But what if we had a lens that was meant to be worn for one day and then replaced with a fresh new lens the following day. Would this negate the need for follow-ups?
There are certainly instances when follow-up appointments are warranted. Patients who may be presenting with ocular conditions such as GPC or visible conjunctival hyperemia that seem to be contributed to by contact lens wear certainly warrant a follow-up of their medical conditions to make sure that they are resolving.
Take the following patient into consideration: a patient comes in for her yearly exam and wants to purchase more contact lenses. When asked about the experience with her current lenses, she reports that she likes her current contact lenses and is not having any problems with them. After a discussion with your patient, you feel that it would be warranted to fit her with a daily disposable contact lens. A diagnostic set of lenses is placed on the patient’s eyes. The vision check, along with an over-refraction, and a fit assessment of the lens is performed. The patient is then supplied with either a five or 10-day supply of the lenses so that the patient can experience the lenses in her real world environment. So is a follow-up appointment required at this point?
Most would argue that if a prescription is available in a daily disposable lens, it would provide patients with a truly remarkable wearing experience. It does not require any care or upkeep of the lens. It doesn’t require any cleaning or disinfection of the lens because of the new lens being placed on the eye every day. So what would be the advantage to having a patient return for a follow-up appointment to assess these lenses on the eyes? They are experienced lens wearers who understand application and removal of lenses on the eyes. The care that is required is a non-issue with this lens modality, and the complication rate is remarkably low.
Follow-ups can be inconvenient
Bringing the patient back actually adds an additional burden to the patient by having her return to the office for what may be an unnecessary visit. Convenience has become an increasingly important consideration in a society that thrives on it. People don’t need to get out of their car to get meals, grab some coffee, or do their banking. People don’t have to call during business hours to speak to a travel agent to book flights but can do this at their convenience online during non-traditional hours. Offering them the convenience of not having to come back to the office adds convenience to busy patients who may have a difficult time scheduling a follow up visit.
Additionally, this allows you to see other patients during the time that may have been occupied by the patient coming in for the contact lens follow-up visit.
So am I suggesting that the patient simply leave the office and at his own accord order contact lenses? Not at all.
Consider the experienced lens wearer leaving the office and receiving the following message from the practitioner who fit her with the daily disposable lenses: “These lenses fit your eyes perfectly, and your vision is excellent. I think that you will do great in these contact lenses. But, so that you can truly experience the benefits that these lenses offer, I am going to give you some additional contact lenses so that you can wear them in your real environment. Assuming that everything goes great with the lenses-which I think they will-you will be able to take advantage of the rebate available and order a year supply of the contact lenses. One of our team members will be contacting you in ___ days to make sure that everything is going great with your lenses and to place your order.”
This convenience-oriented, patient-centric approach truly sets the stage for success and avoids an unnecessary follow-up visit. From a patient and practitioner perspective, it works out to be an advantageous proposition.ODT
1. American Optometric Association. The Optometric Oath. Available at http://www.aoa.org/about-the-aoa/ethics-and-values/the-optometric-oath?sso=y. Accessed 06/12/2014.