Educate presbyopic patients about their options, troubleshoot their problems

July 16, 2012
Nancy Groves

The over-40 segment of your patients may represent a lost opportunity if you aren’t offering contact lenses (CLs) to every possible candidate, since presbyopic patients can be fit with CLs with a high rate of success. Encouraging CL wear and making patients aware of their options is in their best interest.

The over-40 segment of your patients may represent a lost opportunity if you aren’t offering contact lenses (CLs) to every possible candidate, since presbyopic patients can be fit with CLs with a high rate of success. Encouraging CL wear and making patients aware of their options is in their best interest.

“In my experience, taking such a patient-centered approach can improve profitability by contributing to long-term relationships,” said Mile Brujic, OD, partner of Premier Vision Group, Bowling Green, OH.

A study conducted by the London Business School showed that CL patients are 60% more profitable than spectacle-only wearers, Dr. Brujic said. Although the profit from CLs is poor initially, it eventually exceeds that of spectacles alone. Focusing on building long-term, recurring relationships with patients provides additional opportunities to offer high-quality spectacles and sunglasses beyond their CLs.

“I’m not saying you should fit every patient into [CLs] because it’s profitable,” Dr. Brujic emphasized. “By doing what’s in the best interest of our patients, we will ultimately be offering these services to every candidate, which will result in happy patients and the most profitable [CL] practices.”

However, profitability and patient loyalty cannot be secured without tackling a series of problems that could lead to CL dropouts. These challenges include dry eye, seasonal allergies, astigmatism, presbyopia, and inconvenience.

Dr. Brujic offered some tips and strategies that can help minimize drops and maximize new wearers.

• Assess the meibomian glands, checking the quality of secretions and looking for signs of inflammation. “If patients are not disease-free, put together the proper plan for making them disease-free,” Dr. Brujic said. For patients who have stagnant glands, he recommends expression with a Mastrota paddle and warm compresses in mild cases. Medication can be prescribed in more severe cases, coupled with a lipid-based artificial tear to help supplement the insufficiently produced lipid layer of the tear film.

• Evaluate tear film break-up time on every patient. When reduced, it can cause visual fluctuation, ocular corneal changes, and dry eye symptoms.

• Assess conjunctival and corneal staining, using fluorescein and lissamine green.

• Check the lids for lid wiper epitheliopathy, another sign of dry eye disease.

• Always assess the tarsal plate for a papillary response that may compromise comfort.

• Take a complete medical history, including any medications that may predispose the patient to ocular dryness, such as antidepressants, diuretics, and antihistamines. It is important to ask about allergies; patients commonly deny that they have an allergic condition and will self-treat, often by not wearing their lenses for several months of the year. “This is where we can arm patients with the tools they need to wear [CLs] successfully, either through daily disposables-a year’s supply or for a segmented portion of the year,” Dr. Brujic said.

• Provide a prescription for an antihistamine/mast-cell, stabilizing drop to use when allergic eye symptoms return to promote comfortable lens wear. Ask patients where the itching occurs. If it is along the eyelid margin, the problem may be blepharitis or meibomian gland dysfunction, while itching in the corner is more likely to be caused by ocular allergy, he said.

• Target the lens to patients’ goals. Do they want the lenses to help with playing specific sports or working on a computer? Do they intend to wear lenses part time or full time?

• Build relationships early. Have the staff member who instructs new CL wearers make a follow-up call the next day. A staff member, or perhaps even the optometrist, should make another follow-up call a few weeks later. These calls can build patient loyalty.

• Demonstrate success immediately. Show a patient how a multifocal CL can help him/her see the screen of a cell phone without reading glasses-before distance acuity is measured. This will demonstrate the benefits immediately and improve the initial wearing experience.

• Follow the fitting guides precisely.

• Consider incorporating modified monovision for emerging presbyopia. Place a single-vision lens in the dominant eye and a multifocal lens in the non-dominant eye. This is often an effective strategy for patients who are just beginning to experience presbyopia, patients new to multifocals, and part-time wearers.

• Tell patients that they may still need to wear glasses under some circumstances (e.g., reading very small print) even if they are otherwisesuccessful with multifocal CLs.

• Underpromise and overdeliver. Avoid the tendency to dwell on the negatives of multifocal contacts. Although patients won’t be able to see the same as they do out of their glasses, emphasize benefits as wider field of vision or not needing to tip their head back to have clear vision.

• Take compliance seriously. Educate patients about vision care systems, caring for lenses, and CL replacement.

• Market a year’s supply of lenses to patients, touting advantages, such as a mail-in rebate, the convenience, and your office’s pledge of support if their vision changes.OP

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