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Avoiding 'Tunnel Vision'

Break the habit of narrowly defining patients by their chief complaint and you'll improve your opportunities to promote contact lens wear.
By Mile Brujic, OD, and Jason Miller, OD, MBA

10/1/2015


It’s a busy day in your office. You’re about to see your first patient. Before entering the exam room, however, your assistant alerts you that a last-minute patient has been added to your schedule that morning: a 38-year-old female who requests a regular eye exam, noting a slight change in vision. She currently wears eyeglasses. An ocular health assessment reveals that everything otherwise is healthy. The patient is given a new prescription for glasses and sent on her way. 

Is That the Full Story?
While electronic medical records (EMRs) have made practice more efficient, they have also narrowed our approach to patient care. Most EMRs include either a type of “short form”—a code used to identify a specific exam, such as a contact lens fitting—or a color used to denote certain kinds of exams or procedures. So, the EMR for a patient in for a glaucoma work-up would likely be colored or coded differently than a patient coming in for a contact lens fitting or an eye exam.

Logic tells us this gives structure to the practice’s schedule, thus making expectations for the day run much smoother. It also provides us with information on the patient ahead of time, allowing us to filter our thought process and focus on the task at hand once we enter the exam room. This system is particularly useful for patients seen for a medical follow-up visit. For example, the practitioner knows ahead of time that the patient coming in for a glaucoma work-up will need certain procedures and diagnostic testing appropriate for the condition. But does this logic hold true for those coming in for their regular examinations, or does it hinder our opportunity to help these patients to the best of our ability?

Consider this scenario: A contact lens wearer comes in for their yearly examination. Their chief complaint is that they “need to update their contact lens prescription and order more lenses.” We assess the lenses, perform an over-refraction and find no prescription change. We remove the lenses, perform a subjective refraction and eye health assessment. Everything appears normal, and the patient reports the lenses are comfortable. We then order the patient a year’s supply of lenses; this is usually the end of the encounter.  

But, have we done anything to make sure that they have the right prescription for their glasses when they are not wearing contact lenses? If they do have glasses, are they functional and something they would feel comfortable wearing out in public, or are they a 10-year-old pair that’s hanging by a thread?  Additionally, have we made sure that the current contact lenses are the best and most comfortable kind for the patient, or does the lack of complaints simply mean that they are “good enough”?

Unfortunately, many practitioners do not take the time to explore these questions. Why? Is it the product of a healthcare environment that has forced the concept of efficiency at the expense of understanding all of our patient’s ocular needs? Or is it the way that these patients are scheduled in the EMR systems we use that seems to narrow our focus? Can we alter the playing field to open our perspective to the full scope of goods and services that we offer that our patient might benefit from?  

An Alternative Approach
Really, the first step is to mentally remove the patient from the bucket that we may have automatically placed them in based on how they were scheduled. This allows us to think about every patient as a potential contact lens wearer, if appropriate, and also make sure that we discuss glasses with them.

How does this concept relate to the patient discussed at the outset? Odds are that she likely was not asked about her interest in contact lenses. In fact, this patient actually used to wear lenses, but discontinued because of comfort issues and her perception that the lenses were inconvenient to care for. 

The contact lenses she used to wear were monthly replacement lenses that she wore for “a few months” before replacing them.  She used “whatever solution was on sale,” but didn’t really use much because she didn’t replace the solution in her contact lens case as frequently as she was supposed to. She recalls sleeping in her contact lenses a few times a week, even though they weren’t approved for extended wear. 

Thus, her perception of lens wear was one of discomfort, likely secondary to her noncompliant habits. She’s also unaware of the benefits of newer contact lens technologies and how they might help her wear lenses more comfortably. She views contact lenses as being pretty much all the same, so she never asked about them at her appointment—and we never brought it up because of how the patient was scheduled (as a glasses wearer), our busy schedule and her apparent lack of interest. The result: missed opportunities for us both.

In this case, all that would have been required is for the practitioner to ask the patient if she may be interested in being fit with a new contact lens, and briefly tell her about some of the newer technologies available that may enhance her wearing experience.

Create the Opportunity
How do we avoid being so focused on the type of scheduled appointment that we miss the opportunity to provide our patients with other solutions that may benefit them? First, recognize that it may be happening, and make a point to discuss contact lenses with all patients who are candidates. Though some of these individuals may not be interested in contact lenses, there are certainly a number who will be. Additionally, they may be unaware of new options available today that may not have been available several years ago. It is important to keep in mind that patients are often uninformed regarding the newest lens options. 

Of course, one of the major objections to incorporating a discussion of contact lenses with every patient is the additional chair time. In reality, it will only increase the length of the appointment by a small amount—and it’s time spent that is in the patient’s best interest. Educating them about visual options should be at the forefront of a practitioner’s mind in every case. Not all will take advantage of it, but all will appreciate it.

For us personally, we both admit to being so focused on the task at hand and the reason for the visit that we did not always offer contacts as an option to appropriate candidates. When we started to, however, we realized the unmet need that we weren’t tapping into. Only when we changed our habits did we truly cater to the needs of our patients and ultimately grow our contact lens practices.  Will you embrace the same opportunity in your practice?



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