Dispensing protocols

[drk]

We have traditionally/habitually had patients look out the window from the dispensing table and shoved a reading card in their face if multifocal lenses.

90% of the time, it's a "great, fine" response. But those 10 percenters...

"If I hold it off to the side, I can't see it."
"Let me compare to my old glasses..."
"It's still blurry..."
"I have to raise my head, like this."

I don't really see the point in doing a secondary set of visual acuity measurements (in effect) at dispense, anymore. That was already done in the exam room. We checked the lens power at check in.

Why not just tell the patient: "Here's your glasses. We've fitted them perfectly. You may have a slight adaptation period. Enjoy your new glasses!" and kick their butts out of the door?

[NAICITPO]

We have traditionally/habitually had patients look out the window from the dispensing table and shoved a reading card in their face if multifocal lenses.


90% of the time, it's a "great, fine" response. But those 10 percenters...


"If I hold it off to the side, I can't see it."
"Let me compare to my old glasses..."
"It's still blurry..."
"I have to raise my head, like this."


I don't really see the point in doing a secondary set of visual acuity measurements (in effect) at dispense, anymore. That was already done in the exam room. We checked the lens power at check in.


Why not just tell the patient: "Here's your glasses. We've fitted them perfectly. You may have a slight adaptation period. Enjoy your new glasses!" and kick their butts out of the door?

Because that would be poor bedside manner so to speak . I usually look at their records to see what their old Rx was, if they were given more plus (which is typically the biggest reason someone doesn't love their Rx right away in my experience) explain to them it will take some adjustment time. I will turn the screen around so they can see the difference in the two prescriptions to emphasize the point it will take some time. Having someone that can articulate why they aren't seeing as well right away goes a long way. I make them promise to put their old glasses away the next day and only wear the new ones. And if they pushback you say look, the Doc was able to get you to 20/20 with this Rx in your exam and I haven't seen the doctor make many mistakes. But we won't know until you give it the old college try.

[DanLiv]

I do try to dispense as you say drk. 99+% of the time the Rx and fit are excellent. Spending dispensing time on every customer to suss out a 10% complaint rate, and only a 1% problem rate is inefficient, plus distracts from what I consider the two most important parts of dispensing: ensuring proper fit and celebrating wonderful new eyewear. If there is really a problem, the customer will tell you. Too much querying of the final performance of the glasses suggests that the wearer is responsible for diagnostics, and instills doubt about the glasses being "right" until they have passed wearer scrutiny. The doctor and I have done the job to make sure everything is as it should be, the customer's only responsibility is to wear their eyewear as directed, and then report any persistent issues. Of course I answer any questions and will dive as deep into particulars as the customer wants, I try not to be dismissive. But asking if everything is ok, when the customer hasn't made any indication it isn't, is literally asking for problems.

[NAICITPO]

But asking if everything is ok, when the customer hasn't made any indication it isn't, is literally asking for problems.

It's always good to get the WOW moment, but if that's not their reaction then it's not a big deal. Asking if everything is ok is definitely asking for problems.

[CME4SPECS]

Why not be like the on liners, just mail them to the patient. You already have their money, why should you care it they work or not?

[drk]

I do try to dispense as you say drk. 99+% of the time the Rx and fit are excellent. Spending dispensing time on every customer to suss out a 10% complaint rate, and only a 1% problem rate is inefficient, plus distracts from what I consider the two most important parts of dispensing: ensuring proper fit and celebrating wonderful new eyewear. If there is really a problem, the customer will tell you. Too much querying of the final performance of the glasses suggests that the wearer is responsible for diagnostics, and instills doubt about the glasses being "right" until they have passed wearer scrutiny. The doctor and I have done the job to make sure everything is as it should be, the customer's only responsibility is to wear their eyewear as directed, and then report any persistent issues. Of course I answer any questions and will dive as deep into particulars as the customer wants, I try not to be dismissive. But asking if everything is ok, when the customer hasn't made any indication it isn't, is literally asking for problems.

God bless you. I feel mean for suggesting this, but you've been a balm.

[drk]

Why not be like the on liners, just mail them to the patient. You already have their money, why should you care it they work or not?

I know, right?!

Very funny.

[optical24/7]

I stole this totally from Robert M. The word..”Neural “……..When I had patients fight adaption,

1st, acknowledge they have an issue, and it’s real. Then say something like,

“ You see with your brain, not your eyes. Your going through neural adaption. It’s actually common. But you need to complete the neural adaption by wearing your new glasses, and not revert to your old ones.”

You just gave the patient a “medical term” of what they are going through, and the cure.

Works like a charm…

[Uncle Fester]

My biggest problem is the doc telling the patient they need the new prescription when the minimal change is not producing a notable difference from their year old $800 glasses.

I cringe when the right eye changed a mere .25 in the sphere and .25 in the cyl.

And the left rx is the same.

This said- 10% at least of the population are complainers by nature so we deal with it as suggested above.

[KrystleClear]

My biggest problem is the doc telling the patient they need the new prescription when the minimal change is not producing a notable difference from their year old $800 glasses.

I cringe when the right eye changed a mere .25 in the sphere and .25 in the cyl.

And the left rx is the same.

This said- 10% at least of the population are complainers by nature so we deal with it as suggested above.

This! My MD tells people they should get PALS when they're plano with +250 add. I'm happy to do that for those that want to wear glasses all the time but I want them to understand their distance will look the same as without glasses, or sometimes worse. Sometimes emmetropes are bothered by a lens being there at all. And the people with only a few degrees of axis change or a teeeeensy script change. I will happily make glasses for them but I try to address the RX change during the sale/fitting.

I have thought about ditching our reading acuity card for the reasons Dr. K listed. Most of my older patients have at least some visually limiting eye disease and they can't always read that very bottom teeny tiny line (the one that's like miniscule fine print on a prescription drug ad) and they get very worked up when they can't see it perfectly. Then I have to have the dry eye/wet ARMD/ripening cataracts/etc conversation with them. I just like to ensure I have adjusted them in a way that they can access their reading power easily, so I always have them read just for my peace of mind, but maybe I'm creating more issues than I need to...

[NAICITPO]

This! My MD tells people they should get PALS when they're plano with +250 add. I'm happy to do that for those that want to wear glasses all the time but I want them to understand their distance will look the same as without glasses, or sometimes worse. Sometimes emmetropes are bothered by a lens being there at all. And the people with only a few degrees of axis change or a teeeeensy script change. I will happily make glasses for them but I try to address the RX change during the sale/fitting.

I have thought about ditching our reading acuity card for the reasons Dr. K listed. Most of my older patients have at least some visually limiting eye disease and they can't always read that very bottom teeny tiny line (the one that's like miniscule fine print on a prescription drug ad) and they get very worked up when they can't see it perfectly. Then I have to have the dry eye/wet ARMD/ripening cataracts/etc conversation with them. I just like to ensure I have adjusted them in a way that they can access their reading power easily, so I always have them read just for my peace of mind, but maybe I'm creating more issues than I need to...

Our doc's generally won't tell people they need new glasses for an Rx change unless they can improve their VA by a line or two. But they are pretty good at uncovering needs for a 2nd pair of NVF or Rx Suns, I even had a doc look at the glasses and saw scratches and said you should get some new lenses (was a former optician).

I also hate when doc's say the Rx hasn't changed much and the person ends up getting glasses. In the customer's mind the doc is saying it will be easy to adjust to or there will be no adjustment period, which is not necessarily the case. I always try and tell them it still could take some time to get used to. Undersell over deliver...