Increase fitting success with better communication

Patients often arrive at an optometry practice with preconceived notions about contact lenses. Often enough, they don't readily see themselves wearing them.

Maybe somewhere along the line these patients were told they weren't candidates for contact lenses. Or they confide that they tried them once, years ago, when contact lens technology wasn't as evolved as it is today, and, frustrated, they gave up on wearing them. Further, an Aug. 15 study published by the Centers for Disease Control and Prevention indicates that messages about eye health and vision care don't always get through to patients.

But with so much innovation in the contact lens industry and so many better options today for patients, doctors of optometry say, new and renewed conversations during fittings are in order. According to the 2019 AOA Optical Survey, about 78% of responding doctors of optometry say they fit contact lenses in their practices. Of the doctors of optometry who did not fit contacts in 2018, 20% reported that their practices had dedicated staff to perform contact lens fittings.

"Communication is key when it comes to fitting new patients with contact lenses," says Pamela Lowe, O.D., chair of the AOA Contact Lens & Cornea Section (CLCS), noting market research indicating patients are unaware of their options for contact lens. "There are so many benefits to contact lens wear."

Beyond the tangible benefits of corrected vision, eye health and convenience, contact lens wearers also can experience greater social empowerment and self-esteem.

AOA CLCS members offer up five tips for better communication during fittings:

1. Educate patients about their options.

"Education is No. 1," Dr. Lowe says. "Their views may have been tainted by a bad experience—they may have tried and couldn't get them in and they're not revisiting what the options are because they had a bad experience, say, 15 years ago. But effective communication increases your fitting success—just by educating patients about their options. It's a doctor's job to get excited about communicating the life-changing benefits of contact lens­ for new wearers. For experienced wearers, we can communicate how their comfort level can be increased." Also, educating patients about the newest products and solutions gives them a reason to return to your office. The fitting relation of a lens on the cornea will and can change and needs to be examined annually.

2. Fulfill patients' wants or needs.

Patients may think they have to compromise on contact lens comfort. Not so, thanks to new technology, Dr. Lowe says. Innovations have led to greater comfort, convenience and a range of options to accommodate patients' lifestyles. For instance, new innovative materials provide better, more wettable surfaces that often hold water more effectively than older designs. The increased hydration helps many patients who may have struggled with comfort in the past. Dr. Lowe says she typically asks her patients, "Are your contacts fine?" They will say yes, but when she asks them, "How long are they in your eyes before you feel them?" the responses may be different. "They may say, 'Oh my gosh, by the time I get home from work, I want to rip them out of my eyes.' It's the doctor's job to 'uncover' patients' needs through careful history and listening to their experience."

3. Give patients the 'why' on the particular lens you are prescribing.

"Many patients see contact lenses as a commodity and, when they don't know the features of the lenses, their only way to judge is by their purchase price," Dr. Lowe says. "But a lens is not a lens is not a lens. There are different features; there are different treatments to the lenses; there are different polymers and plastics. The doctor's job is to look at all the clinical findings, fulfill the patients' wants or needs and then choose the lens they are going to trial fit and ultimately prescribe."

4. Make them fully aware of what to expect.

"Full disclosure, of what the patient should see and feel, is essential for success," Dr. Lowe says. "That means communicating all the features of the lens, what it will be like to wear and how it can enhance everyday life. Keep it positive—point out what the patient will see, not what they won't." The Optical Survey asked doctors about the reasons their patients reported for discontinuing contact lens wear. According to 51%, discomfort was the No. 1 reason.

5. Review performance of fit.

" Give patients the opportunity to share their 'real-world' experiences with their new contacts," says Dr. Lowe, referring to the follow-up visit after the trial. "Doctors of optometry should communicate to patients any need for changes to lens prescriptions to enhance vision and comfort."

'Teach-back' method 

To help close the patient-provider communication gap, the  AOA developed a resource for doctors of optometry and their contact lens care teams that emphasizes the 'teach-back' method. How does it work? Doctors asks patients and families to reiterate, in their own words, what the health care provider shared. In this way, doctors can make sure patients understand the core takeaways and can allow for immediate intervention should a misunderstanding occur. The AOA recommends providers use teach-back to confirm patients understand  key contact lens wear and care reminders. The Agency for Healthcare Research and Quality offers  additional information on how to use teach-back effectively, including a provider toolkit and interactive learning module.