An eye care practitioner asks his patient how the prescription for his back-up glasses is working out. The patient says that, for the frequency and length of wear time, the glasses are fine. With some prodding, the patient says he only wears the glasses when going from the bedroom to the bathroom in the middle of the night, so they work fine as is. The doctor just nods his head.

With that typical doctor-patient dialogue, is it any wonder why so many -5.00D O.U. patients are walking around with 10-year-old -3.00D O.U. eyeglasses? Let’s examine why this happens and how you can better address it with your next patient.

The Root of the Problem
Just as many psychological problems are connected to one’s childhood, the source of many eye care complications stem from when the patient was first fit in contact lenses. Undoubtedly, contact lenses were presented to the patient as a substitute for eyeglasses. The patient chose to wear contact lenses instead of eyeglasses. However, the contact lenses should have been initially introduced as a vision correction modality in addition to eyeglasses.

When fitting a patient with contact lenses, a practitioner should say: “You should do great with contact lenses. So, in addition to getting your eyeglasses updated for when you won’t be wearing your contact lenses, we’ll fit you today with daily disposables.”

The patient may naturally question the need for glasses, assuming he will be wearing his lenses all the time. At this point, you can explain that contact lens wear will be the primary modality that will be worn most of the time. However, there may be times when this is not the case, and that is why it is important to remember that contacts are not merely a substitute for eyeglasses.

At this point, you can discuss specific scenarios when this may happen. For example, patients should wear eyeglasses instead of contact lenses when on a plane, if they get sick, when swimming or when working with heavy machinery or doing woodwork.

Fixing Past Mistakes
The aforementioned narrative works great with new contact lens patients, but how do you correct past mistakes and address your current lens wearers?

I suggest looking through your notes to pinpoint the original reason you are seeing the patient—which often is the patient’s quest for great vision. As their eye care practitioner, you have an obligation to prescribe what you define as the best treatment modalities. In this case, who could argue that a -3.00D O.U. prescription is clinically appropriate for a -5.00D O.U. patient? If you believe a -2.00D deficit warrants discussion, you are professionally obligated to address it.

Try this explanation: “I understand that you currently wear your glasses at night, after you take out your contact lenses. When you have your eyeglasses on, I’m sure you can tell that your vision is not the same. If you had to drive to work with those glasses, or do anything outside your house, you wouldn’t be able to do it. It’s for that reason, that I recommend you get new glasses with today’s updated prescription.”
Obvious? Of course! Yet, so few of us do it for fear of being perceived as selling eyeglasses to someone who doesn’t need them. Consider the ramifications if this same patient runs out of lenses or has a red eye and can’t wear lenses for a few days; that same patient will now be complaining that they didn’t have the updated prescription and now have to wait for the new glasses.

The point here is that you have a professional obligation and duty to alert your patients about current state of their vision correction. And if there are gaps in their correction, you have to talk about it and explain why. That’s not selling a product, it is doing the right thing to take care of your patients!

Let’s drop the words “back up” from our vocabulary, as they imply that eyeglasses are less important than contact lenses. Which, as you just read, they are not—or at least shouldn’t be!

Note: When presented as above, package pricing (e.g., get a discount on your glasses when you get a year supply of contact lenses) isn’t necessary. The reason more contact lens patients don’t have accurate glasses has nothing to do with price and everything to do with their eye care practitioners not talking about them.