Ophthalmic Lenses

Reduce Remakes by Listening to Patients–and Training Staff to Troubleshoot Problems

By Anne-Marie Lahr, OD

Remakes can sink you. But you can reduce your remake rate by learning to better listen to yourpatients –and by training staff to troubleshoot problems from unsatisfied patients when they try their new eyeglasses on.

Listen to Your Patient for Clues
The art of refraction begins by the doctor listening to his or her patient closely. If you listen attentively, you will pick up clues as to how much of a drastic change–or whether any change at all–your patient will tolerate. For example, a patient is offering you a clue when she repeatedly asks you to show “lens number one again and then lens numbertwo one more time, and lens one just one more time to be sure.” This is a person with exacting requirements. It is likely that she won’t tolerate a big jump in her prescription.

Also, be wary of making big prescription changes for patients with long case histories of lens dissatisfaction. Ask these long-unhappy eyeglasses wearers to describe past lens issues. Then ask them to describetheir ideal eyeglasses. Perhaps the problem in the past has been the inability of multifocal lenses to givethem adequate distance vision. Or maybe none of the eyeglasses they had made in the past allowed for close-up computer work without causing eye strain.

Teach Staff to Troubleshoot a Dissatisfaction Situation
If, despite your greatest care during refraction, the patient returns unhappy, your optical staff should be prepared to assess on their ownwhether the problem is fixable. Give them a checklist to refer to in double-checking the eyeglasses.

• Does the frame need to be adjusted so the patient is looking through the right part of the lenses?

• Is the vertex distance, or the distance between the back surface of the lens and the cornea, correct?

• What about the pantoscopic tilt? Are the glasses lying perfectly flat?

• How does the pupillary distance look? Is that correct?

• Measure where the eye sits on the frame to ensure there is no induced prism. Check the location of the eye and compare that location to the optical center to ensure the patient is not looking through any unwanted prism.

The Doctor, the Last Stop Before Remakes
If, after staff has thoroughly double-checked the eyeglasses, no solution has been found, it is up to the doctor to come up with a last resort to avoida remake. First, apologize.

Doctor: “I’m so sorry, Mrs. Robinson, that your new glasses aren’t working out. Let’s see why.”

Patient: “I feel like the floor is further away with these glasses on, and that I’m taller.”

Doctor: “I’m sorry, that must be very uncomfortable. Sometimes new eyeglasses have that effect for at least the first few days.”

Patient: “Well, I don’t like it.”

Doctor: “Aside from that discomfort, how are the glasses?Are you seeing more clearly?”

Patient: “Yeah, other than that, I’m happy with them. I can read signs from the road that I couldn’t read before, and can see the screen more clearly when I go to the movies.”

Doctor: “OK, then I’ll tell you what: How about we give it a week? If you are still having that odd feeling of the floor being further away from you a week from today, just come back and we’ll remake your lenses at no charge to you.”

Remakes: A Manageable Cost

Remakes add up to a manageable cost for at least one OD–my friend, Mark Newman, OD, of OPTIX Eyecare Center in Durham, N.C.

Remakes
Per Year

24

Lab Policy
One free remake per patient.

Total Cost
Per Year

$2,000

Dr. Newman:
“The only instance where I may take a hit is when I have one of those patients that just nothing works, no matter what I do.

“With today’s edgers, it is rare for me to have a remake due to a fabrication error in my office–I would guess maybe one per month.

“As for going beyond one ‘free’ remake on a patient related issue,I may guess one per month as well.

“Sure, I would rather have the $2,000 on my bottom line, but it is just a fact of doing business that I do not think can be eliminated, so I try not to give it too much thought.”

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Anne Marie Lahr, OD, is a clinical instructor in primary care at The Eye Institute at the Pennsylvania College of Optometry in Philadelphia, Penn. Her responsibilities include the supervision, instruction and evaluation of interns in patient care in a multi-disciplinary clinic. To contact her:ammader@pco.edu

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