You all know the feeling, that sinking, rock in the pit of your stomach feeling.
Cruising through your day, everything's going great, and then a member of your optical team pops their head around the corner and says,
“Hey Doc, Mr. Jones is having issues with his new glasses...”
If you are like me, this one comment will single handedly derail your day. It is that sharp reminder that you could have done better, the humbling experience that each of us needs, but none of us really wants.
Most patients will understand, but the occasional few will not, and their unhappiness will bleed over and become your unhappiness. It will also result in working that patient into the schedule while they are there, putting the office behind with other patients and throwing a kink in an otherwise smooth day.
As optometrists, we are pushing the boundaries of medical care for our patients.
Most, if not all of us, are treating some form of pathology on a daily basis, some significant, some not.
It is not this, however, that keeps me up at night or makes me question my skills as a physician.
Instead, it is my refractions.
Luckily, there is one easy change you can make in your exam flow that will greatly decrease the amount of patients you have coming back for glasses remakes.
It is a quick, easy change that will add no more than thirty seconds to your exam time, possibly even less if your technicians are trained on the procedure.
This will allow you to eliminate one huge variable in inconsistent refractions: the tear film.
By ensuring that patient does not have a significant reduced tear break up time (TBUT), or corneal defects, such as superficial punctate keratitis (SPK), you can rule out one variable that was the cause of a large percentage of our in-office glasses remakes.
What do we do in our office when we see a reduced TBUT or SPK?
Generally, I will let the patient know the findings, and make a strong recommendation that we defer their refraction. With enough education most patients are quite agreeable, but on the occasion they are not, I will often remind them of the investment they make when updating their prescription lenses.
When brought up this way, most patients understand and are willing to hold off on new glasses or contact lenses until their presenting signs improve.
How we treat the in-office findings is based on the patient’s presentation?
At minimum, most patients are started on an artificial tear at two to four times per day. More significant cases may result in the use of prescription medications, such as Lotemax and Restasis. Hot compresses and lid scrubs are utilized in cases where the patient may be exhibiting signs of blepharitis or meibomian gland dysfunction. Other techniques and treatments may be utilized in difficult cases, as well.
With all of our patients, we take the time to discuss lifestyle changes they can also make, such as omega-3 supplements and reduced reliance on directional fans, especially at night.
Utilizing this one step will not cure all your ills when it comes to glasses remakes, but let’s be honest, no single change will.
However, this has made a huge dent in the percentage of patients we see returning for remakes, which in turn has increased our patient satisfaction. That, of course, has increased our staff and doctors’ happiness, too. A win-win if I ever saw one.
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