In some practices, it can be relatively easy for the optometrist's enthusiasm for specialty or premium contact lenses to encourage the entire staff to fit the best possible contact lenses for each patient. In many private practice settings, the optometrist can teach the techs to upgrade patients or work with contact lens manufacturers' incentive programs. These don't have to be costly measures, and most who use them say they're effective motivation strategies.

But what happens when the O.D. handles only the prescription, and the patient goes next door to the dispensary-or elsewhere-to have the Rx filled? Does this mean the doctor loses all opportunity for upgrading the patient into premium contact lenses?

Wesley Jessen recently conducted 50 interviews with O.D.s from a large national optometric company and corresponding managers of optical stores. In each of these high volume contact lens locations, the O.D.'s role went only as far as prescribing the contact lenses. Lenses were dispensed on the retail side. The interviews were designed to reveal to what O.D.s and optical store managers attribute success in contact lens practices.

There was often similarity in the two views, especially in those locations where O.D. and store staff saw themselves as team players. But some myths die hard-and may be prevalent among staff in any type of practice setting. How and where these separate practices make the biggest strides provide valuable information to any type of practice setting. Just as importantly, some firmly held "truths" are, in fact, nothing of the kind.

What About Profit Margin?

"There's no profit margin in contact lenses." Do those words sound familiar?

Unfortunately, that comment is regularly heard-sometimes from O.D.s themselves, but most often from the staff. While lifestyle dispensing is a common practice that encourages upgrades in the purchase of eyeglass frames and lenses, it's rarely used in contact lenses. Several optical side managers said they didn't want the contact lens component of the practice to grow any more because of its limited profitability. However, few of these people put effort -or are even aware-of the increased profit margin of specialty lenses, including cosmetic lenses.

Upon further questioning, it was found that cosmetic lenses are the one specialty lens these practices routinely offer, but optical staff does not necessarily see them as upgrades. When asked whether they promoted cosmetic lenses, in part because of the higher profit margin, several responded that profit margin was irrelevant. The inconsistency is apparent.

TIP #1: Make sure staff understands that contact lenses are not loss leaders for eyeglass sales. That includes making sure staff understands what specialty or upgrade lenses are-soft torics, color torics, disposable bifocals, premium conventional or planned replacement products, those with UV inhibitors, and yes, cosmetic lenses. In the latter, these almost always represent incremental sales. Some patients wear only cosmetic lenses, but most pick up additional colors as fashion accessories.

Color lenses, like FreshLook ColorBlends from Wesley Jessen, provide an attractive feature for contact lens patients.

A common excuse by optical staff for not dispensing premium, or upgraded, contact lenses, was that, "By the time we see them, it's too late." This excuse was most often heard in locations where there was some conflict between the O.D. and the staff. More optical staff said they'd happily send a patient back to the practitioner to change the Rx to a compatible lens that could be purchased in colors.

In fact, some even took it a step further. For example, a high myope comes in to have the eyeglass Rx filled. He finds the perfect frames and is terribly disappointed when he hears how thick the glasses will look at the edges. It's a perfect opportunity to recommend contact lenses: "Let's see if we can get you back into the doctor's office for a contact lens fit, and in the meantime, we can look for frames that suit that Rx better."

It's a great strategy through which everyone wins. The doctor gains a new contact lens patient, the optical side still gets its eyeglass sale, and the patient avoids anger over a disappointing pair of eyeglasses-a pair he purchased because a staff member hadn't intervened. Sure, the approach takes a little more of everyone's time. But if staff had silently let that patient buy those eyeglasses, chances are the patient would have been lost to them for good.

TIP#2: Avoid disappointment in the contact lens area. Simple steps can gauge a patient's interest in contact lenses, such as having the receptionist ask when the patient is making an appointment whether it will be for eyeglasses, contact lenses or both; a written question regarding contact lens preferences on the history form; availability of contact lens brochures or displays in the reception area; and a word of encouragement from a tech doing pretesting, such as, "I think you'd be an excellent contact lens candidate. You should ask the doctor about some new lenses just for your prescription." If these attempts at preempting patient regret don't work, make sure a system is in place that allows patients who at first said no to contact lenses to come back if they've changed their mind, while interest in contact lenses is still high.

Specialty lenses - while not for everyone - provide contact lens customers with a way to express themselves. Pictured here are W-J's WildEyes.

Greg Jellenek, O.D., of Newport News, Va., lets patients know the additional charge for a contact lens fitting fee. To lessen the sticker shock, he'll let them come in anytime in the next six months and get the contact lens exam for the difference. After six months, he'll redo the entire exam.

This plants the seed and often gets patients back a few weeks later.

Work as a Team

If a dispensary staff feels that the doctor only cares about contact lenses, it's no wonder there are conflicts. This was not heard often, but enough to warrant mention. Much more often, optical staff and O.D.s gave examples of how they worked well together to promote eyeglasses and contact lenses. Those doctors who regularly displayed to the optical staff that he or she encouraged patients to wear eyeglasses were most appreciated because that helps the optical staff make multiple sales. As one optical store manager put it, "If the doctor tells the patient it's not conducive to wear the old Rx in eyeglasses and a new Rx in contact lenses, it sounds like professional advice. Coming from us, it sounds like a sales pitch."

TIP #3: Make it easy for optical staff to make multiple sales. Write out two Rx's, one for eyeglasses and one for contact lenses. Many practitioners write just one, and when the patient hands it in for the contact lens prescription, they no longer have a copy of their own to remind them about the eyeglasses. On the contact lens Rx, check off a box that says, "OK for cosmetic lenses."

Other doctors take the patient to the dispensary and introduce the patient to the optician or dispenser, saying, "Mr. X needs to upgrade his glasses and is also interested in contact lenses." Some practitioners even make specific eyeglass lens upgrade suggestions. It only takes an O.D. a few seconds, and it paves the way for the dispensing staff.

Astigmatism No Problem

The moment a patient utters the words, "I can't wear contacts; I have astigmatism," anyone in the office overhearing them should know how to respond because there are so many new lenses available, and they're so much easier to fit. In fact, because disposable spheres are even thinner than they were in the past, they are less able to mask astigmatism. The result is that some low astigmats who had adequate vision with disposable spheres may now comment they don't see as well. This is the perfect upgrade opportunity for a disposable toric lens, say practitioners.

Tom Mack, O.D., of Overland Park, Kan., screens patients with the simplest of questions: "Do you see better with your eyeglasses?" Those who say yes are excellent candidates for a disposable toric lens. David R. Stacy, O.D., Tempe, Ariz., encourages low astigmats to at least give disposable torics a try. "I'll offer a free trial pair and say, 'Try these for a few days. If you like them, come back and we'll move you into this lens. If you don't like it, we'll order your current lenses for you.' Sometimes I charge my typical disposable fee (instead of the higher toric lens fee) just to get the patients into the new lens," he says.

TIP #4: Identify all low astigmats. There's no reason to upgrade a low astigmat to a disposable toric lens if he is content with his acuity. But it's always worth asking since many have settled for less crisp vision because they thought it was all they could get.

Astigmats represent multiple upgrade opportunities because they are often interested in part-time toric lens wear, placing them firmly in both the eyeglass and contact lens patient categories.

Communication is Key

In any practice, whether dispensary and professional services are combined or not, communication between the players is key. The majority of optical store managers reported an excellent working relationship with the O.D. Some said they meet daily, others coordinate promotions together. And they take advantage of the impromptu informal meetings that occur, such as those at the microwave.

Introduce your active patients to performance contact lenses, such as the Prosoft by Wessley Jessen.

Even in practices where the O.D. owns the dispensary, that's important. These are the opportunities for O.D.s to tell staff about new lenses they'll begin fitting, and it's a chance for staff to tell O.D.s what patients are saying once they arrive in the dispensary. It's also a chance to make sure that everyone knows all the details about current promotions so patients receive a uniform message and information.

While optical staff see the optometrist as the driving force behind the contact lens success, O.D.s are not the sole factor.

Marshall Field, O.D., of North Brunswick, N.J., says the optical store staff members are "unusually good at insertion and removal classes. They're sympathetic, skilled, and they like teaching the patients. The contact lens patient is typically a more loyal patient. First-time patients are unlikely to go anywhere else because of the personal care we show them here." That idea was echoed by several others who mentioned patient education as a key to success.

Tip #5: Mutual respect is one of the most important ways to enthuse optical or dispensary staff about dispensing contact lenses-and it also provides for a more open communication should contact lens issues arise. 
It's good for the O.D., good for the dispensary, and most importantly, good for the patient. EB