Remakes: Troubleshoot to Save Time & Money in Your Optical

Like it or not, patient satisfaction is becoming more and more important to the profitability and longevity of your eye care practice. It affects your retention rate, number of referrals, and even your clinical outcomes. When a patient isn’t satisfied with their eyewear, it can lead to a downward spiral of rechecks, remakes, lost time, and lost revenue. But that doesn’t always have to be the case.

“In an ideal world, a patient will put on their new eyewear and see well,” says optical expert Val Manso, who spoke about optical troubleshooting at 2016’s Vision Expo West. But that’s not the reality. There is nothing more disappointing that spending quality time with a patient choosing their perfect frames and lenses, only to see them return days later uttering the dreaded words “I can’t see.”

“How we handle patient complaints, troubleshoot the offending eyewear, and subsequently resolve the problems are important skills.”—Val Manso

Start Off on the Right Foot with Remake Requests

Preparation is the first step of upping your chances for a successful outcome. This is true whether a patient is buying glasses or buying LASIK, choosing contacts or cataract removal. Establishing expectations from the start goes a long way in determining a patient’s ultimate satisfaction level with their newly purchased eyewear. Manso recommends following these tips during the eyewear purchasing process to head off any potential issues:

• Listen to your patient. This seems basic, but don’t take it for granted. When you’re asking the same questions day after day to patient after patient, it’s easy to inadvertently tune out important information. In addition to assessing a patient’s overall lifestyle needs, find out if their needs have changed since their last pair of eyewear was made. With a new patient, it’s also a good idea to ask if they’ve had disappointments or difficulty with previous eyewear.
• Review the patient’s existing eyewear for measurements like pantascopic tilt, face form, vertex distance, and multifocal placement. Then, have a conversation about the differences between their existing eyewear and their newly ordered eyewear. For example, explain to a patient that if their add power has increased, it will narrow their field of intermediate vision. Be sure to demonstrate the differences whenever possible, and use simple, easy-to-understand layman’s terms.
• When the patient picks up their new eyewear, take the time to review and reiterate the differences between the old and new eyewear. Talk about the learning period (don’t call it an “adjustment” period), and emphasize that “different” is not “bad.” Be sure to show your patient how to use the new eyewear, especially if the patient is a first time progressive or multifocal wearer. For example, they may get better visual results by turning their head to look at something rather than just shifting their eyes.

Optical Complaints? Dig Deeper to Avoid Remakes

Even when you’ve done your best to let a patient know what to expect from their new eyewear, you’ll inevitably field complaints including blurry vision, waves, shadows, and more. Some patients let you know immediately when they’re disappointed in their eyewear, while others will struggle with it for a few days. Either way, you’ll need to take both “physical and psychological steps to uncover the source of the problems and ultimately resolve the situation to the patient’s satisfaction,” says Manso.

The first step is to clarify the specific problem the patient reports—“blurry” is just not good enough and you’ll need to dig deeper. Is their vision truly blurry, or do they mean there is some sort of distortion? Does the ground seem “wavy like an ocean” or like they are “stepping into a hole?” Once you correctly identify the problem, you can isolate the cause, Manso says. During her Vision Expo session, Manso elaborated on several common patient eyewear complaints, and how to solve them:

Example #1: The patient says “I have to move to see clearly.”

You ask: “Are you moving your head or moving the glasses?” “How exactly are you moving?”

• If the patient is moving the glasses side to side, the lens may have been made off axis.
• If the patient is lifting their glasses, the optical center may be too low. Try narrowing the bridge or adjusting the nose pads.
• If the patient tilts their head back to read, first verify the add power and fitting heights. Try adjusting the frame to raise the lenses, or lastly, using a lens with a shorter corridor.

Example #2: The patient says “I can’t see the ground.”

You ask: “Does it seem farther away than usual?” “Is the ground ‘swimming’?”

• Check the patient’s prescription—they’re probably a minus. When minus power has increased, objects can seem smaller and farther away that they’re used to. Try increasing the degree of wrap, and explain to the patient that this is normal and part of the learning period.
• If the patient experiences distortion in their peripheral vision, try increasing the pantascopic tilt, increasing the degree of wrap, or decreasing the vertex distance. Any of these adjustments will move the area of distortion out of the patient’s view.

Remake, or Remorse?

You can’t solve every case of patient dissatisfaction with a few new measurements.To illustrate the importance of emotional intelligence (EQ), Laurie Pierce, ABOM, NCLE, who also presented courses at Vision Expo, used this example during her session on solving difficult eyewear problems:

Donna is a new patient in your practice. She is nervous about purchasing new eyewear, and relies heavily on your suggestions. After explaining the latest lens technologies and fashions of today’s eyewear options, Donna decides to purchase a designer frame with high index, aspheric, AR coated lenses. A few days later, Donna comes in complaining of blurry vision. You check all parameters and verified that the optical centers are accurate as well. Upon checking her VA, she states that she cannot see anything but the 20/400 E! You send her back to the optometrist, who finds no change in prescription.

You likely have case of buyer’s remorse on your hands, according to Pierce. A patient who returns because they regret their purchase is perhaps the trickiest to handle—doing so diplomatically takes a high degree of EQ. You don’t want to offend them, and you want to keep them as a patient. They may be embarrassed, and generally you don’t want the patient to know that you know what’s really going on. You want to satisfy the patient, but you can’t just give them their money back. Pierce suggests aiming for a win-win approach by saying something like this:

“I’ve checked everything and all I can think of is that if we can find a different frame—now, this frame must be smaller and have more rounded corners than what you have now—that just might work.”

Then, help the patient choose a new frame (one that is less expensive) and put their lenses in. “When our patient chooses the perfect frame and lenses, without understanding [the] benefits, we stand a chance our patient may return unhappy,” notes Tami Hagemeyer, ABOC, who advised opticians about avoiding remakes at SECO 2017.

To avoid buyer’s remorse, she suggests taking these steps:

• Promote an understanding that the patient’s new eyewear is going to improve and enhance their life.
• Provide the “wow” factor. Engage the patient with positive feedback about their chosen frames.
• Remain accessible after the sale. Provide each patient with your specific business card and encourage them to contact you directly with questions or concerns.
• When you discuss expenditures, be exact and to the point. Consider providing each patient with a price sheet and be specific when defining each charge.

 Know When to Check With the Provider

Hagemeyer recommends using checklists when you place an order for eyewear order. A checklist will help your staff stick to a consistent process when dissatisfied patients return. It also reminds staff that the focus is on patient satisfaction. For example, use a checklist to determine when to verify new prescriptions with the prescribing physician prior to ordering lenses. Check with the prescribing physician if:

• The prescription change is 0.75 diopters or more.
• The prism changes direction.
• The add power decreases.
• The power changes direction.
• The axis change is more than 15 degrees.