Doctor-driven dispensing: Providing patients a complete range of vision correction options

Patients with refractive error today have an unprecedented array of correction options: eyeglasses, contact lenses, refractive surgery, corneal shaping, and even corrective intraocular lenses. Moreover, technological advances—from specialized lenses to new types of surgical procedures—now allow correction to be highly tailored to the needs of each patient. Although this is very good news for patients, it places increasing responsibility on optometrists. More than ever before, optometrists must be ready to counsel patients on the complete range of vision correction options available to them, accurately assess the visual needs of the patient to determine the best vision correction option, and then very specifically recommend the optimal correction.

A few years ago, I coined the term “doctor-driven dispensing” to describe a method of practice that involves providing expert vision correction recommendations to help ensure the best visual outcomes. That means recommending specific vision correction options, following careful consultation, while the patient is in the examination room.

In other words, optometrists should take the same approach in caring for patients with vision problems that they take when caring for patients with eye health problems. For example, when providing care for a patient with dry age-related macular degeneration or dry eye, an eye practitioner will always carefully diagnose the condition, prescribe the exact nutraceutical or pharmaceutical treatment required (specifying strength and dosage), and explain to the patient exactly how the treatment should be carried out. With vision patients, however, practitioners all too often simply diagnose the problem and the degree of correction necessary, and then release the patient to the dispensary staff to determine the type of spectacles the patient will receive.

Diagnosing and then simply referring the patient to the dispensary might have been acceptable a half-century ago when eyeglasses were the only means of vision correction available and the range of spectacle lens options was (by today's standards) relatively limited. It might have even been acceptable a few decades ago when contact lenses first began providing a vision correction alternative. However, the situation is different today. Few patients will be fully aware of all the vision correction alternatives available to them; fewer still will understand which will be most appropriate for their lifestyles. Moreover, rapidly advancing research and development is providing patients with an ever-expanding range of choices in each category of correction. Spectacles today can be highly tailored to the needs of patients, thanks to a wide range of lens designs and materials, as can contact lenses. Patients now can select from among a half-dozen types of refractive surgeries. They even have choices to make when considering such emerging forms of correction as corneal shaping and intraocular lens corrections. The optometrist has the professional training to understand the complete range of correction options available today and should explain them to the patients. Clearly, patients today will benefit when their eye doctor takes the time to consult with them in the examination room and recommend the exact vision correction that will best suit their needs.

Often, practitioners believe they simply do not have time during an examination to fully discuss the range of vision correction options available to patients, let alone determine the specifics of the best possible lenses or corrective treatment. However, the fact is a truly doctor-driven approach to vision correction can be implemented in virtually any practice, enhancing the quality of patient care without sacrificing practice efficiency.

Typically, the system works like this: first, the staff should take a very complete patient history to determine not only the patient's health status but any lifestyle factors that could place demands on vision. During the examination, the practitioner can supplement the information obtained in the patient history by asking the patient about work or recreational activities. After completing an examination, the practitioner can take a few minutes to ask whether the patient has considered various vision correction options that may be appropriate (eyeglasses, contact lenses, laser correction) or whether a combination of corrective measures might be advantageous. Based on the patient's level of interest, the practitioners can then make a recommendation to the patient.

The practitioner can then summon the appropriate staff person to the examination room. While waiting for the staff person, the practitioner can discuss the examination findings and go over the specifics of the vision correction recommendations, explaining how they will benefit the patient at work or at home. After the staff person enters the examination room and is introduced to the patient (noting the staff person's title, e.g., eyeglass dispensary staff, contact lens specialist, or laser correction specialist). The practitioner can then discuss the visual correction recommendation in detail with the staff person.

The patient is then “handed off” to the staff person who accompanies the patient to the appropriate area of the practice (eyewear dispensary, contact lens fitting area, etc.). The staff person should again go over the practitioner's detailed recommendations with the patient, explaining further how the recommendations will meet the patient's needs and improve the quality of vision.

Keys to success 

When implementing a doctor-driven dispensing program, optometrists should keep in mind several key concepts.

Lifestyle dispensing 

Almost inherently, good doctor-driven dispensing is “lifestyle dispensing.” To recommend the best vision correction for a patient, a practitioner must have a firm understanding of the demands placed on the patient's vision. While examining the patient, it is important to ask questions about work (including computer use), recreational activities (such as sports or camping), and interests (such as hobbies or video games). Practitioners will find an extended patient history or a lifestyle questionnaire important in gaining an in-depth understanding of the patients' visual requirements.

Be specific 

Most practitioners are highly specific when prescribing contact lenses. Similarly, in the case of eyeglasses, the optometrist should identify the specific brand of lens as well as the coatings and tints to be used. The benefits of options such as antireflective coatings, polarized lenses, or computer eyewear should be explained to the patient. Likewise, when corrective treatment is suggested, the specific types of correction (e.g., LASIK, LASEK) should be explained.

Say it 3 times 

Communications professionals believe that people must hear a message at least 3 times to remember it. Patients should hear a vision correction recommendation 3 times: once as the doctor makes the recommendation at end of the examination, again as the doctor reviews the recommendations with the appropriate staff person in the examination room, and finally as the staff person reviews the vision option in the dispensary or contact lens fitting area.

Hard copy 

Practitioners should consider providing patients with copies of their prescriptions, with specific recommendations, in the examination room or at the front desk. This is of course required of contact lens prescriptions under federal law. However, it is also a good rule with respect to all types of vision correction. The written document helps to reinforce the practitioner's recommendations. It also serves as an effective reminder of those recommendations should the patient put off purchasing additional eyewear (which many do).

Stay current 

As previously noted, vision correction technology is rapidly advancing, and optometrists must stay current with the latest developments. This edition of Practice Strategies provides an overview of recent developments in spectacle and contact lens correction options for practitioners who wish to implement a comprehensive doctor-driven dispensing program. Additional articles on corneal shaping and intraocular lens (IOL) correction will appear in the September issue. However, practitioners should continue to stay up to date on the latest in vision correction developments by visiting the manufacturer booths at meetings and utilizing education programs offered by manufacturers.

Benefiting patients and practice 

The few additional minutes required during an examination to provide doctor-driven dispensing can reap considerable benefits. Patients will be advised of the exact correction options that best suit their needs. And because the advice comes directly from an optometrist (whom the patient respects as a doctor), the patient will be more inclined to act on those recommendations. With patients today increasingly influenced by media reports, advertising, and advice from friends, doctor-driven dispensing can be highly effective in helping patients separate hype and hearsay from facts. A truly doctor-directed vision correction program can result in better-corrected and therefore more satisfied patients. The result will likely be not only happier patients but a more prosperous practice.