Eye care professionals are discovering many new challenges in communicating with a growing number of presbyopic patients. These patients know little about presbyopia, and for many it is a sensitive and emotional topic. Now, more than ever, professionals must communicate prognoses and recommendations while remaining sensitive to patient needs.

To learn more, review the following discussion between:

Dr. Gary Gerber, president and CEO of The Power Practice™, a company specializing in innovative practice-building tools for optometrists. Dr. Gerber is also in private practice.

Dr. Stephen Cohen, who has delivered lectures on practice management and bifocal contact lenses throughout the United States. He has been recognized by Who's Who in Medicine and is President-elect of the Arizona Optometric Association.

1. Effective communication with presbyopic patients begins with effective listening…

Dr. Cohen: For any recommendation that we make to have value and validity to our patients, we have to be able to tie back into what their needs are. If we effectively listen early on during the history of the examination process, we have an opportunity when we get to the summation and recommendations to then relate it back to what their issues are. So, for instance, if a patient is talking about having difficulty seeing the computer because their bifocal glasses make them tilt their head back in order for them to see the computer effectively, we should not be talking about what it is like when they are reading a newspaper, but take our recommendation and tie it back to what their comments were.

2. The value of ACUVUE® Brand BIFOCAL Contact Lens education prior to the exam…

Dr. Cohen: One of the opportunities that we have is that some of the insurance plans we deal with require getting date of birth in order to obtain insurance benefits. That provides an opportunity for the appointment coordinator to mention, if someone is 45 or 50 years old, to say, "By the way, there is a new disposable bifocal contact lens that we have had some very good success with. You may want to ask Dr. Cohen about that when you come in for your appointment." Additionally, we also utilize point-of-purchase information education materials in our office. And then our pre-tester will also bring up the issue in saying that, "there is a new disposable bifocal contact. Are you interested hearing more about it?" So hopefully by the time they get into the exam room, in addition to what they may have heard on their own as consumers, they have heard about it one or two times prior to it even coming up during the exam. Then at the exam, I will often bring up options like that before we do a single diagnostic test, giving an opportunity to discuss the things that are available and planting the seed, giving the patient an opportunity to think about it while going through the routine portion of the examination.

3. How to talk to presbyopic patients…

Dr. Cohen: Number one, I tell patients there are now contact lenses that can be replaced every day on up. Now I have covered every modality without having to detail each one. Two, there are now contact lenses that have UV protection — a point that I think is often missed by practitioners. And surveys show that there is a tremendous amount of interest from the patients in this, and yet very few patients hear about it from the doctor. Three, there is now a disposable bifocal contact that works. And then four, I might possibly throw in, "You are a good candidate for some of the new refractive surgeries for nearsightedness and farsightedness. Let me know if you are ever interested." But any combination of those four statements provides ample education but doesn't take up a lot of time.

4. Making "recommendations" rather than presenting "options"…

Dr. Gerber: I don't think we should ever present options and I don't think we should ever make suggestions. I think we should make recommendations. I think they are much stronger words. As soon as we use things like options, suggestions or alternatives, we start to get involved with the presbyopic smorgasbord of distance glasses and reading glasses or monovision and we have patients pretty much looking at a menu of things that they can pick from. So what I like to do is just wrap it up and be very direct with patients and say, "What I recommend we do is fit you with this new ACUVUE® Brand BIFOCAL Contact Lenses and you'll get a pair of lenses and let's get started." And that is about as complicated as I get in my presentations.

5. Tactics for handling patient rejections…

Dr. Gerber: I think it is okay if they say no. The key thing is that you gave your absolute best recommendation first and you didn't let things like finances and the patient's ability to pay for it, or your perception of what they may say to you, cloud your judgment. If they say no, the next thing you should do is give your second best clinical recommendation. I don't think the prospect of the patient saying no should prevent you from recommending it in the first place.

6. Setting the record straight about bifocal contact lenses…

Dr. Gerber: If the clinical parameters are there, frankly I don't understand the skepticism since we have been successful about two out of three times. And if we pick the right candidates and we discuss patient expectations ahead of time, two out of three times it is going to work. And I think that is a great batting average. I think what practitioners should consider is what would happen if the ACUVUE® Brand BIFOCAL Contacted Lenses were created first, meaning we had this lens for the last 25 years and now a company invents what they call the monovision contact lens. And the sales rep comes in and says, "Well, instead of using those ACUVUE® BIFOCALs that work two out of three times, why not try these distance lenses and the reading lens. Let's pull out your patient's binocularity and it's going to work about the same amount of time." So, I think we just need to think a little bit differently.

7. The benefits of educating all presbyopic patients about the ACUVUE® BIFOCAL Contact Lens…

Dr. Cohen: I learned something absolutely fascinating about presbyopic patients. They tend to hang out with other presbyopic patients. Mind-boggling. What I found is that this is a very highly motivated group. We know that these are people who are seeking alternatives to having to wear glasses. And the ACUVUE® Brand BIFOCAL Contact Lenses are an ideal opportunity, not only in terms of an option that may work effectively for the patient, but also as an education tool. So that, again, patients are leaving my office knowing more than when they came in. So, I present the option to every presbyopic patient, although clearly, on a clinical level, we want to make sure that we are not going to fit the lens on a patient that … where the parameters may not work. I see it as an education opportunity and have benefited from that in that I have had successful ACUVUE® Brand BIFOCAL fits as a result of referrals from patients who are never going to be able to wear the lens.

8. Setting patient expectations…

Dr. Cohen: The critical issue is: can we create realistic expectations while being enthusiastic; recognizing that this is not a panacea but it is a very, very viable successful alternative to using bifocal glasses? The words that we use have power. There are certain words that can help to create realistic expectations that are not negative. For instance, "adequate," "reasonable," "acceptable," "satisfactory" and "functional" are all words that set the bar at a level that we want it to be without being negative. So I may say to a patient, "This lens will adequately take care of 80 to 90 percent of your activities. It will take care of most of your needs most of the time."

9. Why practitioners should recommend contact lenses…

Dr. Cohen: This is an issue that has come up many times when I have lectured or visited doctors around the country. There are surveys that have shown what reasons people feel they cannot wear contacts. Some of them are obvious, that we would look at them and we would anticipate, "My eyes are too dry" or "I have that stig-a-thing…" that nobody can pronounce. But one of the main reasons that patients say they cannot wear contacts is because they say the doctor never told them they could. When I heard about that, that was mind-boggling to think that not only what I say has an impact on my patients but also what I fail to say.

10. The value of fitting specialty products…

Dr. Gerber: I think there are two values. First is the obvious economic benefit to the practice, meaning that patients easily will understand if there is an additional amount of time involved and hence an additional professional fee to fit a more complicated lens. And second is that you start to position yourself as a specialty fitter.

Dr. Cohen: We don't have a tremendous number of opportunities to fully utilize our education and demonstrate our expertise to our patients. A product like the ACUVUE® BIFOCAL and other specialty products provides us that opportunity. We've also become a society of superlatives. You are not a star; you are a superstar. You are not giving 100 percent; you are giving 110 percent. And when it comes to patient expectations, the goal is not to meet their expectations but to exceed their expectations. If we can present and ultimately be successful with specialty products, we have that opportunity to get to the superlative of exceeding expectations.

11. Evaluating candidates for the ACUVUE® BIFOCAL Contact Lens…

Dr. Cohen: In the past two years, I have fit hundreds of patients for the ACUVUE® BIFOCAL and I have often been surprised by patients who have ultimately been successful that going in I might have predicted otherwise. So, I have made a commitment not to prejudge what the ultimate success would be. Basically, I am looking at someone that if it fits the parameters that are available clinically and if they appear to be motivated to go through the process. I found that patients are successful in ways that I could not have predicted going in. If I educate them effectively during the initial fitting, I will finish by saying, "Let's set up a follow-up for about a week. Between now and then, I want you to think about what we have discussed. Does this lens reach the threshold of adequately taking care of 80 to 90 percent of your normal activities?" What I have found in doing an effective job of planting the seeds of expectations, of alerting them what to look for and discussing it during the fitting, often I have been able to eliminate their three-to-four day visit.

12. Broaching the subject of bifocal contact lenses with monovision wearers…

Dr. Cohen: I have made a commitment to educate my patients about new options every time they come in for an appointment. Someone who is happy with monovision could be doing quite well with monovision. I still make a point to educate them. "By the way, there is now a new disposable bifocal contact that works, and it may be a viable alternative for you." Additionally, when it comes to monovision, it is a bit difficult to gauge what success is. Is it possible that a monovision patient who may have complaints, say, with their night vision, contrast sensitivity, some of the other issues that we know are endemic to monovision are thinking, "Well, if I tell him otherwise he is going to put me back into reading glasses." So, often we can't judge what success is. If overall they seem to be satisfied, I am not encouraging them to switch; I am informing them that this option exists. Additionally, what I might say to a monovision patient is, "What if we are able to fit you with a lens in which you were still able to read but gave you back some of your distance vision in the eye you are wearing your reading lens?" And that often provides an interest level for the patient.

13. Fitting early presbyopes with the ACUVUE® BIFOCAL Contact Lens…

Dr. Gerber: The early presbyopes actually clinically are the slam-dunk of this lens. It is virtually impossible if they are within clinical parameters not to fit these patients. You are going to fit these patients 95 percent of the time. Case presentation is the same, probably on our end and even more so on a positive side because you just know it is going to work.

14. The follow-up visit…

Dr. Cohen: I set the stage for a successful follow-up visit before the patient has even left my office. There are two ways that I do that. And that is that I let the patient know what we are looking for when they come back. "Is the lens adequately meeting most of your needs most of the time? And that is a question that I am going to ask you when you come back for your follow-up." Additionally, one thing I think can be extremely valuable to success is, during the initial fitting process, the initial fitting session, I ask the patient, "What is your objective in wearing this lens?" For example, if the patient says to me, "Well, I'd like to be able to see my computer without having to tilt my head back." When they come back for the follow-up visit and I ask them how the lens is doing, if they say, "Well, I wish my night vision was a little bit sharper." Often what happens with patients is that they feel an obligation to tell us what's not working so that we can fix that. Or, people sometimes will talk about what's wrong with something before talking about what's right with it. So what I do is I say, "Okay, we are going to address that in a moment, but let me ask you, you had mentioned that your goal was to be able to see the computer without having to tilt your head back. How is that working?" "Well, that is ideal." "Well good, we have achieved your main objective, now let's see if we can fix this smaller issue." And I find in doing that keeps the process moving forward and in essence doesn't force us to throw the baby out with the bath water.

15. Why ECPs should consider the ACUVUE® Brand BIFOCAL Contact Lens…

Dr. Gerber: Well, I think they just need to look at the hard clinical facts, that the lens works more than it doesn't work. And, they have to get past the stigma that this is another bifocal contact lens. Because it's not; this is a lens that works. That's the key difference here. And, they will be unsuccessful 100 percent of the time if they don't try the contact lens.

16. Why sell when you can educate…

Dr. Cohen: I see the ACUVUE® Brand BIFOCAL Contact Lenses are an ideal educational tool. I recognize that informed patients are likely to stay my patients. I have also found that patients who are kept informed of advances are likely to respond promptly to my recall efforts. Lastly, patients educated about advances are more likely to refer other patients. Even though we may not be comfortable with the term "selling," the bottom line of it is we are selling every day. We are selling patients the concept that they made a wise choice to come see us. And we are selling them on the idea that they make a wise choice to come see us when they're due for their next exam. Even though we may be uncomfortable with the term "selling," most doctors would agree we have an obligation to educate our patients about what might be best for them. And we shouldn't view the activity as selling, but rather educating.

17. Why the ACUVUE® Brand BIFOCAL Contact Lens are worth the effort…

Dr. Gerber: It is a great practice-building tool, it is a great revenue generator, it is professionally rewarding to get a former presbyopic eyeglass wearer into contact lenses and it is absolutely worth the time and the effort. And, the time and the effort are not that much — I think that is a little bit overrated with this modality. It doesn't take that long, it is not that hard, and to answer your question, yeah, it is worth it.

18. Three tips for successful communication…

Dr. Cohen: One, I would say that we should recognize that we are educating patients, not selling them on an idea. If we're uncomfortable in the communication process, it can be practiced, it can be improved, but bottom line is that in order to grow we have to be willing to get out of our comfort zone. Two, utilize the ACUVUE® Brand BIFOCAL Contact Lenses as a tool to support what I called before the three "R's" of patient education: retention, recalls and referrals. And three, the more enthusiastic we are about the ACUVUE® Brand BIFOCAL or any option that might be available, for that matter, the more enthusiastic our patients become. Invariably, if we are enthusiastic, our staffs and our patients will be enthusiastic in return.