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PRESCRIBE, OUTDOOR EYEWEAR'S CALL TO ACTION

By John Lahr O.D. and Mark Mattison-Shupnick B.S., ABOM

PRESCRIBE is the call to action by the American Optometric Association and the Opticians Association of America for your participation in SUN, Protect, Prescribe, Present. For doctors, the prescription is the actionable result of PRESCRIBE, the discussion about the protective and preventive need for outdoor eyewear. For opticians and optometric staff, Prescribe is a mindset. "Prescribe" is a discussion, with all patient/customer's about the benefits of minimizing the dangerous effects of UV and HEV that results in the sale and dispensing of outdoor eyewear.

For the practice, PRESCRIBE becomes an action plan that is measurable and profitable. SUN, through the courses Protect, Prescribe and Present, is a process that describes the everyday activities of all office staff when discussing sunwear. It's the actions taken today that could result in a longer-term reduction of the eye issues that result from the cumulative effects of UV and HEV. Together it's a collective call to action for ECPs.

OUTDOOR EYEWEAR IS A PROCESS

Many practice management groups teach that successful practices have a repeatable process as a way to ensure continuity of service and the optimal eye care. This is especially true for product sales. It is office process, not patient preference that determines spectacle or contact lens mix. That means that an office's success at delivering the right eye care and eyewear includes a set of clear goals, a plan to achieve them, the education needed and a review method to correct the bumps in the road that occur.

For Protect, Prescribe and Present to be successful, PRESCRIBE defines the process for setting goals and the path from reception through the exam room and transfer to the optical.

DEFINE YOUR GOALS

An effective SUN program starts with a goal that all patients will be told about the requirements for protective eyewear outdoors. For example, every mom learns why quality sunglasses, Plano and Rx are required since children's eyes transmit more destructive UV than adults. Every staff member understands and communicates that the effects of UV and HEV are cumulative. For the business, that translates into product dispensing and sales that can be measured.

A stretch goal to which your office can aspire might be 30% i.e., almost a third of your patients that buy spectacles, also buy outdoor eyewear. That's a big number since the MBA (Best Practices, Spectacle Lens Management, May 2011) reports that an average independent office sells 15% of their unit sales as sunwear; 10% in Rx sun and 5% as Plano sunglasses. Run your practice sun sales to determine how your practice compares to the MBA numbers. Are you ahead or behind these industry norms? However, the top independent practices report dispensing 20% of their volume annually in Rx and 10% in Plano sunwear. Therefore, a stretch goal of 30% total is possible. For example, every first time contact lens patient is an opportunity. You know that they buy sunglasses within days of their insertion and removal training. You're taught that they will be sensitive to glare and brightness as they learn to use their lenses. Now think of your patients that are referred for LASIK. Aren't they as or more light sensitive than your new contact lens wearers? Are you best positioned with product and the skills to be their source for quality plano sunwear? How can you be ready?

SET GOALS AND MEASURE SUCCESS

To set goals, that can be achieved, it requires participation by everyone in the office. At an upcoming office meeting, agree to adopt a SUN Initiative. Then agree to three goals. First, everyone in the office will talk about the issues of UV & HEV with every patient. Second, learn sun facts and the details about each of the lenses and frames that work. Finally, set capture and sales goals as one measure of success and drill down at each office station for the actual tactics needed.

Reception- Patients call to make that appointment BUT, before you hang-up, say "Before/when you come for your appointment..."
"View, download, read..." (Provide a variety of materials on your office's website that describes your commitment to the importance of outdoor eyewear.) "Visit our website and take a short survey about why everyone needs outdoor eyewear. The right outdoor eyewear, for every one of our patients, is of primary importance to Dr.(s) ____________ and everyone in our office. Like the need for protection for our skin in the SPF sunscreen and cosmetics , eyes are just as vulnerable. So, we're committed to protecting your eyes from UV. When you are here we'll spend more time explaining the right outdoor eyewear for you." "Bring all the glasses you currently wear, especially your outdoor eyewear..." This identifies that there is a difference between indoor/general purpose eyewear and that, which is worn outdoors. This starts the conversation.

When the patient arrives for their appointment, prepare them for a SUN focused experience i.e., that this office is part of a 2012 SUN Initiative. They will learn about the importance of outdoor eyewear throughout their appointment for themselves and those around them. "This office is committed to show you all the great sun and outdoor eyewear products that will protect from effects of UV and HEV."

UNDER THE SUN, THE VISION COUNCIL

SHOPPING GUIDE FOR SUNGLASSES,

Pre-Testing - This is the initial clinical interaction with the patient; it's logical to discuss the healthy and the unhealthy aspects of the sun when outdoors. When collecting information that augments patient history, note the patient's comments regarding all outdoor activities that might lead to an outdoor eyewear need.

In many practices today, technicians are cross-trained as opticians and vice versa. This is a smart practice since it ensures that the information collected in pre-testing can influence discussions with the doctor and then again in the dispensary. This is especially true if the pre-testing tasks include a wide variety of responsibilities. What do we mean?

Pre-testing is a busy area and the use of instruments should be quick and efficient. It is the before and after when questions about SUN and UV/HEV can be discussed. When a contact lens patient is removing their lenses before the exam, ask, "Tell me about your latest sunglasses - did you bring them with you? Are they as comfortable as they can be? Then, complete an accurate autorefraction, field screening and tonometry but when verifying the prescription in their habitual (current) glasses, ask, "Can I also see your sunwear or the glasses you use for outdoor activities? We want to be sure of all of the prescriptions that you are wearing. Some of our patients continue to wear older Rx's in sunglasses. We'll help you understand your options for new outdoor eyewear with your new prescription in mind."

When a technician also participates in the dispensary, there is better continuity of product recommendations. When information is learned early on in the visit where sunwear choices are needed, this results in a better sunwear discussion that will result in a decision to purchase. . When technicians manage the patient through the office, their skills and knowledge of the patient better match the needs learned. The decision is based on the real information that the technician uncovered when taking the patient's history. That, of course, also applies to other products like computer, reading or other glasses that complements a primary pair of glasses.

The technician that also is involved in the optical increases the technical and sales capabilities of the technician so patients are better served. The technician also participates in a consultative role with the other professionals in the office.

Sometimes, the patient, after history taking in the exam room, is left to wait a short time for the doctor. This is the time when technicians can describe, "...How the eye is just as susceptible to UV as is the skin resulting in sunburn, cancers and cataracts. ...How quality indoor and outdoor eyewear, delivered by this office, ensures that 100% of all UV radiation and most HEV is absorbed to help prevent the accumulated effects of these rays." In addition, it's the right time to give the patient brochures or an iPad/tablet with information about product recommended for their identified wants, and actual needs. For example, if the patient is a cyclist, lens materials like polycarbonate for their UV and impact protective qualities, in colors like red and brown, might be recommended for the protection needed in an all day ride. With this kind of information, the patient is ready for the doctor.

Exam room - "The solution—one that will provide your patient with superior vision and you with a healthier bottom line—is to prescribe chairside. Make a strong and clear brand specific recommendation to the patient, and have your optician and ancillary staff reinforce that message when the patient moves to the dispensary. (Source: Dispensing the Best Lenses Begins in the Exam Room, By Mark Wright, OD, http://www.reviewob.com/prescribing-from-the-chair.aspx)

In this case, the reason to prescribe chairside is a preventive one. Especially if there are no conditions that suggest UV & HEV damage. Today's consumer is very receptive to preventing future events that compromise health. Examples are of course, baby aspirin (heart attacks), dental cleanings (abscess, cavities), sunscreen (sunburn, melanoma), etc. As a result, opening with a statement like "I'd like to spend some time continuing the discussion about the need for outdoor eyewear/sunglasses. My staff (or name of staff member) first mentioned the need for sunwear when you checked-in for this appointment and then again during the testing before you're my components of the eye exam.... Let me tell you the doctor's point of view of the need for, and the components of, good quality sunwear. This is important, even if you don't require or if there is no change to your lens prescription." Many doctors are averse to product discussions but the contemporary consumer looks to the professional for a personalized, individual advice.

From a Jobson Optical Insight survey, "...patients consider a doctor's product recommendation as one of the most important discussions during a comprehensive exam. In fact, patients receiving a product recommendation are more likely to recommend their eye doctor to friends and relatives." (March 2009, n=1198 patients)

For the Doctor, there are many likely touch points during the exam, for the variety of patients seen, for an outdoor eyewear discussion. This is a partial overview of suggested information and wording, more are available on the SUN website.

Mom/children - Moms are health care intermediaries every day because they are making health decisions for their children, of course advising a spouse and often caring for elderly parents. According to the 2005 Pew Internet and American Life Project, 8 of 10 people searching information online has researched a health topic and those searching are likely to be women, college educated and Internet experienced. As a result, those that visit your office are looking for the right information that protects the health of their families. UV protection will resonate. So, the information you tell mom can be most impactful.

For infants and toddlers, "You're smart to have your child's eyes examined early on. Did you know that the lens in their eye is much more transparent to UV than even a child at ten years old? The accumulated effects of ultraviolet radiation and a new finding, that some of the visible, blue light rays, outdoors, over a lifetime, can be very damaging. As a result, we prescribe sunglasses for all children. Our dispensary has great new frames for children that are soft, have head bands and are really cute."

For the under 12, "We know that kids don't always wear their glasses at school or when they're out of your sight, that's why we prescribe photochromics and spend the time we do to choose the right frame. Kids love photochromic lenses because they're not just any glasses. They change tint outdoors and they are always 100% UV absorbing."

For Tweens and teens, "There's lots of (pick one - cool, awesome, bad, ill, extreme, uber) glasses to choose from, but the most important is to keep those harmful UV rays from getting to your eyes. Eyes and suntans don't go together. Want to know more?" Then translate this for mom - whew, that's easy.

Adults and young adults, "I love the newer styles because they've gotten larger so everyday eyewear is more protective from UV. We have a number of the newest 'geekier looking', eyewear. For lenses, we only use lenses that absorb 100% of the UV but it's your sunglasses I'd like to talk to you about..(due to the cumulative effects of UV and HEV, it is never too late to begin protecting your eyes)."

At this point refer to the points made in the Protect course defining the long-term effects of repeated exposure to UV and HEV. For young adults a short discussion of the bad effects of tanning beds and the potential for eye damage is also important.

Brands also resonate with patients, from tweens to adults; especially sunglass brands. Those with high sport identities make the discussion of eye protection easy. For either the serious or occasional athlete, understand requirements by sport, which makes a difference, as part of the exam discussion. The environment of the activity when skiing, playing golf, cycling or fishing, for example, should affect the final choice of lens filter color and their protective properties. It's not just Gray lenses anymore... Prescribing the other characteristics of Outdoor lenses is an opportunity.

Other counseling points; the optician and optometric staff will provide further details after the exam are: "...frame size doesn't have to be big but instead provide good coverage of the eye and the skin surrounding the eye, ...when working outdoors (landscaping, repairs, etc.), I am prescribing in addition to 100% UV absorbent lenses, eyewear that will also protect from potential impact injuries."

Seniors have special needs since they have been affected by a lifetime of UV and HEV. In a combination with genetics and nutrition the senior may exhibit cloudy media, small pupil, cataract, retinal issues, etc. At 75, a quarter of the population have some form of significant cataract so ensure lenses that are 100% UV absorbing AR lenses for general wear. They provide the clearest vision. Outdoor eyewear is essential. Blue light absorbing lenses reduce scatter so can improve potential vision clarity. Contrast enhancing colors, like amber and brown help with object edge contrast, for greater confidence where mobility is of concern. These lenses are usually lighter in transmission so more useful for a senior with a very small pupil when dark gray lenses can be too dark for all day wear. And, since dark adaptation is slowed as we age, the right density sunwear during the day ensures that rhodopsin is not over-bleached creating a greater dark adapting disadvantage at night. Of course, any combination of these solutions and suggested words can work.

TOOLS AND PADS

As you know, the number of products adds to the complexity of prescribing. A good answer is an Rx pad that provides the suggested components of the prescription. In fact, providing two or more Rx's makes sense, one for outdoors, the others as primary indoor and complementary pairs.

PUTTING WORDS IN YOUR MOUTH

Having a set of electronic index cards with the right words at just the right moment would be helpful. Consider the Beaver Dam Study. It found that without eye protection cataracts are 3 times more prevalent, the more UV, the higher the incidence of cataracts and UV and HEV are linked to AMD. Here are a few examples, the rest will be on the SUN website for quick reference (visit AOA.org and OAA.org). We don't think you'll need them all so choose the ones that work best for you and visit the website when needed.

BENCHMARKS

How do you measure success when only the long-term results will tell? Since the research findings about the eye damage from UV and HEV is strong, prescribing is a responsibility. In the short term, measuring the dispensing and sales of outdoor eyewear and sunglasses is an effective measure of the process change. In addition, consider a short patient survey, post - visit that asks about their experience and some of the facts they learned about how sunwear could reduce the impact of UV on their eyes.

Start with an umbrella strategy i.e., Improve Capture Rate then drill down tactically to deliver more outdoor eyewear. Capture rate is an overall measure of the patients that have had a comprehensive eye exam and also became an eyewear purchaser. If they have purchased eyewear, it's a good indication that the trust felt in the exam also extends through to optical. Capture rate = Purchasers / Total number of comprehensive eye exams. This is a measure of the effectiveness of the doctor, Optician, staff and overall office attitude.

Tactical benchmarks are employee checklists. In Reception, consider keeping track of patients that brought sunwear, were asked about their outdoor eyewear needs, sports, issues that "we should talk to the optician or doctor about".... In Pre-testing, what was discovered during history taking that indicates more discussion in the exam room and the dispensary, ...bothered by glare outdoors, really comfortable when driving, problems driving at night, etc.

Doctor, how many prescriptions were written for prescription and quality Plano sunwear? Then, the metrics of the dispensary take over as the measures of success. Without measuring actual sales, i.e., the results of everyone's efforts, the effectiveness of the program is certainly diminished. So, here's the set-up for Part 3, of this series, Present.

In the dispensary consider detailing the eyewear sold as a result of the presentation of the outdoor eyewear program and the prescription from the doctor. A suggested table below shows daily metrics from which we'll graph and trend results. Of course, the Rx's sold daily, in the table, may also include some sales as a result of a previous examination. That's OK, just add it in, this data is for trending. Decide who will collect this information, especially since this requires counting the different prescriptions that are written in the exam room.

Some definitions of the above are required. Counting appointments, exams and Rx's are straightforward. Purchasers are the individuals that have made a purchase of spectacles or contact lenses, not the number of pairs of eyewear purchased. Calculate Capture Rate (Purchasers/Exams) as a percent. In this way, there is a measure of the individuals seen and their activity in your office. Then, Rx's Sold, each day allows everyone in the office to see the results of their work. So, it is important to keep these numbers visible for all to see. Post them in the break room or other area of employee only traffic and be prepared to discuss them at staff meetings. This spreadsheet is an Excel file, downloadable on the SUN website.

Conclusion

The proof is in the pudding - or the Outdoor Eyewear (in this case). Sunwear is the result of Prescribe, this call to action by the American Optometric Association and the Opticians Association of America. For doctors, PRESCRIBE results in a prescription and a recurring discussion about the protective and preventive need for outdoor eyewear. For opticians and optometric staff, Prescribe is a mindset"; a discussion about the benefits of minimizing the dangerous effects of UV and HEV. It results in the sale of outdoor eyewear. And, the results of increased revenue are evidence that patients are the ones that benefit.

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