A WIDE-EYED DR. Newton approached Estelle, the optician, with a chart to hand off. “Little Carl got his first exam and glasses here almost two years ago. At the last visit he had a sizeable prescription, which I had cut back. He also has an eye turn, and we went over patching and the process to treat a turn. They ended up not returning for Carl’s follow-up—possible Rx change and patching check-in appointment.”
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Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.
ABOUT THE AUTHOR
Carissa Dunphy has been working in private practice optometry since 2008 and is the founder of Optician Now (opticiannow.com). Follow Carissa on Instagram and Facebook at @opticiannow.
Estelle responded, “Well, I’m glad they have finally decided to come back to stay on track with the plan.”
“They returned because Carl’s glasses broke a while ago and his hardware benefit just became available again.” Dr. Newton continued, “So… he hasn’t been wearing his glasses for a while, nor patching because the glasses are broken…”
“I understand. Are we back at square one?” Estelle replied.
“Yes.” Dr. Newton added, “Of course, Carl needs a new pair of glasses, but also please show his mom the patches that don’t require a frame, discuss repairing the broken glasses, and make sure to schedule a follow-up in three months.”
Estelle commented, “I will address all of those with mom before they leave.”
“Excellent. I’ve already explained the importance of patching and wearing glasses NOW, and why a follow-up is needed, so you don’t have to go over all of that,” Dr. Newton concluded.
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Estelle made her way to Carl and his mother. After introducing herself she let Carl try on some frames while she discussed the broken pair with his mom.
“I already told the doctor, we didn’t bring the old glasses in because they are broken. He can’t wear them,” Carl’s mom stated, annoyed.
“We may be able to fix them or replace them using the manufacturer’s warranty. How are they broken?” Estelle asked.
Carl’s mom, exasperated, answered, “The arm part just broke in half.”
“I’ve pulled up the original order in the computer and that particular frame is still under warranty and could be replaced at no cost to you.” Estelle continued, “When you come in to pick up his new glasses, bring in the broken pair and we can get the replacement ordered. It would be great for him to have a back-up pair in case something happens to his primary pair.”
As Carl continued to try on frames, Estelle showed his mom patches that did not require a frame and scheduled his follow-up. “When he comes in for the follow-up in three months, if there is a change in prescription, we have a small window in which his lenses can be updated to that new prescription at no cost.” Estelle added, “As long as you come in for this scheduled visit, we will fall within that window.”
After completing the glasses order, and addressing all of the information Dr. Newton advised, Estelle had faith that she had sufficently conveyed the importance of it to Carl’s mom and hoped they would return in three months.
The Big Questions
- Are there any ways the staff could have helped to ensure Carl’s plan was implemented at the outset? What about at the second visit?
- How much is too much when explaining the importance of this time-sensitive correctability or multi-prong treatment plan?
- Do you have a proven approach to get children’s guardians to comply with treatment plans?
Dave G.
Newport Beach, CA
As someone with amblyopia, I cannot stress enough just how important it is for a child to be compliant with wearing a patch. Mine was caught just before the end of the critical period, but still I only get 20/50 at best out of my right eye. To ensure compliance, it’s important to involve both the parent and child. In this hypothetical situation, I feel like this is something that was missed. There’s nothing better than a child acting like a squeaky wheel in this scenario. The staff should also provide a communication of treatment letter to the school, which can also help engage teachers in the treatment plan. A critical part of the process is to emphasize the benefits of wearing the eyepatch, including improved vision and reduced risk of complications. Also, encouraging the child to personalize the eyepatch can make it a more enjoyable experience. This activity can be done during office visits, adding to the child’s enthusiasm for the treatment. It also goes without saying that the child needs a backup pair!
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Cathy D.
New Bern, NC
This scenario is very difficult to picture in my office; I just don’t treat refractive/strabismic amblyopes this way. In this sort of case, it’s important to know the child’s age, current vision level, type of strabismus, and prescription. I never recommend patching without glasses if there is a “sizeable Rx” due to the possibility of occlusion amblyopia of the better eye. Three months is too long between initiating patching and following up; my patching follow ups are monthly, not every three months. I also use Atropine therapy as much or more than patching therapy and no discussion of Atropine was included in the scenario. I do like how the optician jumped into the warranty discussion and the benefits of having a backup pair of glasses. I also like the fact that the doctor’s lab allows him to change an Rx within 90 days at no charge to the patient. That is exactly what we do.
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