Personalising lens corrections for your patient isn’t only about providing them with the very best vision that modern technology offers. It goes beyond your patient’s stage of life, their work and their hobbies, all the way to their state of mind and the way in which they view the world.
A few years before his death, Australian dancer, actor, theatre director, and choreographer Sir Robert Helpman CBE wanted contact lenses, so he went to see the late Professor Brien Holden to be fitted. As you’d expect, the contact lenses prescribed provided the sharpest vision to meet the visual demands of an internationally renowned performance artist.
However Prof. Brien was surprised when, with his first glances, Sir Robert looked alarmed and exclaimed, “Oh No! I can’t possibly wear these!” When Prof. Holden asked what was wrong Sir Robert replied, “All the lines on your face.” His experience was poor because his vision was too clear. Sir Robert was happy living in a soft focus world.
the emotional state of most patients contributes as much to their outcomes as does the best visual acuity that technology can provide
Dr Alexandra Roos, Head of Essilor’s Centre for Innovations and Technologies AMERA (Asia-Pacific, Middle East, Russia and Africa), acknowledges that this kind of reaction can be difficult for optometrists to comprehend, given that it goes against everything they’ve been trained to achieve. However, she says, patient research conducted at Essilor has confirmed that Sir Robert’s preferences were not unique.
“We filmed a highly myopic arts academy student at work. We watched her take her glasses off at regular intervals when she looked up from her painting. When we asked her why, she had no idea that she was behaving in this way. Then we showed her the footage and she realised why. She told us she used her glasses to see the fine detail of her work but took them off to see the big picture around her that was her subject matter. The blur that she saw without the glasses didn’t bother her because it was that big picture she was after. Her glasses were a tool to be used,” said Dr Roos.
The psychology of this myopic girl is not unlike the “undetected myope”. In the absence of a point of comparison, they can’t see through someone else’s eyes, their behaviour and what’s more, their belief about their vision is self-guided. This may be why so many myopes present at the point where their myopia is beginning to progress quickly, rather than at a point where intervention may have had more impact.
WHAT DO THEY REALLY WANT?
Dealing with the general public every day, it probably comes as no surprise to many practitioners that the emotional state of most patients contributes as much to their outcomes as does the best visual acuity that technology can provide.
That means that if you don’t want to start off on the wrong foot when talking to patients about their vision and lenses, you need to be totally aware of the individual in front of you. After all, choosing a frame is fun and most patients get a kick out of it. The correction part is much harder for them to understand. Lenses can be a grudge purchase and if not handled correctly the patient’s perception can be that it’s an expensive requirement simply due to a change in Rx or damaged spectacles.
As lens and treatment options increase, engagement is what you need – so that you can really meet your patient’s expectations.
So where do you start?
Dr Roos says to make the lens discussion easier on yourself and your patient, you need to gain an understanding of their emotional needs from the very start – you must engage with empathy.
In an effort to improve their understanding of the emotional needs of patients, Essilor R&D has defined and mapped market segments by stage in life: children (<18yrs); young adults (19–44 yrs); mid-lifers (45–65yrs); and seniors (65yrs +), (Figure 1). The behaviours of people within these segments, (like the myopic arts student), have been studied by teams that include clinical psychologists and sales professionals.
While the functional differences between each segment are well known, what’s less understood are the emotional ones. These are important to understand, says Dr Roos, because throughout their time in your practice a patient’s emotions will range from pleasure at one end of the scale to pain or frustration at the other. Naturally, this can impact on finding the right solution to meet their needs (Figure 2).
THE DIFFERENT SEGMENTS
Children through to their late teens can be reluctant lens users. They may be happy to choose their frames to match their fashion style, but they don’t like the way glasses may interfere with sport and lifestyle. The lenses may be of little concern to children and expenditure is usually controlled and constrained by their parents’ budget.
State of mind: reluctant and constrained by budget / parent supervision of the purchase.
Young adults may be used to wearing glasses and buying new ones can be a process of maintenance or deliberate choice. The fashion side of frame selection is enjoyable and they may have more capacity to pay for the lens options they believe will best suit their needs.
State of mind: emotionally balanced, understanding, and open.
People in middle age can begrudge getting older. They’re seeing signs of the ageing process everyday as their skin, hair, and vision changes. Worse still, their children are happy to remind them that they’re now “old”. If they’ve never worn glasses before, they may be particularly disgruntled long before they arrive in your practice.
State of mind: from resigned to upset / in denial about the ageing process, they want to feel young and they can see wearing glasses as a chore.
The elderly often have to deal with the health issues that come with age and vision is just one of them. They may have a partner who is unwell or recently deceased. They may feel financially insecure, or they may be financially well-off.
State of mind: worried, perhaps anxious or depressed, vision may feel insignificant compared to other problems.
BREAK IT DOWN
Within these macro profiles, there are more specific consumer profiles and emotional challenges being faced that optometrists need to understand so they can empathise with their patient. An elderly person may be grieving the death of their loved one. A middle aged person may have just divorced and see themselves as starting out again. A young woman may be pregnant and as such, dealing with multiple changes from body image, to sense of identity and financial security etc.
Dr Roos says asking questions about the patient’s lifestyle, whether they’re an introvert or an extrovert, their family and work circumstances, etc. will quickly give you an insight into their state of mind. These insights should frame your approach to their overall visual solution.
“When you are selling a product, what will be the person’s state of mind? It doesn’t make sense to have an amazing product if you don’t connect with the consumer… in order to provide them a personalised solution,” she says.
Different approaches to questioning can elicit completely different responses from the patient.
For example many practitioners are afraid of changing older patients out of bifocals and ask questions like, “Wouldn’t you like to get rid of that line in your glasses?”
However, a question like, “Are you afraid of falling… How much do your glasses contribute to that fear?”, can touch on an emotional reality that can be making their day to day life difficult.
A patient with pale blue eyes and a pale complexion may make the connection to UV protection via questions like, “How often do you wear sunscreen?” followed by, “Are you aware that you also need to protect your eyes?”
“Looking at a person gives you some information about them but engaging in conversation with them will tell you so much more,” said Dr Roos. “Our research is showing us that a certain group of six or eight questions may be enough to get all the insight we need. In addition, perhaps the patient will show you a picture of their children as you converse. A patient who proudly shares a photo of their tattooed child is likely to be more open to less conventional frames, for instance.”
Similarly, a patient who tells you about their interest in technology is likely to want to know more about lens technology. A patient who expresses concerns about their job security is less likely to choose the most expensive frame and lens package today, however they may be interested to know about them for the future.
Dr Roos said the specific questions you ask a patient will depend on your initial impression of the patient and the feedback they give you. While it’s not always possible, what can be helpful is to match the optometrist with the patient in terms of age and style. A young patient is more likely to openly engage with a young optometrist, where as an older, more conservative patient, will feel more comfortable talking to a more mature optometrist.
“It’s a matter of posture – if you have someone looking for high fashion frames and your optometrist presents in a white coat and speaks to them in medical terms, it’s just not going to work,” she said.
HOW MUCH KNOWLEDGE IS TOO MUCH?
Dr Roos says most patients have little knowledge about the complex technology behind lens design.
“It’s good for consumers to be somewhat aware of the technologies available because then they know the questions to ask in order to find the lens that best suits their needs. However sometimes, providing too much information is not good. Lenses are complex and highly technical so it’s easy for people to become confused about the options. We need to find the balance.”
When explaining the technology behind lenses, particularly to those who show little understanding or appreciation of the complexity, she says, “show don’t tell”.
While this is not always possible, for example with progressives, to as great an extent as possible, she says, “let people experience the different features of lenses.
“When recommending lenses, put all the benefits together as they relate to that patient….‘We’re prescribing this because you told us about ‘xyz’; and we noticed ‘xyz’ during the examination and you told us about your concerns about ‘xyz’.
“Tie in the emotional and functional facts you’ve identified during your discussion. In doing so, your patient will know you have listened intently to them and have absolutely considered their needs.”