CONTINUING EDUCATION, 1 CE Credit � $9.99, 1 Hour, General Knowledge, Level 1, Release date: October 2007, Expiration date: October 31, 2012

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THROUGH THE LENS

Calculate The Free Form WOW

Predict Which Patients Will Love Their New Free Form Lenses

Doctors, opticians and staff can work together toward predicting which patients will love their new free form lenses. First, consider fundamental elements that wow your patient, then develop a method to calculate a probability score, the likelihood that your patient will love top tier optics. With this understanding, opticians can communicate appropriate benefit statements during the sale. Never over-promise a WOW to someone who won�t experience improvement. Always recommend best possible optics when your patient will see noticeably better.

Today I will share optical analysis resources and propose one method to predict patient satisfaction, by weighting three elements of WOW. This article is intended for staff training toward understanding optics and improving patient education. The WOW factor scores are based upon science, opinion, and personal experience. Use your own professional judgment. Test the method I propose, or use tools and resources toward devising your own tactics. Practice predicting which patients will love their new free form lenses.
As you begin to ponder the elements of wow, recognize that few patients will purchase a conventional lens plus a clinically equivalent free form lens simply to compare them. Only eye care providers think this way. From the patient�s point of view, the new lenses are better if he sees better when he puts them on. He will make a comparison between his new glasses and his habitual Rx. Patient satisfaction is based upon Big Picture improvement.

For this reason, the best method to predict patient satisfaction, will weight multiple factors that contribute to improving each patient�s overall, visual experience of their world.

With this in mind, I propose scoring three elements of WOW. First, assign an Acuity Change WOW Factor that indicates lines of visual acuity improvement due to a change in prescription. Second, assign a Prescription Strength WOW Factor based upon the patient�s prescription numbers. Third, assign a Personality WOW Factor that indicates your patient�s sensitivity to small changes in their Rx, plus their attitude toward new technology. Then, add the assigned scores to predict patient satisfaction on a scale of 0 to 10. A low score predicts your patient will not be wowed by their new free form lenses. A high score predicts the patient will see significantly better.

Score Three Elements of WOW

Element #1: Acuity Change WOW
The Acuity Change WOW Factor indicates noticeable improvement in vision due to a change in prescription.

In general, eye care professionals know that multiple factors influence improvement of best corrected acuity. These include the amount of Rx change, plus the status of accommodation, and also eye diseases such as cataracts or dry eyes. Some diseases cause decreasing acuity; some cause fluctuating quality of vision. For this reason, we can�t promise edge to edge visual clarity to every patient who purchases free form lenses. Evaluate each patient case by case. See Figure 1.

Figure 1:

The doctor is best positioned to assign this score because visual acuity improvements are documented in the patient�s record during the exam.

Simply assign 1 Factor of Wow for each line of visual acuity improvement due to the change in prescription. If a new Rx makes no improvement in VA, when compared to the habitual Rx, then assign a WOW Factor of zero. Notice that the maximum possible Acuity Change WOW Factor is 3.

After assigning an Acuity Change WOW factor, score a Prescription Strength WOW Factor.

Element #2: Prescription Strength WOW
People who understand optical math realize that free form technology provides the greatest visual benefit to those patients who have strong prescriptions. Patients with low prescriptions will notice little if any improvement in optics from buying free form lenses instead of aspheric or conventional lenses. To predict a wow, resulting from the patient�s prescription numbers, we can think of prescriptions along a continuum, and then apply what we know about optical science.

There are many ways to describe free form technology. I think of it as the ability to calculate point by point asphericity, across a lens surface, toward decreasing optical distortion and improving the patient�s natural view of the world. Computers use complex algorithms to calculate the best lens topography, unique for each prescription. Then robotic surfacing equipment digitally shapes each lens to exacting design parameters. Free form optics are the result of computer design plus digital manufacturing.

Applying this concept, we can say that free form lenses will improve the optics of any unique prescription, if small asphericity-changes to the traditional lens shape, applied across the entire lens surface, will cause noticeable improvement in visual clarity. The improvements are due to science, reducing optical distortion and aberration.

Dynamic analysis of optical design is complicated, yet Darryl Meister ABOM created a suite of resources any optical professional can use to advance their understanding. Find downloadable program files at OptiCampus.com. www.opticampus.com/tools/spectacle_optics.php

Using the Spectacle Optics-Optical Analysis tool you can data enter lens power, diameter, and a traditional base curve, then dynamically vary asphericity and observe changes in tangential error, sagittal error, oblique astigmatism, mean power error, and more.

Using the Spectacle Optics � Prescription Analysis tool, you can data enter the patient�s prescription, and frame parameters plus vertex distance, pantoscopic angle, and facial wrap. You can vary all of the parameters including index of refraction, and the tool will dynamically calculate the resultant compensated prescription and spectacle magnification.

I used these tools plus my experience and opinions to devise a method for assigning a Prescription Strength WOW Factor. See Figure 2.

Figure 2:

For example, assign an RX Strength WOW for the prescription:

OD: -4.50  -1.25  x  043
OS: -4.25  -1.50  x  137

When you circle all of the lens power numbers for the right eye, the highest assigned WOW will score 2.5. When you circle all of the lens power numbers for the left eye, the highest Assigned WOW will score 2.25. Evaluating both eyes, the highest number is the Rx Strength Wow Factor of the right eye, 2.5. Notice that the maximum possible score is 4.

After assigning an RX Strength WOW Factor, score a Personality WOW Factor.

Element #3: Personality WOW
The Personality WOW Factor indicates your patient�s appreciation of small changes in their prescription plus their attitude toward new technology. There is no optical science to this score. Use your best judgment.

We know from experience that one patient will exclaim that -0.25 diopters of change makes a world of difference to how they see. At the other extreme, a patient might experience 3 lines of improved acuity, yet claim the difference is hardly noticeable. Patients vary in their sensitivity and opinions about prescription change.

People also have a range of attitudes regarding new technologies. For some, the words �newest technology� can have a placebo effect. Some patients want the newest iPhone, the latest HD television with 3D capability, and they want top tier lenses. At the other extreme, some patients won�t purchase bifocals because they can read by wearing OTC magnifiers over their distance eyeglasses.

Personality is an element determining patient satisfaction. Opticians are highly skilled at evaluating a patient�s temperament toward change. See Figure 3.

Figure 3:

If you have that patient who rejects the new prescription because his vision �is just too sharp�, that patient who prefers 20/30 binocular acuity over adapting to 20/20 acuity, then the Personality WOW Factor score = zero. You get the idea.

Predict Patient Satisfaction on a Scale of 0 to 10

Figure 4:

After assigning all three factors of wow, add up the scores. A low score predicts your patient will not be wowed by their new free form lenses. A high score predicts the patient will love top tier lenses. With this understanding, opticians can communicate appropriate benefit statements with confidence. Let�s look at an example. See Figure 4.

Example: Terry James is a historical architect who specializes in restoring heritage buildings. Recently he noticed he squints to read road signs and addresses. With both eyes open, Terry sees 20/25-3 through his habitual Rx. During the eye examination, Terry saw 20/15 with each eye, through the phoropter, with his new Rx. He experiences two lines of improvement, measured on the distance eye chart. 

During the subjective refraction, Terry James reacts quickly to small differences in prescription change. He refines the cylinder axis to the exact one degree. Finally, Terry James is tech savvy. He seems to light up when his doctor recommends top tier technology, free form lenses.

Given this history, score the WOW Factors:

Acuity Change WOW Factor = 2.0 See Figure 1
Prescription Strength WOW Factor = 2.5 See Figure 2
Personality WOW Factor = 3.0 See Figure 3
Total Free Form Wow Factor = 7.5 on a scale of 0 to 10.


Using this method, we have determined, with 75% confidence, that Terry James will love his new free form lenses.

Use Common Sense

Practice this method with a variety of patient profiles. Discuss the elements of wow. If you have recent patients who were disappointed with their free form lenses, then pull those charts. Apply the method. You might gain new insights.

In addition, run a couple of hypothetical scenarios. Notice what happens if a patient experiences no improvement in visual acuity and hates change. Then, depending upon their prescription numbers, the highest possible score is 4 out of 10, 40% confidence the patient will love free form lenses. What do you think of that?

Notice what happens if the patient has three lines of improved acuity, and loves change, and their Prescription Strength WOW Factor scores zero. 

In this case the patient can score 6 out of 10, and have zero benefit due to the optical benefits of free form technology, namely reduced aberration and distortion. What do you think of that? Ethically, in this situation, would you sell top tier technology or conventional lenses? What if the free form lenses have lower wholesale cost, better turn-around time and greater product availability? Talk about it. Draw your own conclusions.

Today I shared optical analysis resources and proposed one method to predict patient satisfaction with top tier technology lenses. This article is intended for staff training toward understanding optics and improving patient education as well as setting the stage for patient satisfaction. The WOW Factor scores are based upon science, opinion, and personal experience.

Always apply good judgment and use common sense. Nothing proposed in this article diminishes the importance of ordering the best corridor length for each patient who wears progressives. Nothing diminishes the importance of accurate measurements and accurate fabrication.

You can test the method I propose, or use tools and resources toward devising your own tactics. Practice predicting which patients will love their new free form lenses. Never over-promise a WOW to someone who won�t experience improvement as this is a recipe for patient dissatisfaction. Always recommend best possible optics when your patient will see noticeably better.

Renee Jacobs, OD, M.A.

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