For decades, the conventional wisdom has
been to discuss lens options first with every patient. The
idea being that lens design, material and treatment would
dictate much of the options available for frame selection.
Has this long-standing technique fallen by the wayside?
Yet there are still some valid arguments for “lenses first”.
The patient has just finished discussing vision and
vision concerns with the doctor. Lens needs and any
suggestions made in the exam lane are foremost in the
thought process. There should be no better time to discuss
lens needs and wants.
There is the possibility, however remote, that the frame
selection will not accommodate the lens availabilities and
If the patient is working within a budget, the cost of
lenses may, by necessity, dictate the availability of
affordable lens and frame choices.
The patients vision insurance may dictate both lens and
frame choices, often creating a “lesser of two evils”
The optician has done such a perfect job of extolling the
value, durability and appeal of the patient’s current frame,
that prying it off his or her face requires mental and
verbal gymnastics heretofore unseen by any living human
The patient has just learned that he or she is (gasp!) presbyopic and/or has (the horror of) astigmatism and much
of the optician’s time will be spent explaining that the new
lenses will not make them look (insert adjective).
The patient has researched lenses on the internet and is
“prepared” to tell the optician what will be the best
solution for his or her visual needs…because Google said so.
The patient has a degree in engineering.
However, the lens landscape has changed…a lot! The factors
that limited frame selection, i.e. material availability,
designs, etc., have been replaced with hundreds of options
and combinations of options. Eye care professionals can
literally design lenses to provide optimal vision, optimal
performance and still allow their patients to choose from
almost any frame design.
The arguments for selecting frames first are pretty
Most patients have at least a basic idea of what they
want new eyewear to look like. Sometimes the “cult of
personality” influences a frame style or look. From Sir
Elton John to Sarah Palin to Buddy Holly, eyewear has come
to define a “look” or an attitude.
Frames have become an affordable luxury. It’s possible to
wear a designer brand for a reasonable price and designers
have discovered that their brand currency is expanding from
haute couture to mass market with very little negative
impact on perceived value and they are hopping on that
bandwagon from Kmart to Kohl’s.
Frames have become more fun. Eyeglass wearers in the US
have become more adventurous and are willing, if not
excited, to try new looks, materials, shapes and colors once
restricted to fashion-forward Europe.
The patient is wearing a frame that has seen better days.
In fact, a sharp-eyed optician can see the frame
deteriorating as the patient is checking in at the reception
Most importantly, the availability of more than just a
handful of lens options allows eye care professionals to
completely customize fashionable and functional eyewear to
meet almost any requirement. Even the most extreme lens
powers can now be fabricated in high-index, aspheric or
double aspheric lens designs to allow wearers both visual
comfort and acuity, and a fashionable look.
This “which came first” question sparked a lively discussion
among a group of the most forward-thinking eye care
professionals in the industry.
The initial question was, “How do you start your
conversation with patients after the Dr. hand-off?”
The one absolute was, “Never take the patient back to the
waiting area or front desk because it makes them think the
process is over.” No arguments there. That’s like asking a
closed-end question to which the answer is always “no”.
The responses were fairly evenly split between “lenses
first” and “frames first”. The one caveat being that
assessing needs and wants had to be addressed either in the
exam room or at the dispensing table. With that
understanding, the optician can begin the conversation
wherever is the most comfortable. This sort of modified
lifestyle dispensing gently guides the patient to understand
the need for more than a single pair of eyeglasses,
regardless of the multi-functionality of many lens materials
There is no more “one size fits all” lens design or even
family of lenses any more than there is a “one frame line
fits all” frame vendor. For that reason, extensive product
knowledge is paramount, not just about lenses but on frames
Many of these savvy ECPs advised keeping the process,
especially the lens selection process, as simple as
possible. Remember that keeping the information simple means
having as much product information at hand to be secure in
making recommendations. Good marketing does not necessarily
mean good, useable information. The best and most skilled
are constantly upgrading their knowledge base. Said one
participant, “Frames are personal, lenses are all on us, be
thorough and thoughtful.” Excellent advice.
Another added “I always prefer a 10-15 minute conversation
with the customer before we look at frames. Needs and
expectations get uncovered, I establish myself as the
expert, and usually only have to show a couple of frames. It
doesn’t feel like selling to the patient if I am showing
them the one perfect thing that they have already told me
that they need. I’m the hero and it saves the confusion that
can come from having too many choices. The patient always
feels comfortable, in control and catered to.”
As more professional practices embrace a medical model,
doctors are increasingly dependent upon a well-trained,
skilled optician to manage patient expectations, to provide
world class advice and to expertly troubleshoot patient
problems and/or concerns.
Does this new doctor/optician/patient relationship need new
parameters? Who then decides which comes first? The lenses
or the frame?
It would seem from this group of eye care professionals,
that there are advantages to either strategy. The key to a
successful hand off and subsequent eyewear conversation is
coordination. A coordinated strategy between doctor and
optician to ensure a smooth transition from exam room to
dispensary should include:
Location of the hand off—who escorts the patient where?
What information should be shared?
How involved should the doctor become in the fitting
When and how should the doctor defer to the optician’s
Since the dispensary accounts for roughly 60% of practice
revenue, it is not just wise, but absolutely necessary for
every ECP in every practice to coordinate every aspect of
every transaction. Not to micromanage, but to ensure that
every player has the education and skills to present a
seamless patient experience from check-in to final dispense
To paraphrase one contributor, what drives patients to
online retailers is the feeling that they’ve invested a lot
of hard-earned money in our products and feel that they
haven’t received the value that was expected. “When online
retailers don’t do any worse for hundreds (of dollars) less,
the online retailers win (and) we lose.” Food for thought.
Lenses first? Frames first? Do what you are comfortable
doing, but do it to the best of your ability with the best
interests of your patient in mind.