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What Came First? 
The Frame or the Lens?

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”.

  1. 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.

  2. There is the possibility, however remote, that the frame selection will not accommodate the lens availabilities and options.

  3. If the patient is working within a budget, the cost of lenses may, by necessity, dictate the availability of affordable lens and frame choices.

  4. The patients vision insurance may dictate both lens and frame choices, often creating a “lesser of two evils” selection process.

  5. 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 being.

  6. 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).

  7. 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.

  8. 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 straightforward.

  1. 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.

  2. 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.

  3. 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.

  4. 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 desk.

  5. 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 and designs.

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 as well.

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 process?

  • When and how should the doctor defer to the optician’s judgment/suggestions?

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 and beyond.

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.

Judy Canty

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