Photo illustration by Iris Johnson

By Palmer R. Cook, OD

Psychology is an important part of our daily life. All of us are hardwired for it.

When you take delivery of a new car, it is detailed and waiting in sparkling splendor in front of the dealership, and the keys are not carelessly slung across a desk at you—they are presented to you. The manufacturers have done their part too. In the early ’70s digital gas gauges were introduced. The new gauges showed the number of gallons in the tank dropping in one-gallon increments as the fuel was used. New car owners began complaining bitterly of poor gas mileage. Manufacturers recognized that the remaining fuel was dropping too rapidly after a fill-up. The solution: gauges were modified to drop in two-gallon increments so the tank seemed to stay full longer, and the poor mileage complaints disappeared. All of this is applied psychology, and it is used in one form or another in nearly every industry.

The mechanics and the importance of dispensing prescription eyewear are well understood by eyecare providers, and they are misunderstood and misperceived by virtually everyone else. We have all experienced the patient who announces he is here “to pick up his glasses.” This is a problem that results in part because we often fail to recognize the importance of using a bit of psychology in our dispensing regimen.

On my first visit to an optometry school clinic when an OD degree was still just a twinkle in my eye, I saw a distinguished professor in a white coat carry a bespattered plastic tray brimming with multiple copies of some kind of paperwork and a pair of glasses to a dispensing desk. I watched as he applied a series of tarnished, worn tools to a new pair of glasses. I was uninitiated to the profession, but what I saw didn’t fit my expectation.

Try reviewing the way in which dispensing is carried out in your own office. You probably already use some dispensing psychology intuitively, but a step-by-step tour may prove helpful.

Most patients’ first response is to turn to the mirror. This simple act can waste a lot of your time over a year. Not only that, the appearance of the eyewear is optimal only after you have completed the dispensing. The patients who do not turn to the mirror usually want to test the lens performance, and that too will be better after you have worked your dispensing magic. If you can arrange it, don’t allow mirrors in your dispensing area, and keep magazines and reading cards out of reach until the dispenser is ready to hand them to the patient. A window or an eye chart at a 20-foot distance can allow a patient to experience their new distance vision, but arrange this if you can, to ensure a post-dispensing experience.


Be sure the frames are preadjusted so you don’t have to wedge them onto the patient’s face. Remember, this is your patient’s first experience with his or her new eyewear. A good rule is “First Impression—Best Impression.” Also, it’s a good idea to loosen the eyewire screws a half turn or so. Lenses tightly clamped in a metal eyewire can chip if the temples are forced open, or if the patient removes the eyewear with one hand, exerting stress on the opposing temple.

Present the new eyewear in a specially selected tray that is clean, lined with velvet or other suitable material. Put any paperwork, folded neatly, into your lab jacket pocket. That’s right, a lab jacket. Never underestimate the power of white. A white lab coat or jacket gives authority and garners respect, even though these items originated as clothing protectors against blood (and other) splatters. A slip of paper should also be in the tray with the patient’s name so you don’t accidentally dispense the right job to the wrong patient.

A dispensing card is a business card that shows your name, position (ophthalmic dispenser, optician, ophthalmic technician) and the name, address, e-mail address and phone number of the practice. It should have a place for the patient’s name and areas to write the dispensing date, the date and time of any follow-up appointment and your initials. This dispensing card is part of building a bond with the patient. It shows the emphasis your practice places on service. Of course that’s part of the psychology, but what about your initials? That’s part of personalizing the service, and it’s positive psychology too. In fact, anytime you give your patient a pamphlet about myopia, a printed explanation about cleaning their eyewear, or any other printed information about their care, jot the date, your initial and pertinent comments (i.e., Bobby, age nine) right on the material. This is both good psychology and exponentially increases the perceived value of the information you are providing.

A case insert can have several uses. It can reinforce the information you provide about cleaning the eyewear and about adaptation. It can also let your patient know more about the eyewear he or she has purchased. Did the patient get an anti-static, oleophobic AR? Was a standard AR used? Was a lightweight lens material used? Was a glare reducing, indoor tint used? Do the lenses block UV? Was a designer frame used? Was a warranty provided? Are the lenses impact resistant? Was a bi-centric grind used? Are the lenses a “special curve” for lash relief? All of these eyewear attributes add value, comfort and/or improve appearance, durability and performance. They can easily be listed in check-off form on a case insert so the patient can easily see what was purchased. Additionally, it highlights other products such as prescription polarizing sunglasses, computer lenses, safety glasses or other special use eyewear.

A case insert can be one of the best ways to avoid problems of buyer’s remorse. It tells your patient about the value they have purchased, and it helps them respond to “friendly” comments from others who tell them they might have gotten eyewear cheaper elsewhere. If you use a case insert, make it your own. Some manufacturers provide cards that advertise their products, but you are responsible for the total eyewear, so it is your story to tell. If you dispense a top quality product with high name recognition, you may choose to write that information on the case insert. If you imprint these manufacturers’ brand names, be sure it does not make your case insert look like advertising. It’s also important for your case insert to include your access information including your after-hours emergency number. Is using a case insert good psychology? It is, but only if you do it, and do it well.


Of course you clean the lenses thoroughly before you release them to the patient. But if you are dispensing with style (and elegance), don’t allow your patient to look through smudges and smears on their new lenses as you are doing the dispensing either. Washing your hands before each dispensing is a good idea. Do you have a washbasin in your dispensing area? You are part of the health care community—it sets a good example and speaks volumes about your attention to care. Also, how about that pastrami and onion sandwich you had at lunch? Some odors cling to you like they were attached with rubber bands. Avoid these problems by sticking to less fragrant lunches. Be sure your nails are neat and clean. If all the hand washing is having a drying effect, try Corn Huskers Lotion. If you are handling gas permeable lenses, you already know about this. Corn Huskers is one hand lotion that does not leave a residue to smudge and smear the contact lenses, and the same goes for glasses.

Always handle the new eyewear as you would handle a uniquely designed medical device or fine jewelry—in fact it’s both. When you bend on the eyewear or apply pliers and file, do so out of the patient’s view. This keeps respect for the eyewear high, and reduces the likelihood that the patient will engage in “monkey see, monkey do” attempts at realignment.


Eyewear needs care, but don’t assume patients understand the hows and whys. Only the cleaner you recommend should be used. In a pinch, Dawn dishwashing liquid, which has a nearly neutral pH, can be used, but caution against using commercial glass cleaning products and other common cleaners and detergents. A quick check of the previous eyewear can often reveal scratches and other indicators of abuse that should be discussed.

An often overlooked aspect of lens cleaning is the importance of flushing all grit from the lens’ surfaces before using a lens cleaner. This is the source of troubling “hairline cleaning scratches.” Handing the patient a bottle of cleaning solution and a cloth is not enough. Giving some expert, albeit simple, instruction is good psychology and adds value to your services.


Most new lens prescriptions require a certain amount of adaptation. This effect generally passes in about three to ten days. Be confident in telling your patient the worst of adaptation will be over in about three days and adaptation should be complete in no more than about another seven to ten days.  This is proactive, applied psychology that bolsters patients’ confidence.

If more time than this is needed, there may be a real problem. If your patient is having real problems other than buyer’s remorse, beyond about ten days of constant wear, there is probably a medical or optical issue that should be carefully investigated.


“Keep up with your eyecare” and “tell us if you have a problem” are the two important follow-up messages. The first is easy to reinforce. If you know when the doctor wants to see the patient again, just remind the patient. If you don’t know, ask and then stress the importance of following that plan.

“Tell us if you have a problem,” is not so easy. If you bring up “problems,” patients will too often oblige with one or several problems—real or otherwise. Suggestion is a powerful tool, so it is best not to suggest problems. Instead, simply indicate you want to do a follow-up in a few days after the eyewear has “settled.” Actually, during the first few days of wear the average patient allows at least two or three friends, coworkers or family members to “try on” the new eyewear. This can seriously affect your carefully crafted fitting. A quick follow-up and fix-of-the-fit assures your patient’s long term satisfaction. Your on-target psychology of anticipating a need also establishes an opportunity to hear about problems or concerns. 

You have completed the fit, buffed and cleaned the frame, and retightened the eyewire screws. It’s time to invite the patient to take a look in the mirror, and try out his vision at distance and near. Be sure they get your professional card and the case insert, along with a case for their new eyewear, an appointment for their “follow-up after the eyewear settles,” and cleaning solution for the new lenses. All of this raises the perceived value of your services and the eyewear that your patient purchased. If they did not get computer glasses or prescription sunglasses you might want to demo polarizing with a lens flipper and give them a pamphlet that explains computer lenses or other special use eyewear that can be discussed at the follow-up.

Believe it or not, patients’ psychology is often affected by uncertainty about whether or not they “passed their eye exam.” They may feel they are gambling that the new Rx is right. Once the initial lenses prove satisfactory, the idea of prescription sun lenses, computer glasses, spare pairs and more may be better accepted. Another aspect of patient psychology is that our patients tend to focus on cost, because cost, just a set of numbers, seems easy to understand. Your psychology as an eyecare provider must focus on value, because value is what your services, care and skills are all about.

Applying psychology to the way eyewear is dispensed in your office is neither time-consuming nor difficult. As an eyecare provider you have a working knowledge of applied psychology. Extending this knowledge to include dispensing helps assure your patients’ understanding and enthusiasm about the quality of care you provide.

Dr. Palmer R. Cook is director of professional education at Diversified Ophthalmics in Cincinnati, Ohio.