When our normally calm and pleasant optometrist barreled into the optical department frustrated because she had been scheduled to ReRefract a patient who was having problems seeing had her right and left lenses switched in her frame. "Why didn't someone catch this?" she exclaimed. And she was right. How embarrassing. This patient had left the office and tried to wear the glasses and finally returned because she couldn't see well. It didn't matter whether we made her glasses or not—this was a waste of her time and should have been caught before the patient was back in the doctor's chair to be refracted again.

Luckily we don't see many patients returning to our office having troubles seeing or adapting to their new glasses, but it does happen. These patients may have purchased eyewear from our optical, an optical retail chain or discounter or other independent. When these patients come in to report their issues we now have a process aimed at keeping patients happy and seeing correctly as well as minimizing the doctor's chair time—if the doctor's time is needed at all.

Now when a person calls or comes in the office complaining they can't see as they expected in their new glasses they are ushered directly to the optical area to a skilled optician or technician to analyze their glasses and previous glasses and query the patient about their visual complaints. We've developed an office process for handling the troubleshooting required to solve their problem. A form was developed (by the optometrists and the opticians) to record the pertinent information and troubleshoot the issues of non-adapt. Some of the items included are the powers of the lenses, pupillary distances, lens style, lens material, base curves, frame pd, and patients actual monocular pupillary distance. Ideally this is done on both their new pair of glasses as well as their previous pair. A copy of the form is available via this link.

The first step of the process is for the optician or technician to explain to the patient that we want to work with them to solve their vision issues, no matter who made their glasses. This is important because they are often very anxious, especially if they didn't have their eyewear made in your office. Once they know you are going to help them they often relax and are much easier to work with.

Next we take out a ReCheck/ReRefract form and listen carefully to their vision issues, questioning them and recording their concerns. Do they have the same problem with their old glasses? Do they see better in their old glasses? Do they have the vision problem with and without their glasses on? Occlude each eye and ask the patient to look at distance and near? It is important to present an attitude of non-judgment; at this point you are in investigator, uncovering the clues of what might be wrong. The patient usually feels better because you are listening to them and writing down their issues.

ReCheck/ReRefract Process

  1. Assure patient you want to help solve their problem.
  2. Ask patient to describe problems and ask questions, document on form.
  3. Explain ReCheck process to patient.
  4. Analyze their new glasses and prior glasses if available, record on form.
  5. Explain to patient what you discover, adjust and advise as needed.
  6. If the optician can't solve the problem, a 10-minute ReRefraction is scheduled with the doctor.
  7. ReCheck/ReRefract form is scanned and attached to the patient's record.

At this point we explain our "ReCheck" process with the patient, letting them know that after we've completely gathered their information and analyzed their eyewear and tried to solve their problem that they may have to come back for a quick recheck by one of our doctors. (This is always assigned to one of our optometrists on staff.)

Next we analyze their new eyewear and compare them to previous pairs. I always advise patients this will take 10 to 15 minutes so they can relax. This also helps them understand there are many things to measure and analyze about their eyewear, as evidenced by the form you are filling out as well as the time needed to evaluate.

The ReCheck Form is fairly complete and works well for us. We note the red flags, such as off powers, un-prescribed prism, base curve differences, poor adjustments, eyewear sitting too far away from the face or too high putting the bifocal in the way, etc.

Often an explanation or adjustment takes care of the issue. I've had patients tell me after an adjustment and checking their vision again at far and near in each eye that they think their issue is solved, or that they want to try a bit longer to adjust to the new glasses before seeing the doctor again.

My ultimate goal is to troubleshoot with the patient and together discover the issue and come to a solution or conclusion that everything is going to be okay following an adjustment or explanation.

Depending upon what we discover we are careful what and how we share our evaluation of their eyewear.

We aren't quick to remake lenses but we also don't push patient's to "get used to it" if there is a legitimate problem. Sometimes it requires sending the patient back to wherever their glasses were made to request they be corrected and brought within ANSI standards. Recently a woman came in and the markings on her lenses were not in the Progressive Identifier listing. I suspected they were digitally produced and therefore the prescription could have been compensated. Indeed the lenses did not match the written prescription. I called the optician and explained that we had a mutual patient and she was having some difficulty with her new lenses and the prescription didn't match her Rx but wondered if they were compensated. She answered that they were a compensated Rx design, but she wanted to review the patient's glasses and would work with her to solve the issue. She thanked me for the call.

Occasionally we need to remake a patient's lenses to change the lens style or raise/lower their segment height. The point is, we try to solve their issue without having to see the doctor again.

Even after our best efforts, sometimes a patient does need to have a short ReRefraction to check their prescription. We schedule those quick recheck appointments and the doctor always begin by reviewing our ReCheck form with all the patients eyeglass measurements along with our notes from our discussion with the patient. Having the information and analysis already completed makes ReCheck appointments go much smoother.

Don't be afraid of patients with problems. No one likes dealing with problems and no patient wants the hassles either. But you can turn around a negative situation and create a loyal patient if you handle it professionally and communicate that you care about their vision and well-being.

Mindi Lewis is the Managing Editor of the Optician’s Handbook. She is currently an Optician at MarinEyes, a multi doctor practice in San Rafael, California. Mindi has had held positions in marketing, training and sales at SOLA Optical/Carl Zeiss Vision and Vision Ease Lens. She is a graduate of and former Instructor at St Petersburg College, Optometric Technology program. She also has a Masters degree in Psychology and Organizational Development from Sonoma State University. Mindi has loved all things related to vision and optics for many years and lives in Petaluma, California with her husband Craig and wonderful doggie Max.