Happily High--Index
How high-index boosts both patient satisfaction and practice income
By Karlen McLean, ABOC, NCLE

Today, most new lens materials boast a refractive index higher than conventional glass or plastic. But high-index lenses are not just about the index. Additional lens attributes, including asphericity/atoricity, impact-resistance, weight, and improved optics--all enhanced by AR--contribute to the high-index category's success in the marketplace.

Digital imagery by Peter Baker

Because each high-index lens has different features, it's important for ECPs to understand the nuances of every high-index lens they recommend and dispense. While "lighter and thinner" have become the two buzz words for high-index in the marketplace, high-index lenses today are about a lot more than that. Recognizing and capitalizing on the ability of high-index lenses to boost patient satisfaction and practice income, more and more ECPs are making high-index the focal point of their eyewear recommendations.

"We always recommend high-index lenses, polycarbonate, or Trivex with AR," says Robert Layman, OD, of the Pinnacle Eye Group, with locations in Lambertville, Mich., and Toledo, Ohio.

Adds Gregg Ossip, OD, of Ossip Optometry & Ophthalmology in Indianapolis, Ind.: "We truly believe in high-index lenses. They give patients incredible optics and the cosmetic thinness everyone desires. High-index is our first choice for most prescriptions."

With attitudes and practice policies like these, high-index continues its upward trend as a lens that increases patient satisfaction and the bottom line.

HIGHLIGHTING HIGH-INDEX

ECPs report that consumer awareness of high-index lenses is definitely on the rise. "Most patients are well informed these days due to commercials on TV and in print," says Mark Cloer, instructor and director of University Ophthalmology Associates, University of Mississippi Medical Center in Jackson, Miss.

Following are a few tips for educating your patients on high-index lenses.

Keep it simple. When it comes to recommendations and dispensing techniques, keeping it simple is the key.

"In the exam room I tell patients that I'd recommend high-index lenses for them because they're thinner, lighter-weight, and, combined with AR, they'll have better visual acuity. I also explain that high-index lenses will be more comfortable both from a wearing and visual standpoint," Layman explains.

Transfer authority. Upon finishing the exam, the doctor escorts patients to the dispensary to meet with an optician, then explains the recommendation to the optician and patient. "The optician follows up by using demonstration tools to show the patient," he adds. "I leave the discussion of which index to select for each patient's Rx up to the optician."

Use demos. Pinnacle Eye Group uses an array of demos, including frames mounted with a standard plastic lens on one side and a high-index lens on the other. The same demo with and without AR is also used. A customized demo created by Toledo Optical (Pinnacle's wholesale lab) features a -6.00D lens in poly on one side and a high-index lens on the other. The practice also uses a virtual dispensing system, "which helps clinically and also in a visual way to explain what high-index is and what it does," says Layman.

Discuss Rx. Cook Inlet Eyewear in Anchorage, Alaska, stresses the advantages of high-index aspheric lenses in relation to Rx. "We have samples of lenses cut in half representing powers of -2.00D, -4.00D, and -6.00D in 1.60 and 1.67 indices, and +2.00D, +4.00D, and +6.00D in aspheric high-index," says Beverly Harper, co-president. "This gives patients a visual of how their lenses may appear."

Wear them. In addition to verbal explanations and demos, Pinnacle Eye Group's doctors and staff wear high-index lenses so they can speak from personal experience when discussing the lenses with their patients.

DISCUSSING OPTIONS

As a rule, as refractive index increases, so does the cost. This is why sales standards like Pinnacle Eye Group's "consultative dispensing" techniques are so important.

"We take our time and use an individualized approach," Layman says. "We want each patient to understand our menu and how it pertains to their quality of life."

"The key is education, and to keep it simple," says Doug Kollar, an optician at Lapeer County Vision Centers with several locations in Lapeer County, Mich. "We use range charts and typically fit plano to -3.00D Rx's in 1.60 index, and -3.25D and up in 1.67 index if available. We always use demos to show the nuances of each type."

Some lens designs are currently not available in high-index in some manufacturer's lens menus. This is changing as the market continues to be successful working with high-index materials and demands more high-index variety.

For example, photochromic high-index lenses today offer many design choices including flattop and PAL multifocals, and a variety of indices from 1.53 to 1.67.

High-index glass options include 1.60 glass, which can be processed with 1.5mm center thickness and pass drop-ball testing; 1.70 glass that can be chemically tempered to meet U.S. standards; and 1.80 and 1.90 glass, which require a release from the doctor to the lab and a patient signature on a waiver.

Currently viewed as a high-end niche market in the U.S., high-index glass is being processed here by a few labs.

ADDRESSING ABERRATION

As lens index increases, less light is transmitted, which can cause visual distortion known as chromatic aberration. Some patients are sensitive to it and can experience tunnel vision.

Distortion can also come from internal reflections in the lens caused by high-indices, along with the infamous "Coke bottle" or ring effect.

Today's high-index lenses--especially when combined with AR--help eliminate visual distortions. There are, however, two schools of thought on discussing aberration with patients.

"Unless the dispenser discusses aberration, it's rarely noticed by the patient. I can only remember one or two cases over the years where I had to address that issue with a patient's eyewear," says Cloer.

Kollar says he prefers the "forewarned is forearmed" approach to interactions with his patients. "I tell them about it in the beginning, so if they experience the problem, they'll think 'this is what we talked about' and be reassured."

"Aberration becomes more problematic when the index of refraction increases, especially above 1.60," says Harper. "AR goes a long way to eliminating those effects."

To ensure the best vision, include AR as part of the high-index lens package. Explain the total lens fee, including AR, by focusing on the overall "best technology" message. That is, after all, what you are striving to provide.