Patient Perceptions Drive Referrals

Most patients are satisfied with their eyecare providers and can be a great source of referrals for a practice.


Patient Perceptions Drive Referrals

Most patients are satisfied with their eyecare providers and can be a great source of referrals for a practice.

images Dr. Schnider is senior director of Professional Communications for Vistakon Division of Johnson & Johnson Vision Care, Inc.

By Cristina Schnider, OD

The vast majority of U.S. adults (79 percent) wear some type of vision correction, and nearly all (96 percent) place a high value on maintaining proper vision, according to a recent survey conducted by Harris Interactive, Inc. on behalf of Vistakon Division of Johnson & Johnson Vision Care, Inc.

The 2012 Americans’ Attitudes and Perceptions about Vision Care Survey was conducted in February and March 2012, with a nationally representative sample of 1,000 U.S. adults responding to the online questionnaire.

More than half (55 percent) of those responding reported having visited an eyecare professional within the past year, an increase compared to the 50-percent figure from the same survey in 2006. The improvement may be due in part to more people getting their eyes checked on a set schedule (e.g., annually or every other year) and to more people receiving reminders from their eyecare professionals to schedule an exam (Figure 1). Still, the survey indicated that approximately one in five adults (21 percent) mistakenly think that they do not need an eye exam unless they are having difficulty seeing.

“The good news in this survey is that people are seeing an eyecare practitioner more often, so we have more opportunities to educate,” says Christi Closson, OD, FAAO, who has an independent optometric practice in a Walmart Vision Center in Cornelius, Ore., and serves as an adjunct professor at Pacific University College of Optometry. Among the most challenging group to target, she says, are healthy 20- to 40-year-old adults who aren’t experiencing refractive changes that might motivate them to seek an exam. “One of the things I try to impress upon people in this age group is how much more we know and are still learning about the preventive benefits of good nutrition and ultraviolet protection,” says Dr. Closson. “A dilated eye exam is really the baseline for educating patients about developing healthy habits now that will help them maintain their eyesight into the future.”

Contact Lens Wearers

Eight in 10 contact lens wearers feel much more attractive in contact lenses than in eyeglasses, according to the survey, and about one in seven spectacles-only wearers said that they would consider wearing contact lenses that could handle their specific vision correction needs.


Figure 1. Graph from survey showing what drives exams.

When it comes to deciding what type of contact lenses they wear, 91 percent of contact lens wearers reported that they rely on their eyecare practitioner to recommend a brand. But 20 percent also seek information online, and 16 percent said that they ask family and friends for product recommendations. Eyecare providers are considered the leading and most trusted source for information about vision care products overall.

About one in 10 astigmats (11 percent) said that they have been told by their eyecare provider that they can’t wear contact lenses because of astigmatism, but a much higher percentage (71 percent) mistakenly believe that they aren’t candidates for contact lens wear because of their astigmatism. By educating these patients about newer toric lens options that offer better rotational stability and all-day comfort for astigmats, practitioners have an opportunity to exceed their expectations.

The survey showed that the use of daily disposable contact lenses is increasing. Nearly one in five contact lens wearers (17 percent) reported that they wear this type of contact lens, while slightly more (22 percent to 24 percent) said that their eyecare provider has suggested daily disposable lenses.

Dr. Closson frequently recommends a daily disposable lens. “It’s always my first choice because I feel strongly that it’s the healthiest way to wear lenses,” she says. Although her independent practice is in a Walmart Vision Center, Dr. Closson rarely finds price to be a significant barrier, especially once patients have a chance to try out the lenses.

She recently saw a young man who was a first-time contact lens wearer and had prepared for his exam by researching contact lenses online. “When I recommended daily disposables, his first reaction was to say, ‘Aren’t those really expensive?’ and his tone and body language were really negative,” recalls Dr. Closson. But after she discussed the convenience, the cost of care solutions, and the actual price difference compared to the lenses that he thought he wanted, the patient changed his mind completely. “Sometimes, all it takes is a two-minute conversation to re-frame the discussion and potentially fit such patients with a lens that will keep them comfortable and happy for a longer duration,” she says.

Retaining Patients and Purchases

The top two drivers for where patients purchase their contact lenses are price and convenience. Nearly all (93 percent) purchased lenses from the same place where they’d had their last eye exam, a significant increase compared to 9 percent in 2006. This echoes findings in other recent studies, as does the fact that most lens purchases are made at the offices of independent eyecare professionals (Olivares et al, 2011).

“Patients want convenience,” says Charles F. Bittel III, OD, a practitioner in Yorba Linda, Calif. “So getting them in your exam chair is half the battle. Once there, the most convenient choice is to make a purchase from you,” he says. Too often, patients have preconceived notions that there is a huge gap between in-office prices and those of an online retailer. “Once we explain all the insurance benefits and discounts available to them, patients see there isn’t a big difference, and they typically prefer to get all of their vision care services and products in one place.”

Building Professional Referrals

You can build professional referrals through simple measures such as routine correspondence. Every time you perform a diabetic eye exam, for example, send a courtesy status update back to the primary care physician, whether that physician referred the patient to you or not. Sharing information helps to improve care—and it also earns you referrals that might otherwise go to MD colleagues, says Christi Closson, OD. “It’s a sign of professionalism and one that keeps you top-of-mind when that busy family practitioner needs to make a referral for an eye exam.”


Figure 2. Graph from survey showing which respondents sought referrals.

Turning Satisfaction Into Referrals

More than three in four people (78 percent) said that they had sought a referral to choose their current eyecare provider (Figure 2), with women being more likely to do so compared to men. The largest source of referrals was word-of-mouth, from family members, friends, or coworkers (40 percent). A large percentage also sought professional referrals from their healthcare provider (21 percent), insurance company (19 percent), or another eyecare provider (10 percent).

“This report really highlights for me the importance of managing your relationships with pediatricians and other healthcare providers who may be an important source of referrals,” says Dr. Bittel. See also “Building Professional Referrals” on p. 42.

One way that Dr. Bittel tries to engage current patients and encourage referrals is by making sure he and his staff educate patients about something new every time they come in. “You never want that annual visit to feel like a waste of time,” he says.

But for contact lens wearers, the exam experience itself may not be the most important factor in whether they recommend their eyecare practitioner. Six months after that exam, when a co-worker asks for a recommendation at the end of a long day at the office, the most important factor may be how their eyes feel at that moment.

“That’s why it is so important to prescribe contact lenses that offer the best possible vision, comfort, and convenience,” says Dr. Bittel. “If I’ve given patients the best products I can—good glasses and contact lenses that don’t dry out—then they will have something to brag about to friends and family members who might not be as happy with their vision correction.”

He’s right that exceeding expectations affects referrals. Among contact lens wearers who are very happy with their eyecare provider, 73 percent are extremely likely to recommend that practitioner to others, compared to just 3 percent of moderately satisfied to dissatisfied patients, according to the survey.

Cultivate a Positive Online and Offline Presence

Among the best news in this survey is that 80 percent of patients are “extremely satisfied” or “very satisfied” with their regular eyecare professional, an 18-percent increase compared to 2006 (Figure 3). One strategy to garner referrals is to turn those happy, highly motivated patients into online cheerleaders for your practice. Today’s patients often access information about their vision care on Facebook, Google searches, and online review sites.

“I think Yelp is one of the best-kept secrets,” says Thomas D. Barreto, OD, owner of Eyes on Broadway in Portland, Ore. He encourages every patient to review him on Yelp because having more reviews helps move his website to the top of Google searches and influences those searching for a new provider. “People trust this community of strangers almost as much as they trust people whom they actually know,” he says. “Moreover, people who read reviews tend to be exactly the sort of patients you want—those who choose practitioners based on perceived quality rather than just price or a buy-one-get-one-free deal on frames.”


Figure 3. Graph from survey showing patient satisfaction with their eyecare practitioner.

Of course, unhappy patients are also motivated to post online reviews. It’s important to stay on top of those reviews and to personally reach out to patients who, for example, had a negative interaction with a staff member. It’s not always possible to turn the negative review into a positive one, but Dr. Barreto says online readers don’t necessarily expect a perfect rating. “A solid volume of positive reviews helps to counter the negative ones,” he says.

Building and regularly refreshing online content takes a lot of effort, but it can pay off. “An active Facebook page is essentially free advertising for your practice,” says Dr. Bittel. His staff encourages patients to “check in” on Facebook upon arrival at their office.

Dr. Barreto also finds that being active in his community generates referrals. “People remember that you’ve been a loyal supporter of their kids’ school, or the symphony, or the garden club. They get to know and like you as a person, and that translates into trust in your professional abilities as well,” he says. “Eye care is fundamentally a relationship business. People want to go to practitioners whom they trust.”

Satisfied Lens Wearers Can Generate Referrals

A healthy, enduring practice has to be a mix of loyal patient retention and new patient recruitment—and contact lenses play a critical role in both areas. For contact lens wearers, satisfaction (or dissatisfaction) with the product is registered every day that they wear their lenses, which in turn significantly affects their satisfaction with their eyecare professional and practice. Those on the verge of dropout may quietly go elsewhere if they feel their provider doesn’t have a solution to improve their comfort. Solve their problem, and you gain advocates. Not only do you retain those patients, but you also have an opportunity to build a constant flow of new business through the network of people influenced by your happy patients. CLS

Dr. Closson and Dr. Bittel are consultants to Vistakon; Dr. Barreto has no financial relationships to disclose.

For references, please visit and click on document #210.