The main problem is that they don't pay you enough for the exam to pay for your staff while the patient is there, much less leave enough left to pay you. When may dad had it, they sent us a list of what to tell your patient so they would "up-sell" to more coating, thinner lenses, second pairs, add contacts... All things your patient does not really need. But the thing is that you have to do that in order to make any money off them!