Article Date: 9/1/2012

Contact Lenses: A Tool for Building Patient Loyalty
contact lens patients

Contact Lenses: A Tool for Building Patient Loyalty

Solve patients' problems and demonstrate value — and they will reward you with loyalty and referrals.

Mile Brujic, O.D.

Success in contact lens fitting is one of the most important components in developing a successful optometric practice. There are many opportunities to do a better job in serving our contact lens patients. According to Gary Gerber, O.D., founder of The Power Practice in Franklin Lakes, N.J., roughly 10% of an optometrist's practice revenue is comprised of contact lens services, which means there is great potential for growth.

Educate patients that they're candidates

First and foremost, our patients need to know that they are contact lens candidates. Often, former contact lens wearers and patients who have astigmatism or presbyopia don't even realize new options are available that can make contact lens wear viable for them. A recent survey shows that only 8% of presbyopic patients who complained about near vision were told they were candidates for multifocal contact lenses.1 But the interest in presbyopic contact lens wear is significantly greater. In another study, when contact lens wearers learned they were candidates for multifocal contact lenses, 75% were interested in trying them. Similarly, nearly half of patients requiring vision correction are significantly astigmatic in at least one eye, yet the percentage of toric lens fits is much lower than this.2

This graph describes a model with two practices with 1,000 contact lens wearing patients in year one with an average revenue per patient of $305/year. One practice (red) is proactive and increases their contact lens-wearing base by 7.5% per year, while the other (blue) does not emphasize contact lenses and decreases the number of contact lens wearers by 2.5% every year.

Solve their problems

Once awareness has been increased about the options, there are many other opportunities for promoting successful lens wear. Comfort is consistently identified as a primary reason for discontinuing contact lens wear. As such, we need to be vigilant in identifying and resolving the sources of ocular discomfort for our contact lens wearers.

Chief among these is underlying ocular surface disease.3,4 Dry eye will silently erode a contact lens practice if we are not careful to identify and treat the underlying problems (See “I.D. the Source,” page 54). For a more comfortable wearing experience, improve the quantity and quality of the patient's tear film, and fit the patient with a lens design that optimizes comfort by retaining moisture.

Allergic conjunctivitis also has a negative effect on comfortable contact lens wear and may be hard to identify if the patient is not symptomatic at the time of the appointment. To combat this, I ask about allergies at every patient's visit. Then, I try to enhance their wearing experience by proactively giving them the tools to manage ocular allergies, including the appropriate eye drops, lens materials that do not promote the deposition of proteins, robust care systems and the option of daily disposable contact lenses.

Many patients don't realize the impact their own poor compliance has on their ability to wear lenses comfortably. I find that selecting the best lens option for the patient, educating them on proper care, and then relating care habits to comfort has been a successful strategy. Since we know that comfort resonates so strongly with patients, we should use it as a leverage point in communicating with them.

To a non-compliant lens wearer, I might say: “In my experience, patients who do not replace their lenses on a regular schedule often end up eventually dropping out of lens wear completely because of comfort issues. I always want you to be able to wear your contact lenses comfortably. The best chance of doing that is to wear and care for your lenses the way we discussed and not to let decreased comfort of your lenses guide when you replace them.”

Identify opportunities

With the versatility of designs and materials available in our current contact lens armamentarium, we are fortunate to be able to offer most patients who are interested the opportunity to wear contact lenses. We have a broad range of modalities, from daily disposables to frequent-replacement lenses. Optimizing the replacement schedule for the needs of the patient is critical to maximizing wearing success.

As an example, someone who is more apt to deposit excessive debris on contact lenses even when they are compliant with the care regimen would be poorly served by longer replacement intervals. In fact, a daily disposable lens may be the most appropriate choice for such a patient.

We also have an opportunity to increase comfort and safety for part-time or sporadic lens wearers with daily disposable lenses. Although some part-time wearers can accurately track the age of their lenses and the number of times they have worn them, very few do. These patients may be best served by using a fresh lens every time they wear contact lenses.

Exceed expectations

Patients are looking for good value in contact lenses — but “value” shouldn't be confused with “low cost.” To create value and foster a sense of loyalty, we strive to provide a truly positive experience that exceeds patients' expectations.

One way to do this is by maximizing the time the doctor spends with the patient. This is where the patient will get a sense of the practitioner's passion and commitment to delivering the best vision to them. For contact lens wearers, this means critically assessing the health of the ocular surface, optimizing it to support lens wear and fitting the most advanced lens designs and materials.

Over time, there are new opportunities to enhance even relatively happy lens wearers' contact lens experience. Exceeding expectations makes patients more likely to share their positive experiences with others and be a key referral source of new patients for your practice.

Several years ago, Jason Miller, O.D., M.B.A. (EyeCare Professionals Inc., Powell, Ohio) and I published a model of the economic impact of a reduction in dropouts vs. encouragement of new wearers (See graph on page 52). Today, I would add increased patient loyalty and referrals to that model as additional benefits of the contact lens patient-centered approach. These additional factors contribute significant benefits to practice profitability.

Ultimately, I believe that the best practice management rule is to do what is in the best interest of the patient. When that becomes the impetus for clinical decisions in contact lens fitting, we set the stage for healthy, loyal contact lens wearers. By carefully examining your patient encounters, clinical assessments, contact lens materials and designs with a critical eye to improved patient outcomes, you will be certain to achieve these goals and create a profitable practice with a highly loyal patient base. OM

I.D. the Source
There are certain critical components to an anterior segment examination that will reveal compromise to the ocular surface. I would recommend incorporating these elements into every slit lamp examination:
► Use fluorescein with a wratten filter to assess corneal and conjunctival staining. Pay careful attention to the lid wiper area, which is the area just posterior to the meibomian glands on the superior eyelid. Additionally, measuring tear film break-up time can also aid in assessing the quality of the tear film.
► Use lissamine green to evaluate corneal and conjunctival staining.
► Assess the meibomian glands, applying pressure to the eyelid, to determine the quality of the lipids that are expressed and whether there is any stagnation.
► Always assess the superior tarsal plate.

1. The Contact Lens Council. Aug., 2007.
2. Young G, Sulley A, Hunt C. Prevalence of astigmatism in relation to soft contact lens fitting. Eye & Contact Lens 2011 Jan; 37.
3. Nichols JJ, Ziegler C, Nichols KK. Self-reported dry eye disease across refractive modalities. Invest Ophthalmol Vis Sci 2005 Jun;46(6):1911-4.
4. Guillon M, Maissa, C. Dry eye symptomatology of soft contact lens wearers and nonwearers. Optom Vis Sci 2005 Sep;82(9): 829-34.

Dr. Brujic is a partner of Premier Vision Group, a 4-location optometric practice in northwest Ohio. He has lectured, written, acted in an advisory capacity or performed research for the following companies: Alcon, Allergan, Odyssey Medical, TelScreen, Valeant Pharmaceuticals and VISTAKON Division of Johnson & Johnson Vision Care, Inc. Dr. Brujic received an honorarium from VISTAKON for his work in developing this article. E-mail him at brujic@prodigy.net, or send comments to optometricmanagement@gmail.com.


Optometric Management, Volume: 47 , Issue: September 2012, page(s): 52 - 54