Article Date: 5/1/2004

contact lens
Examining the Impact of High-Tech Contact Lenses in One O.D. Practice

This three-O.D. practice sees bottom-line benefits from adopting new technologies -- in this case, a new silicone hydrogel lens.

The early adopters of any new product or technology stand to garner the lion's share of the market. That's proven true with hyper-Dk/t silicone hydrogel contact lenses, for which the 80/20 rule pertains -- namely that about 80% of the first wave of prescriptions come from around 20% of practitioners, according to CIBA Vision sales figures. So who are these practitioners? Do they recognize the potential? Here's a profile of one optometric practice for which the commitment to integrate new high-tech products has made a difference. 

True to our practice philosophy of offering a higher level of patient satisfaction, we were primed to fit hyper-Dk/t silicone hydrogel contact lenses for continuous wear when they became available. We knew the market demand for continuous wear was strong, and we believed that with the right product, the right fit and the right oversight, patients could find success.

We knew this from our experience in the late 1970s, when Dr. Anderson was one of five clinical evaluators in Michigan on early extended wear lenses. He fit and followed 550 patients with 100% silicone soft lenses and found they were very successful for many patients.

Left to right: Fred Anderson, O.D.; Douglas Batchelder, O.D.; and Stephen Prince, O.D.

Generate early interest

So it was with keen interest that we met the news that a manufacturer was developing a silicone hydrogel material. During a trip to CIBA Vision, a Canadian practitioner told us of the excellent clinical results he'd had with Focus Night & Day, the company's hyper-Dk/t silicone hydrogel lens. We determined we wanted to be among the first to have a fitting set.

As soon as the FDA approved the lens, we began talking with patients about the new technology. By the time our fitting set arrived, we had more than 150 patient names on a waiting list. These patients were eager to try the lens on a continuous wear basis for up to 30 nights, and they were enthusiastic ambassadors for the practice in those first months the lens was out. Indeed, by embracing the technology right from the start, we managed to get a substantial leap on the competition. Plus, that early recognition builds on itself. Referrals were strong.

Establish fitting guidelines

We make it a practice that the three of us have lunch together every day. These informal sessions allow us to exchange ideas and share clinical experiences.

Through those discussions, we came up with a set of fitting guidelines for the lens. We decided that the 8.6 mm lens would be our first choice for most patients because we want the loosest fit that's still comfortable for the patient. For a lens fit to be successful, there must be some movement, but not too much. We'll prescribe the
8.4 mm base curve if we observe a poor fit or if the patient complains of edge awareness.

We were all impressed with the clinical results and the health aspects of the lens. About six weeks after the lens arrived, we came to a conclusion: We should routinely offer it as our lens of choice.

Define the market

We began aggressively promoting the lens, primarily because of its health benefits and patient convenience. This lens wouldn't contribute to edema when patients slept in it. We knew from our shared experiences that if a patient had good tear flow, a good blink pattern and as long as the lens moved well and felt comfortable, we would get a successful fit, assuming we could provide good vision. Patients jumped at the opportunity to not have to clean or disinfect a lens. In fact, the convenience that a 30-day continuous wear lens offers created a new market among patients who didn't want to wear eyeglasses and didn't want LASIK, but weren't interested in "fussing" with contact lenses.

That new market, in a word, was "men." Because many women apply make-up in the morning, taking the time to put in contact lenses wasn't seen as too much of a hassle. But men instantly saw the appeal of contact lenses they didn't have to remove and insert daily.

That's not to say we overlooked female patients as candidates. But men who weren't currently wearing contact lenses became a prime new area for us.

Two-year results

Now that we've been fitting the lens for more than two years, about 70% of our spherical soft contact lens patients are wearing it. We explain to new patients that a new lens material is superior in eye physiology; not only is it more breathable, but they can wear the lens for up to 30 nights and days at a time. That appeals to nearly everyone, as evidenced by the fact that we're dispensing approximately 250 boxes of Night & Day each month.

Cost and follow-up care

If the patient's initial response to the fit is good, then we explain the costs of the lens. Patients expect that the unique lens will be costlier and they understand the cost of convenience. We also explain that our fitting fees for this lens are higher because we feel that it's important to do checkups on our continuous wear patients regularly. We see patients at one week of continuous wear, and if all is going well, then we see them again two weeks after that. That's when we provide a six-month supply of contact lenses and tell the patient we want to see them again at six weeks after the initial fit. At that point, the patient should be on the second set of lenses.

While the conventional wisdom is to get patients into annual supply purchases whenever possible, with this new contact lens, we go with a six-month supply in the first year. One reason is that it serves as a chance to reinforce the replacement schedule. At our six-month visit, they should have just opened their last package of lenses. With more frequent visits, we can ensure that patients are complying with our instructions (we'd rather not discover that at their annual exams). After one year of successful wear, we offer the patient the opportunity to purchase a 12-month supply.

The office vs. mail order

We set our price per box of Night & Day somewhat higher than mail-order competitors' prices. We tell patients, "It's a little more expensive than if you ordered it through mail-order, but we offer a free trial replacement for any lens." In other words, "If you put on a new lens and it's uncomfortable, take it out, rinse it, make sure it's not inside out and try it again. If it's still uncomfortable, throw it away and we'll replace it."

When patients hear that, they know it's an offer that an online or mail-order seller would never match. They see our slightly higher price per box as an inexpensive insurance policy on their lenses. Even the most price-conscious patient sees that just one free replacement would more than make up the savings offered by a low-cost seller.

Plus, by maintaining an inventory of these lenses, we're able to send patients home with a six-month supply. Patients appreciate knowing they don't have to return for a shipment of lenses. They also know that we have enough on hand should they need one of the guaranteed replacement lenses.

All in all, by offering greater service and satisfaction, patients are less likely to shop around for a lower price.

Setting the schedule

About half of our Night & Day patients wear their lenses for the full 30 days continuously. Others have developed their own flexible wear schedule. Some patients remove the lens after two weeks of continuous wear; some remove it two or three times a week. Only about 5% wear the lens as a daily wear lens. We recommend Clear Care for those patients who require a cleaning and disinfection system.

Patients gradually evolve into a wearing pattern that's most comfortable for them. We tell them, "Check your eyes for signs of redness, irritation or blurred vision; if that happens, remove the lenses and call our office."

The benefits of technology

Our experience with the Night & Day lens has proven what we thought to be the case: Resistance to continuous wear is primarily practitioner-driven. If you assure patients that they can safely wear lenses overnight, then they'll be delighted to try them. And success multiplies quickly. More than two years after its introduction, we're still benefiting from being out in front with the new technology. It's provided us with immediate financial benefits and a long-lasting lead.

Drs. Anderson, Batchelder and Prince are in a group private practice.


Optometric Management, Issue: May 2004