Article Date: 9/1/2004

contact lens dropouts
Treat Your Contact Lens Dropouts
The author suggests a system for refitting dropouts or unhappy contact lens wearers.
BY CHARLES M. KNUDSON, O.D., Denver, Colo.

The patient: A beautiful woman, highly successful in the cosmetics business. The problem: red, irritated eyes from her contact lenses. That's hardly unusual in Denver's dry climate.


What was unusual was her willingness to try different contact lenses, hoping that a new lens would solve her problems. Last year, I converted her to the hyper-Dk/t (Dk/t of 125 or above) silicone hydrogel lens approved for up to 30 nights of continuous wear. She returned to my office recently with a big smile and stunningly white, bright eyes.

Not only is she a delightful patient, but she has already referred quite a few new patients to the practice. If she hadn't switched to the hyper-Dk/t silicone hydrogel lens, chances are that sooner rather than later, she would've joined the 2.4 million U.S. contact lens wearers each year who drop out.

Don't write them off

Each year, U.S. eyecare professionals prescribe contact lenses to more than 3 million new wearers. However, with the high dropout rate, the overall market penetration only creeps upward. When viewing the market potential, it's important to keep the more than 16 million former contact lens wearers in mind. If we can persuade them that today's hyper-Dk/t silicone hydrogel contact lenses are more convenient, more comfortable and healthier, then this group can be among our prime contact lens candidate.

Just as importantly (from a practice perspective), retaining patients is far less expensive than attracting new patients. The more our patients help advertise our practices, the better.

When approaching patients, the first step is always: Ask questions. In our practice, it all starts with a lifestyle questionnaire. It asks patients to include not only the chief reason for their visit, but also if they have any questions or interest in LASIK, contact lenses or eyeglasses. It also asks if patients have ever worn contact lenses before. From there on, the approach differs.

For ex-contact lens wearers

Whenever I meet a patient who used to wear contact lenses but no longer does, I ask why. Patients cite a variety of reasons for dropping out, but the most common are discomfort and annoyance with cleaning and care. Dryness issues and ease of handling fall under those categories. Given the fact that nearly as many patients drop out of contact lenses each year as start with contact lenses, this is a large group of patients. Learning the factors that caused these patients to drop out provides an opportunity to say that great strides have been made in the technology, comfort, handling and convenience of contact lenses.

In our practice, many patients overcame their hesitation by trying a pair of hyper-Dk/t silicone lenses, of which there is only one -- Focus Night & Day. (Editor's note: Under the terms of a recent settlement, Bausch & Lomb may resume the sale of PureVision, its hyper-Dk/t silicone hydrogel lens, in the United States on April 27, 2005.) Before these patients leave the office with a trial pair, we've reviewed the advantages of the new technology:

Breathable material. With a Dk/t of 175, the Night & Day lens surpasses the benchmark of 125 Dk/t needed for no corneal edema during overnight wear. I explain to patients how low-Dk/t lenses can cause overnight corneal swelling, but clinical results with the hyper-Dk/t silicone lenses show overnight edema at about the same level as not wearing any contacts at all.

Convenience. Just because the lens is approved for up to 30 nights of continuous wear doesn't mean patients must wear it that way. I tell patients that my wife and I both wear our lenses for 30 nights continuously -- a fact that provides them with a measure of comfort in choosing the wearing schedule that best suits them.

I surprise patients when I start talking about the possibility of sleeping in contact lenses because, until recently, I was one of those O.D.s sternly warning about the consequences of overnight wear. I wasn't comfortable with the idea, which is why my wife and I served as my first guinea pigs. Patients realize that I can choose any lens on the market, so the fact that I chose this one carries substantial weight.

Patients who dropped out of contact lenses because they didn't like cleaning their lenses or had difficulties handling them agree that handling lenses only once a month seems much easier.

Greater comfort. Patients often tell me they stopped wearing contact lenses when they moved to Denver. The mile-high climate is particularly hostile to anyone who experiences dryness with contact lenses. After an initial adjustment period, most patients find they can wear these lenses comfortably for long hours -- if not overnight -- with no dryness symptoms.

Deposit resistance. This hyper-Dk/t silicone hydrogel material has been designed to be deposit-resistant, improving its overall comfort even more.

Dealing with the dissatisfied

Because comfort and convenience are the major reasons why patients drop out of contact lenses, it's not surprising that those are the factors cited by patients who are approaching the dropout point. I listen carefully for signs of dissatisfaction from returning contact lens patients. These include comments such as, "I need to take my contacts out around dinner time," or "I traveled to a more humid climate and my contact lenses felt great." A patient who has been wearing contact lenses and returns only for an eyeglass exam is also signaling that they're losing interest in the modality.

What these patients want to hear is that the problem isn't with them, but with the contact lenses or even with the solutions that they're using. I explain the benefits of the new technology, just as I would with patients who've already dropped out. In many ways, these patients are similar, having become disenchanted with contact lens wear.

Don't let them cross the line

Many practitioners may find this approach obvious. Most of us even have a selection of lenses that we turn to when solving problems. But I don't consider hyper-Dk/t silicone lenses a niche product -- and that's where our approach may begin to differ.

We believe that a fine line differentiates a complacent contact lens wearer from a dissatisfied patient. The factors that push them from one category into the next are numerous. It might be the cleaning solution they buy one month that causes irritation. It might be as simple as a change in working hours that makes minor annoyances major ones. It might be a change in hobbies for which the contact lenses don't suit their visual needs as well. And if we simply refit those complacent patients with a new prescription in their existing lens, then in a way we're simply hoping that all goes well for the next year.

Question the status quo

Most patients, when asked how they're doing with their contact lenses, will answer, "Fine." In other words, unless a problem is fairly severe, patients won't complain. That may be because they fear our only response will be to take them out of contact lenses. Or because they simply don't know any better. If a decade of experience has taught them that contact lenses feel dry and uncomfortable by 6 p.m., then they figure that's how it must be.

While I may let "fine" be their initial answer, I never expect it to be their last. During the exam, I ask other questions -- about lens handling, end-of-day comfort or appearance of their eyes and convenience. It's a rare patient who is ecstatic about all elements of their contact lenses. As they begin describing the ideal lens -- and how their current lens falls short -- they essentially describe the hyper-Dk/t silicone lens.

Beware the LASIK signal

Patients who ask questions about LASIK are typically also signaling some discontent with their eyeglasses or contact lenses. For many, hyper-Dk/t silicone lenses provides a permanent alternative to surgery or a satisfactory interim solution until they decide or can afford to have LASIK.

I suggest to any patient seriously planning LASIK to switch into this lens first. That way, their corneas can achieve optimum health and oxygen flow now -- with the bonus of continuous vision. Many decide that hyper-Dk/t silicone lenses fit the bill quite nicely and change their minds about having the surgery.

Don't neglect follow through

Beyond following up an initial fit, it's also important to follow through with the patient. In this office, that includes the specific request to refer friends and family to the practice. Our practice does little to no paid external advertising other than maintaining a Yellow Pages listing. We're reliant on word-of-mouth advertising. Our follow-through procedure includes the following:

Ask for referrals. When I solve a patient's problem -- or keep one from developing -- I say, "If you know other people who are having the same issues, please send them to me. I'd be happy to do the same for them." If you don't ask for referrals, patients often assume the practice is too busy to take new patients.

Reward referrals. We reward patients with in-office coupons for any referrals they make. Existing patients can receive a $10 coupon for any new eye exam patient who comes to us and a $50 coupon for any LASIK patient managed through our office. Patients can use these coupons on the purchase of any eye wear in our office. The forms are available through our Web site, so it's easy for patients to get credit for their referrals.

Educate patients. Before patients leave my office, I hand them several of my business cards that they can distribute to their friends and family. I also hand Night & Day patients the product brochure. I've told them a lot of information about what makes this lens unique and special, but I can't expect them to remember it all. Having the brochure in hand means it's more likely they can effectively spread the word to their friends.

We've found that this approach of discussing contact lenses with patients works much better. Certainly, we could spend money on newspaper advertisements, but who gets excited about those? However, patients do get excited when someone else tells them, "Dr. Knudson gave me these brand new contact lenses that I can sleep in. And, they're much safer for my eyes than the two-week disposables that I used to sleep in."

One last piece of advice

Stay in the lead. Our practice has received a lot of free publicity for being on the cutting edge of technology. When hyper-Dk/t silicone lenses first became available, the local news featured us talking about the advanced material. Those news reports are now part of an ongoing video loop that plays in our reception areas. It reinforces our image in the community as experts and cutting-edge practitioners.

Patients want to know that their practitioners can provide the latest and greatest. In our case, we take that to include solving problems patients haven't yet begun to articulate.

References available on request

Dr. Knudson is president and CEO of Vision Care Specialists, a 13-O.D., three-M.D. practice with five locations in the Denver Metro area.


Optometric Management, Issue: September 2004