Smoother Sailing for the Contact
first part of this series on silicone hydrogel lenses discusses the benefits of
SHEARER, O.D., Jacksonville, Fla.
I started prescribing contact lenses 20 years ago, my first rule in lens selection
has been to follow the old adage, "What's best for your patients is best for your
practice." The corollary of this rule: "Never fit your patient in a lens you wouldn't
fit on a family member or wear yourself." When I follow these rules, the business
side of my practice falls into place.
most important considerations as I select lenses are ocular health, comfortable
wear and convenience. If I optimize these benefits for patients, everything else
Because contact lens technology keeps evolving, we shouldn't become
complacent and assume that if contact lens patients do not complain, there's no
need to recommend new designs and materials. Complacency is a recipe for prescribing
commodity lenses that patients can buy anywhere. I prefer to fit "high-performance"
lenses they will talk to their friends about. This habit also helps me satisfy my
Benefits of the cutting edge
I continuously test new lenses on small groups of patients. Once
I'm satisfied with the results, I proactively recommend lenses that pass my test,
even to happy patients. Upgrading them to new technology is usually both good practice
and good business; new and improved products usually command higher fees and generate
Silicone hydrogel material is one of those new technologies that
is revolutionizing the contact lens field. These lenses satisfy both my first rule
of lens selection and its corollary. Patients are enthusiastic about these new lenses,
which they are able to wear comfortably all day.
The breakthrough of silicone hydrogels is their superior oxygen
transmissibility. This alleviates many of the traditional problems of lens wear
that we simply learned to tolerate because nothing better was available.
When I refit patients into silicone hydrogels, I observe rapid
and dramatic reductions in the potential signs and symptoms of corneal oxygen deficiency,
including end-of-day discomfort, limbal redness, and corneal neovascularization.
They are easy to fit and patients usually find them comfortable. Silicone hydrogel
lenses have transformed my contact lens practice, and are now my lens of choice.
Getting the lens right
I make extensive use of the new silicone hydrogel lenses designed
for biweekly replacement, and the continuous-wear lenses designed for monthly replacement.
Each appeals to a distinct segment of wearers and each has unique properties designed
for its particular indication.
I began experimenting with continuous-wear lenses in early 2002,
shortly after the FDA approved them for up to 30 continuous nights of wear. They
appealed to me because they offer extremely high levels of oxygen transmissibility
and promise safe overnight wear. My experience back in the '80s taught me that many
patients are convenience-oriented and prefer to eliminate the daily grind of lens
My patients wear their continuous-wear lenses for periods ranging
from a week to the full 30 days. Once I verify there are no clinical contraindications,
I let them decide on the schedule they find most comfortable. I recommend continuous-wear
lenses to those patients who want to regularly sleep in their lenses over night,
or are already doing so with their low-Dk lenses.
My lens of choice offers a Dk of 175, the highest oxygen transmissibility
of any soft lens currently available. This is well above the 125 Dk standard that
researchers have established is necessary to avoid stromal anoxia in overnight wear.
Because continuous-wear is a more demanding wearing schedule for the cornea, it
only makes sense to maximize the amount of oxygen transmissibility we provide these
patients to ensure healthy wear.
Benefits run both ways
Technology: Silicone Hydrogels on the U.S. Market|
are several options for patients who are interested in this type of lens in
both daily-wear and continuous wear.
Acuvue Advance with
Daily wear, two-week
Acuvue Advance for Astigmatism (Vistakon)
Daily wear, two-week
Acuvue Oasys (Vistakon)
Daily wear, two-week
Focus Night & Day
O2 Optix (CIBA Vision)
Daily wear, two-week
Many of my patients report that wearing continuous-wear lenses
has been a life-changing experience. Continuous-wear lenses offer the closest thing
to natural vision. They are the first lens option that can really compete with the
appeal of refractive surgery. The high cost of materials for continuous-wear lenses
and the need for regular follow-up care make these patients among the most profitable
contact lens patients of any practice.
Currently, I estimate that about 10-15% of my soft lens patients
choose a continuous- wear regimen. I expect further growth this year as more patients
become aware of the option.
The silicone option
A much larger segment of my patient base is primarily interested
in a cost-effective daily- or extended-wear lens alternative. They are accustomed
to the routine of daily removal, no-rub cleaning, disinfection and two-week lens
replacement. While most express satisfaction with their HEMA-based, two-week replacement
lenses, they may experience potential symptoms of hypoxia, such as dryness or end-of-day
Patients seldom volunteer these complaints to me. They've come
to accept such annoyances as a necessary evil of wearing contact lenses. Many daily
wear patients occasionally sleep with their lenses on overnight, even though they
are reluctant to admit it.
Silicone hydrogels are the ideal choice for these patients. By
helping to reduce the signs and symptoms of corneal oxygen deficiency, you can dramatically
improve their wearing experience. The contact lenses are available for modestly
more money than traditional two-week replacement lenses and fit into the patient's
Transmissibility is good
When I present silicone hydrogels, I focus on the benefits of
increased oxygen transmissibility. Patients readily understand that their eyes
need oxygen to stay healthy. They are impressed that a silicone hydrogel lens can
provide up to five or six times the oxygen transmissibility of traditional soft
contact lenses. I tell them the result will be less "wear and tear" on their eyes.
My silicone hydrogel lens of choice for daily or extended wear
received FDA approval for up to six nights extended wear. I am also reassured by
the higher oxygen transmissibility of the contact lens.
A balmy future in sight
I estimate that I am now fitting approximately 90% of spherical
lens patients with silicone hydrogels. As more silicone hydrogels become available,
I hope to eliminate the HEMA-based, two-week replacement lenses entirely from my
practice. I eagerly anticipate the launch of toric silicone hydrogels, which may
revitalize that part of my contact lens practice.
This is an exciting time for contact lens wearers. The manufacturers
have "cracked the code" on how to make a lens more breathable, which is a huge leap
forward in healthy lens wear.
I would estimate that last year silicone hydrogels increased my
soft lens materials revenue by at least 20%. And because I know silicone hydrogel
lenses are better for patients, I'm doing them a favor by recommending them. I encourage
you to restore your tired contact lens practices with silicone hydrogel lenses. OM
Modality Makes Sense For Patients and Practitioners|
may prefer a longer replacement schedule.
Rhonda Robinson, O.D.. Indianapolis
contact lens wearers embrace the convenience, comfort, and better vision of modern
lenses. They also are savvy about their purchasing options, including deals online
and through national warehouses. Despite their resourcefulness, many stretch the
length of time they wear their lenses.
Patients who stretch their modality
schedule increase the risk of bacterial binding and infection. Stretching also
reduces the number of times they purchase lenses, and it may reduce the frequency
with which patients visit your practice, even for annual eye exams. By switching
patients from a two-week- to a monthly-replacement lens, you may increase compliance,
ensure eye health, encourage loyalty and increase your profits.
They'll remember if it's monthly
According to research by SCH &
Associates, less than 10% of contact lens wearers are prescribed lenses with a month-long
replacement cycle. But these patients are the most compliant 82% maintain
the recommended monthly frequency for replacing lenses. Compliance rates for wearers
of two-week lenses drops to less than 33%. In fact, 67% of these patients admit
to stretching the wear of their lenses for up to twice as long as they should. (See
The good news is that a majority of
contact lens wearers confirm interest in a 30-day replacement modality. With the
advancements in silicone hydrogel lenses, a monthly modality is appropriate (and
may be preferred) for many patients. According to research silicone hydrogel lenses
with a monthly replacement schedule (Pure Vision, Bausch & Lomb) were superior
to two-week replacement HEMA lenses in slit lamp findings, on-eye performance, patient
symptoms and patient preferences.
Two-Week Replacement Modality
Claimed Frequency of Replacing
Every 3-5 weeks
More than 5 weeks|
than 33% of lens wearers are compliant on a two-week modality.
� Sixty-seven percent of two-week modality lens wearers stretch their
� A majority are wearing a two-week lens for twice as long � they are only
paying half price for those lenses!
Monthly modality and a better bottom line
Low compliance not only affects ocular
health, but also the practice's financial health. Patients who stretch two-week
lenses to four-week wear buy half as many lenses and pay half as much. Monthly
modality provides as much convenience to your practice as it does to the lens wearer.
A year's supply of one-month lenses equates to four boxes easy to sell, easy
to carry when compared with a year's supply of two-week lenses. Monthly disposable
lenses also offer more to your bottom line than an annual supply of two-week disposable
Your patients are also "pantry-stocked"
for 12 months, and may be less inclined to seek out other suppliers by the
time they runout, they'll have returned to your office for their annual exam. This
annual exam/annual supply habit can be easier and more convenient for your patients
than any other lens supply alternative.
Research revealed that patients
on a monthly lens replacement schedule buy an average of 3.7 boxes of lenses a year,
or 93% of the four boxes they should purchase. Two-week wearers purchase an average
of 5.2 boxes a 65% conversion rate, or 28% fewer lenses.
Simple steps for happy, healthy patients
The convenience and comfort that monthly-replacement
lenses offer should make it easy for you to position them as the norm in your practice.
References available upon request.
Our coverage of silicone
hydrogel contact lenses continues in our February 2006 issue with an in-depth discussion
on two-week replacement lenses.
Silicone Hydrogel Bottom Line|
primary motivation for upgrading patients to silicone hydrogel lenses is my belief
that these new materials offer a healthy lens choice. But the financial impact on
my practice has been very beneficial as well.|
HEMA-based disposable-type lenses have become
commodities that are available everywhere, often advertised at very low prices.
That encourages long-term patients to shop around for replacement lenses.
As with all new technology, silicone
hydrogel lenses are now being prescribed most by innovative contact lens specialists
and are not yet heavily advertised by the commercial channels. That makes it easier
for eyecare practitioners to retain silicone hydrogel patients.
To illustrate the financial impact
of silicone hydrogel lenses, I compared my profit from selling a box of daily-wear
silicone hydrogel (02Optix, CIBA Vision) and continuous-wear lenses (Night &
Day, CIBA Vision) versus a box of traditional two-week soft contact lenses. I generate
47% more gross profit when I upgrade patients to two-week replacement silicone hydrogels
from traditional disposable-type lenses, and 206% more profit per box from upgrading
to continuous wear lenses.
With hundreds of patients making the
switch, that provides a sizeable profit boost to the practice.
Cost of Goods
2-week HEMA lenses
2-week silicone hydrogels
Monthly continuous-wear lenses
Shearer has been in his self-started
private practice since 1987, and is a proud member of the American Optometric Association.
He is also a member and past president of the Northeast Florida Optometric Society.
Optometric Management, Issue: December 2005