Article Date: 12/1/2005

Layout 1

Smoother Sailing for the Contact Lens Practice
The first part of this series on silicone hydrogel lenses discusses the benefits of continuous wear.
BY JEFFREY SHEARER, O.D., Jacksonville, Fla.

Since 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.

My most important considerations as I select lenses are ocular health, comfortable wear and convenience. If I optimize these benefits for patients, everything else is secondary.

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 guiding rule.

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 more referrals.

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 care.

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

High Technology: Silicone Hydrogels on the U.S. Market
There are several options for patients who are interested in this type of lens in both daily-wear and continuous wear.

Acuvue Advance with Hydraclear (Vistakon)
Daily wear, two-week

Acuvue Advance for Astigmatism (Vistakon)
Daily wear, two-week

Acuvue Oasys (Vistakon)
Daily wear, two-week

Focus Night & Day
(CIBA Vision)
30-day continuous-wear

O2 Optix (CIBA Vision)
Daily wear, two-week

Pure Vision
(Bausch & Lomb)
30-day continuous-wear

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 discomfort.

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 normal routine.

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

Monthly Modality Makes Sense — For Patients and Practitioners
Patients may prefer a longer replacement schedule.
By Rhonda Robinson, O.D.. Indianapolis

Today's 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 figure below.)

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
Lenses with New Pair
Every 1-2 weeks Every 3-5 weeks More than 5 weeks

� Less than 33% of lens wearers are compliant on a two-week modality.
� Sixty-seven percent of two-week modality lens wearers stretch their lenses.
� 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 lenses.

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.

More to Come

Our coverage of silicone hydrogel contact lenses continues in our February 2006 issue with an in-depth discussion on two-week replacement lenses.


The Silicone Hydrogel Bottom Line
My 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.

Per Box Materials Fee Cost of Goods Gross Profit  Profit Increase
2-week HEMA lenses $22.50 $13.50 $ 9.00 _
2-week silicone hydrogels $28.00 $14.75 $13.25 + 47%
Monthly continuous-wear lenses  $70.00 $42.50 $27.50 + 206%

Dr. 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