O.D. to O.D.



WHERE DID all your contact lens patients go? Maybe you’ve asked that question. Or maybe you hear, “I just can’t wear contact lenses anymore.” These are the symptoms of contact lens intolerance, a “dual” disease that leads to drop out and kills your contact lens practice! The good news. If you recognize it early, you can treat the disease. Let’s take a look.


The first part of the disease is a physiological condition: dry eye. Think about it. If there is not enough tear film to surround both sides of the contact lens, the patient develops increased shear of the epithelial surface and increased lipoprotein deposition on the back surface of the lens.

Most importantly, increased deposition and wettability issues on the front surface of the lens leads to visual fluctuation, the most common symptom of contact lens-associated dry eye. Next, come mechanical and inflammatory changes on the undersurface of the lids.

Eventually, you even get lens dehydration that causes changes in the way the lens fits, especially at the edges, which leads to the conjunctival staining ring around the outside and just inside the lens’ edge. These signs and symptoms “tell” us we have a problem, usually even before the patient voices the issue. Predominantly, patients don’t initially complain, as they think the issue is just the contact lens.


This brings us to the second part of the disease process. Patients visit the office when it gets “bad enough” to bother them. Doctors typically tell them to change solutions. If that doesn’t work, then doctors try to change the contact lens. If that doesn’t work, then doctors add some artificial tears. Three to five visits — and a lot of chair time — later, these patients assume they can’t wear contact lenses anymore. Eventually, the doctor agrees and directs the patient to the optical.

These are the signs and symptoms of the practice disease called “apathy.” This part of the disease is costly. Granted, before dropping out, the contact lens wearer purchased glasses and created a nice revenue stream that year. But after dropping out, he or she now returns every 2 to 3 years. Maybe the patient purchases glasses, and maybe he or she doesn’t. In contrast, contact lens patients return (and purchase a few hundred dollars of materials) every 12 to 14 months. They might purchase sunwear (prescription and non-prescription) and “back-up” glasses every few years. In fact, through a 10-year interim, the contact lens patient creates more than double the revenue stream. In turn, the practice keeps these patients in contact lenses by treating the dry eye. This keeps them functional and happy in contact lenses, which is where they wanted to be in the first place. A pretty great solution where everyone benefits, if you ask me.

To grow your practice, treat dry eye patients currently wearing contact lenses, and they will tell all their friends who “now must wear glasses.” Of course, the downside is that all their friends may leave their current eye care provider and come to your practice. There are worse problems!

So I ask you to listen for the symptoms of “dried out,” or face the drop out, not just from contact lenses but maybe from your practice. OM.