By Judith Lee
The loss of a single contact lens patient has a cost, both to your patient and to your practice. For the patient who drops out of contact lens wear, they are doing so for reasons that can often be addressed by you, their doctor and contact lens specialist. For the practice, the loss of revenues from that patient is considerable, and, for the first time, a study has placed a value upon that.
A patient who drops out of contact lens wear can cost a practice up to $24,000 over the patient’s lifetime. Much of that revenue loss is attributable to the fact that contact lens patients visit your practice more frequently than do eyeglasses-only patients and pay enhanced fees for the additional services you provide.
Don’t Underestimate Dropout Rate
Dropouts are difficult to diagnose because great numbers of contact lens dropouts do so silently; they simply start leaving their contact lenses in a drawer. It is only when they are asked, by their doctor or staff in the course of an annual visit, “How are you enjoying your contact lenses?” that they reveal problems. Common answer: “Well, um, I don’t really wear them much…I mean, not at all.”
The conventional wisdom is that the dropout rate is five to 10 percent of wearers, but it is, in fact, much higher, according to an ongoing worldwide study conducted by Practice Resource Management (PRM). An interim report on the study, which appeared in Review of Optometry in January 2010, puts the dropout rate at 16 percent in the U.S., and even higher in other parts of the world. “We don’t know enough about how, why or which patients discontinue contact lens wear,” said John Rumpakis, OD, MBA, founder of PRM, “but we do know this has a considerable economic impact on a practice.”
Contact Lens Patients Spend…
Contact lens eye exam
Separate charge for CL services $70
Spending on eyeglasses $245
Contact Lens Patients Dropout Because… Comfort/fit: 50%
Eyeglasses vision better: 16%
(U.S. Data, based on 138 practices, 2009)
Be Part of the Study.
The PRM study is ongoing. John Rumpakis, OD, MBA, founder of PRM, invites ECPs to contribute to the growing database about contact lens dropouts: http://GCLAC.PracticeResourceMgmt.com
Address Discomfort: Ask Patients Questions
The PRM study points to discomfort as the leading reason for dropping out of contact lens wear: Fully 50 percent of the dropouts in the study cite this, followed by 16 percent who say their vision is better with eyeglasses. The next logical conclusion: Effectively dealing with these issues can reduce the number of dropouts and minimize losses to your practice. Again, the challenge is patients are reluctant to speak up about lens discomfort.
“A lot of patients have issues they never mention to the doctor; they just put up with it.” says Kevin Roe, OD, director of professional relations at CIBA VISION. “If the doctor doesn’t ask in a way that elicits a candid response, the doctor will never know. Eventually, the patient quietly stops wearing the lenses,” says Roe. That’s why Dr. Roe recommends that ECPs ask leading questions [see Talk the Talk, below], rather than a simple, “So how are you doing with your lenses?”
“Most patients will just say, ‘Fine.’ They don’t know that the doctor could refit with a different lens material or design, that there is new technology that can help,” Dr. Roe observes.
Use Many Tools to Address Discomfort
Steven Bennett, OD, FAAO, a contact lens specialist in Ann Arbor, MI, says clinicians now have excellent tools to resolve lens discomfort. If Dr. Bennett suspects a solutions issue, he will recommend a hydrogen peroxide care system, or refit the patient into daily disposable lenses. For dry eye patients, he will do a complete workup, then recommend whatever he believes will help: a different lens, prescription meds or over the counter artificial tears. “A lot of patients think irritation is just a part of wearing contact lenses,” he says. “Once the patient is educated about the problems, they often will not drop out because they understand it now,” Dr. Bennett said. Patients with low amounts of astigmatism (52 percent of the astigmatic population) are also likely to “grin and bear it.” According to CIBA VISION data, something like 30 percent of current soft lens wearers have cylinder in their spectacle Rx, yet only 16 percent are wearing toric lenses.
Dr. Roe said ECPs should proactively refit low astigmats with toric lenses so they do not ultimately drop out for eyeglasses that provide sharper vision.
As contact lens wearers reach their late 30s, Dr. Bennett “plants the seed” by mentioning presbyopia and the multifocal lenses that are available. When they become emerging presbyopes, he refits with multifocal lenses before they drop out of contact lens wear. Dr. Bennett also recommends that presbyopes who previously dropped out of contact lenses try the newer multifocal lenses.
Talk the Talk
How long can you wear your lenses?
“Can you wear your contact lenses as long in the day as you need to?”
“Is there a time or place where your contact lenses bother you?”
“Do you see better with your contact lenses or your eyeglasses?”
Once the patient gives an answer that indicates a comfort or vision issue, Dr. Roe will respond: “There are new materials/designs that can help you. I recommend that we try another lens on you today.”
Are you happy in them?
“Do you love your contact lenses?”
“What would it take for you to love them?”
Dr. Bennett responds by describing his plan to diagnose or address the issues.
When contact lens wearers are in their late 30s, initiate a new conversation.
“Your eyes are fine now, but in the next few years you will be needing correction for near vision. There are some lenses that will really help you when you do.”
Dr. Roe suggests you ask these questions of every eyeglasses-only patient:
“Have you ever worn contact lenses?
“When was this?
“Why did you stop wearing them?”
Present Benefits of Silicone Hydrogel Lenses
Not only are newer lenses more stable, delivering better vision, they are available in silicone hydrogel (SiHy) materials, which is healthier for the eye and more comfortable for many wearers, notes Dwight Akerman, OD, FAAO, director of professional programs for CIBA VISION. “For aging patients, silicone hydrogel materials are a major step forward. As people age, dry eye symptoms may begin or worsen. They need a lens that doesn’t exacerbate dry eye, and new silicone hydrogel designs fill that need,” Dr. Akerman says.
Some 61 percent of single-vision contact lens wearers are now in SiHy lenses, but only 30 percent of multifocal wearers are in SiHy, according to CIBA VISION data. Drs. Akerman, Roe and Bennett all say that proactively moving patients into monthly replacement lenses will improve compliance, which helps contact lens wearers succeed.
“Consider that 72 percent of patients who wear monthly replacement lenses are compliant with the manufacturer’s recommended replacement schedule, compared with just 48 percent of two-week replacement wearers,” Dr. Akerman explains. “When you convert these patients, ECPs are supporting a better wearing experience.”
Also in this contact lens series: