Contact Lenses

Do You Know Who Your “Slow CL Dropouts” Are? How to Find Out & Stop It From Happening.

The contact-lens room in Dr. Stewart’s practice. She says that you can head off contact-lens dropouts before they even happen by having the right conversations with patients.

By Jennifer L. Stewart, OD

March 30, 2022

Contact-lens patients are more profitable for a practice than glasses-only patients. They return more frequently for comprehensive eyecare and spend more in our practices, coming to us for contact-lens exams, lens purchases, glasses and sunwear.

In addition, happy contact-lens patients are a great source of friends-and-family referrals. My multifocal patients are extremely happy to be independent of glasses and refer me many new patients! When you can wow a patient with new technology, they are appreciative and loyal.

They are especially loyal if you can bring them back to contact lenses after dropping out, or move them to a better lens before dropping out in the first place. There is a group of patients I think of as “slow contact-lens dropouts.” These patients are slowly cutting down on time spent in their contacts. I have learned how to identify these patients and find ways to keep them in their lenses.

Identify Your Slow Dropouts
I track contact-lens sales, including boxes sold and annual supplies. If our percentage of annual supplies is decreasing, it could be indicative of “slow dropouts.” When this happens, it means we have many patients who are still wearing contact lenses, but less frequently.

You May Be Asking the Wrong Question(s)
Don’t ask, “How are your contact lenses?” Ask, “Is there anything I can improve about your current contact lenses?”

Asking open-ended questions is key. If you ask a patient how their lenses are, most will say fine. Some are worried if they say “dry” or “uncomfortable” you will tell them they can’t wear contacts anymore (the contact-lens wearer’s biggest fear!). By asking an open-ended question to encourage dialogue about what can be improved, you can make this conversation less confrontational and dive into areas you can make better.

My techs/scribes start by asking good questions about contact lens wear (frequency, dryness, blurred vision). Then I ask these questions again at the start of the exam. Asking patients if there is anything I can do to improve their contact lens wear takes me less than a minute and greatly enhances patient engagement. It shows the patient that I want to work with them to find a contact lens that suits their needs. This engagement decreases the fear the patient may have that keeps them from being open with me about discomfort and other concerns. I have this conversation about wished-for lens improvements with all patients, even those who have expressed happiness with their contacts.

Zeroing in On the Slow Dropout
This patient used to buy an annual supply, but this year may “have four boxes left because I’ve been wearing my glasses more.” This gradual reduction of contact lens wear could easily turn a patient who buys eight boxes of daily disposable lenses, and used to be highly satisfied with their lenses, and extremely profitable for the practice, into a patient who buys two boxes every two years.

These patients may not have had their needs properly addressed (see above), and instead of telling the ECP why they are wearing less, just find they are less likely to wear their lenses. This could be due to dryness, visual changes (presbyopes not wanting to wear reading glasses) or other discomforts.

Staff can be trained to notice slow dropouts by checking how many boxes of lenses a patient usually purchases. If it is slowing down, a light bulb should go off for both support staff and doctors to ask good, probing questions about dryness, blurry vision at distances and other issues that can cause dissatisfaction.

Is it dryness? Change in work situation? Patient doesn’t want to wear reading glasses? These are all opportunities to showcase new materials and designs of lenses and be excited about the new ways we can wow our patients.

Concentrate on Catching Slow Dropouts Due to Presbyopia
I offer multifocals to all pre-presbyopic and presbyopic contact lens-wearing patients and presbyopic non-contact lens wearers. Current contact lens-wearing patients are not always interested in putting reading glasses on over contact lenses. They may transition to full-time glasses wear instead. By offering the newest in multifocal technology, you can keep these patients in contact lenses full-time.

Front-desk staff should be well versed in fee schedules for contact lens exams. Techs/scribes can ask patients if they are currently wearing multifocal contact lenses to set the stage. Patients can also have multifocal lenses inserted to look at frames in the optical (and opticians can be excited for patients to have clear vision at all distances!). All presbyopic staff, including doctors, should be fit with the newest multifocal lenses to be able to talk about their personal experiences.

ECPs need to feel confident and comfortable fitting multifocal lenses. The new designs do not take much more chair time than fitting single-vision lenses. Utilizing contact-lens reps to learn best practices, and taking advantage of resources from companies (online fitting calculators, fitting guides), will help streamline the process.

Time is required to become more familiar with the multifocal fitting process and how to troubleshoot adaption problems, but that small amount of time can deliver big rewards in patient satisfaction and return visits to your office with annual supplies of multifocal lenses purchased.

Bottom Line
Taking the actions described in this article cost little in time and little-to-no money, and provide the strong potential for increased profitability from greater contact lens sales, increased fitting of premium materials and designs and happy patients more likely to return for care and refer others.

Jennifer Stewart, OD, is a partner at Norwalk Eye Care in Norwalk, Conn, and the co-founder and Chief  Vision Officer of Performance 20/20, a sports and performance training center. She also provides advisory services and consulting to the optometric community through her company, OD Perspectives. She can be reached at


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