By Chris Smiley, OD
One-month and one-day replacement contact lenses increase compliance, enhance comfort and reduce costly dropouts.
SEIZE OPPORTUNITY to improve patient compliance, comfort and limit dropouts
EDUCATE patients on why daily- and monthly-replacement is better.
RECOMMEND the best modality for patients using doctor’s authority.
Our contact lens patients usually love their contact lenses, but often don’t love complying with the wear and care regimens we give them. For that reason, one-day and one-month replacement contacts often are the best modality. It’s easier to remember to throw away a contact lens once a month than once every two weeks, and it’s even easier to simply remember to throw out the contacts every night and put a fresh pair on the next morning. Here is the approach my practice takes to prescribing one-day and one-month replacement lenses.
Some 1,400-1,500 contact lens wearers are seen at our practice annually. About 45-50 percent of these wearers are in one-day lenses. About 40-45 percent are in one-month lenses. The rest are in some sort of specialty lens.
Is there any other choice other than a daily- or one-month lens? I favor daily replacement when the product is available in a patient’s prescription and lean toward monthly due to the current broader availability of product. However, I expect that to change with future product launches, so that in the next few years, I expect my daily-replacement lens prescriptions to approach 80 percent. Air OPTIX Night & Day is my lens of choice for patients who prefer the convenience of being able to sleep in their lenses.
Dr. Smiley’s practice, Vision Professionals, in New Albany, Ohio. Contact lens supplies can be seen in the distance, on a shelf adjacent to the optical dispensary.
The majority of patients drop out due to comfort issues or quality of vision issues, especially as they become presbyopic. I believe that daily lenses offer patients the opportunity to wear contacts for particular days or activities when glasses get in the way. I believe that newer daily-replacement lenses are making lens wear more comfortable for a lot of people. Monthly lenses offer presbyopic options better than ever before. Materials such as those used in DAILIES Total 1 lenses will make a dent in slowing the dropout rate as this technology allows the lens to feel comfortable from morning to evening, and many patients don’t even notice they are wearing the lens. I estimate my practice’s dropout rate to be around 5 percent annually overall (for wearers in all modalities). Editor’s Note: According to the Management & Business Academy 2013 Key Metrics (p. 30), contact lens materials generate 16 percent of total gross revenue in the average independent optometric practice.
Daily lenses allow the patient to insert a clean and sterile lens every day. No lens could possibly be healthier. For monthly replacement patients, the compliance advantage compared to wearers of two-week lenses is substantial. Monthly replacement options such as AIR OPTIX AQUA contains the “tricomfort technology” which allows the lens to have 1. Breathability (rich oxygen flow), 2. moisture retention (for all-day comfort) and 3. deposit resistance (via ultra smooth surface).
I find that non-compliance with a daily lens is rare. It certainly is the most compliant modality. Studies show that compliance is better for daily than for monthly lenses. It’s not as hard for patients to remember.
I explain to patients that most new contact lenses being launched are daily, meaning it is the latest and best contact lens technology. I further explain that we are seeing that having a clean, sterile lens every day is the healthiest option. I tend to be forward-looking and let patients know the future of contact lenses is the daily modality. I’m of the opinion that all other options will eventually be obsolete. Daily lenses often contain a moisturizing agent that releases with every blink to keep the eyes comfortable all day (e.g. Dailies Aqua Comfort Plus) or a water gradient lens (e.g. DAILIES Total 1) that mimics the eye’s natural environment that is ultra slick (lubricious) and mimics blinking over the natural eye.
I usually find that patients are wearing their two-week lenses monthly anyway. I then ask them: “Why not wear a lens that is designed for how you are already wearing your lenses?
Generally speaking, I make the recommendation as to which lens I think is best, and there is little discussion on the differences unless the patient questions or exhibits resistance. Patients look to us for our recommendations. I try to update patients’ lens technology every three years, so our patients frequently come in asking what is new. For skeptical patients, is helpful to find an issue such as decreased end-of-day comfort to make the recommendation to change–understandably this sometimes can be difficult to do. Discussing the benefits such as improved ocular health and comfort can be helpful. For really skeptical patients, I advise them that I want them to be wearing contact lenses 10 or 20 years from now . . . the best way to do that is to wear the very best and healthiest lens NOW, not later when a problem exists. I add: “I know you like your 1990 model car, but when you go to the car dealer, will you buy a new 1990 model car or upgrade to the latest model? Similar technology advancements exist in contact lenses to help ensure your long-term contact lens wearing success.”
In the end, if a patient still resists, I don’t want them to lose trust in me, therefore, I use the opportunity to “plant the seed,” finding if I do so that patients are much more ready to make the upgrade the next year–often times they even ask for the upgrade themselves.
I think many OD’s avoid the daily or monthly lens recommendation because they assume a patient will resist or say no. It is our job to educate every patient. Don’t take a resisting patient personally, but, rather see it as an opportunity. These “seed plantings” will grow and so will your success in converting patients in subsequent years.
Don’t Prejudge Patients’ Buying Ability
I don’t make financial decisions for patients. I let them make those decisions for me. Cost-conscious patients often give “red flags” that alert me to this. I still let them know what is best for them, which I think patients appreciate. If the patient asks about cost, I advise them that a daily lens does cost more than a monthly or two-week lens. Why shouldn’t it if the patient is getting 360 pairs of lenses vs.12 or 24 pairs of lenses. But I further explain that as an example the Dailies ACP product offers a large annual supply rebate ($100) and the patient really needs to consider the total cost as they will be saving $10 a month or $120 per year roughly in solutions that is in their grocery bill. So, while they are spending more on lenses, they are saving at the grocery store. The daily lens cost ends up only being $5-$10 (a visit to Starbucks) more a month when all factors are considered. So, why not wear the healthier lens? I usually only offer this discussion when brought up. I keep the focus on the benefits and improvements the lenses offer, but this is a helpful tactic when price resistance occurs.
Don’t be afraid of the cost discussion. Compared to dental and other healthcare costs, an annual supply of premium daily contacts is very reasonable. Doctors complain that the 1-800 contact lens retailers and other competitors are hurting profits and driving down cost, yet maintain the status quo by keeping patients in the same lens year after year. Doctors must utilize the exam as an opportunity to upgrade and restore value to the services we provide. An essential part of that value proposition is moving patients into one-day and one-month contact lenses.
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