PHOTOCHROMICS:Better Products for Better Care
Technology transforms photochromics into an everyday, high-performance lens.
KENNETH J. SCHERICK, O.D.

Having dispensed photochromics since the introduction of some of the first glass lenses in the 1970s, I'm among the large group of eyecare professionals whose first impression of them wasn't the best. These heavy lenses, which stayed too dark indoors yet were never dark enough outdoors, were, in my opinion, only to be dispensed to patients who asked for them.

But technology has come a long way since then, and I'm now among the converted. The newest generation of light-weight plastic photochromic lenses are virtually clear indoors and sunglass-dark outdoors. With all of the benefits of regular, clear lenses, plus visual comfort and 100 percent automatic ultraviolet (UV) protection in bright sunlight, they're now a high-   performing option for the clear lens wearer.

ILLUSTRATION BY JOHN SCHREINER

I've found that offering photochromic lenses leads to increased patient satisfaction and a positive impact on my practice's bottom line. If you're still among the eyecare professionals who think of the old technology when they hear the term "photochromics," let me tell you how new technology has turned these lenses into a benefit for any optometric practice -- and how easy it is to bring them into yours.

Technology to the rescue

All photochromic lenses change from one state indoors (usually lighter) to another state outdoors (usually darker) when they're activated by UV light from the sun. Although the first glass photochromic lenses activated well, they were slow to fade back when the wearer went inside and retained a residual tint. When new, they offered 88 percent light transmission indoors, but within a year that percentage degenerated into the low 70s, leaving the wearer with an even darker indoor tint. Because the photochromic crystals were distributed throughout the lens -- leaving more at the thicker parts and less at the thinner parts -- raccoon and bull's eye patterns were common.

The first plastic photochromic lenses were introduced in 1991 and offered the light weight that many patients desired. They had a clear state of 78 percent light transmission and outdoors delivered 35 percent transmission. They were made using a proprietary new surface treatment technology (imbibition), which provided more consistent coloration throughout the lens. In the patented imbibing process, photochromic dye is applied to the front surface of the lens and then processed in a way that causes it to penetrate the plastic. The imbibition process places the photochromic dyes where needed -- on the front surface of the lens only -- so these lenses overcame the problem of bull's eye or raccoon effects.

Another surface technology, Trans-Bonding, was introduced in 1997, making it possible to offer photochromic technology in desirable high-index and polycarbonate materials.

By the late 1990s, more plastic photochromic lenses were introduced by other manufac- turers. These were made using in-mass manufacturing techniques. Like the old glass photochromics, these photochromic compounds are mixed into the monomer, then poured into a mold and cured. Some of these lenses were darker outdoors than the first plastic photochromics, but in-mass technology was unable to deliver truly clear performance indoors.

Times change

In 2002, the first company to successfully offer plastic photochromics introduced a new generation that represented a milestone in photochromic technology. The lenses are made using the imbibition process and exhibit unprecedented indoor clarity and outdoor darkness. Indoors, these new lenses have an 89-percent light transmission, virtually indistinguishable from regular clear lenses, which have a 92-percent light transmission. Outdoors, the lenses allow only 15-percent light transmission -- the industry standard for sunglasses. Because of their superior performance and wide availability, we dispense these lenses almost exclusively in our practice.

Many eyecare professionals, because of outdated perceptions, may reserve photochromics only for light-sensitive patients or for patients who spend a lot of time going in and out of doors. Yet clinical research indicates that four out of five patients prefer the comfort of the new photochromic lenses over standard lenses. In my practice, we're committed to offering all patients -- both children and adults -- this choice.

Demonstration tools can be helpful in educating patients about new photochromic lens technology. PHOTO COURTESY OF TRANSITIONS OPTICAL INC.

Bottom-line benefits

Because photochromic lenses are now a higher performing everyday lens, they provide the opportunity to offer a premium product to patients who would normally wear regular, clear ophthalmic lenses.

We have more than tripled the number of photochromic lenses we dispense since the introduction of the latest technology -- going from approximately 10 percent to 30 percent of our patients -- boosting our profits from premium products significantly. Industry tools are available to help you calculate the profitability of photochromics over regular clear lenses, as well as the profitability of combining photochromics with other premium add ons, such as an anti-reflective coating. These help identify the potential of converting just one clear lens wearer each day to a higher-value product such as a photochromic. Check with your manufacturer or laboratory representative.

Additional impact on the bottom line that's more difficult to estimate is the effect of high patient satisfaction, which can lead to more loyal patients, referrals and increased volume of purchases. Again, clinical research provides insight. One recent study explored the impact of photochromic lenses on vision-related quality of life, comparing the experiences of patients wearing regular clear lenses with those wearing the newest generation of photochromic lenses. The study found that patients wearing the photochromic lenses had higher overall satisfaction with their eyewear, reporting greater visual comfort.

Getting the point across

A few simple strategies can make you and your staff more effective in educating patients about their options, including photochromics, as an everyday lens. The best way to learn how to implement these strategies is to seek training from your manufacturer representative. Obviously, representatives from companies that offer photo-chromic lenses are experts on their own products and some offer professional, modular in-office training as part of a national program. The training will teach you about the products' features and benefits and may include general dispensing techniques to help you and your staff educate patients about issues such as the need for convenient, everyday UV protection. Representatives can also make you aware of any waiting room and demonstration tools you can use.

We approach dispensing photochromic lenses as an education process that we can reinforce throughout the patient's visit, from making the appointment to the waiting room, exam room and dispensary.

A phone script or on-hold message can first introduce patients to photochromics when they call for appointments. Posters, patient brochures and other materials can provide information in the waiting room. There's even a short video available that you can play in your waiting room to introduce patients to the importance of UV protection and photochromics as an everyday lens solution.

At our practice, we believe the most effective lens recommendations come directly from the doctor in the exam room and are reinforced in the dispensary, where an optician can more fully explain the benefits of each option. I often indicate right on the prescription pad that the patient should wear a photochromic lens and reinforce this when I introduce the patient to the optician. While time is of the essence -- busy eyecare professionals may see 20 to 40 patients a day -- this interaction can take just a minute.

Many patients aren't aware of photochromic lenses or suffer from outdated perceptions. To present the newest technology, we use a UV demonstrator and a lens demonstration card. We first show the patient the lenses in the demonstration card in their inactivated state to show the indoor clarity. We then close the front flap of the card, leaving the lens half-exposed, and activate the lenses with the UV demonstrator. When we remove the lenses and lift the flap, the contrast between clear and dark is obvious -- and patients are impressed.

If a patient isn't prepared to make a decision, then we give him a brochure with photochromic film to take home. Those who choose to go with regular, clear lenses often cite the cost of photochromics as the reason -- a common objection to premium products.

Starting out

The investment to begin dispensing photochromic lenses is minimal. Training from manufacturers' representatives is available and most demonstration tools are free of charge. The small time investment necessary to keep up to date on the latest technology and most effective dispensing techniques is well justified by the potential for increased patient satisfaction and profitability. Improvements in photochromic technology have been significant -- now is the perfect time to take a fresh look at the benefits of these lenses.

References are available on request.

Dr. Scherick is a clinical instructor for the Department of Ophthalmology at New York University and has instructed courses for the Contact Lens Association of Ophthalmologists and for the American Academy of Ophthalmology. You can reach him by phone at (212) 686-1653.