disposable lenses
An Indispensable Opportunity
Keep patients in your office and happy with this modality of contact lens wear.
BY STEPHEN COHEN, O.D., Scottsdale, Ariz.

Anyone who's seen the movie "Forrest Gump" remembers the endless stream of culinary consciousness from Forrest's Army buddy, Bubba: "You can have broiled shrimp, fried shrimp, shrimp creole, . . . ."

The same thought applies to current contact lens replacement options: "You can have one day, one week, two weeks, one month, . . . ."

When the first disposable contact lens arrived almost 15 years ago, it changed a lot about how we looked at soft lenses. We weren't dealing with contact lens replacement service agreements anymore and patients no longer paid the entire cost of the lenses. Instead we had six packs, discount pricing and two-box dispensing. Disposable lenses have given us many great opportunities. I'll discuss these in this article.

ILLUSTRATION BY CAM WILSON

Taking action

We can complain about the ills of the contact lens marketplace or we can seize the opportunities we have. Optometry thrives on facing challenges and embracing change. That's why I'm reviewing several potential areas of opportunity: Disposable contact lenses, annual dispensing, direct-to-patient shipping, patient education and partnering with manufacturers.

Introducing disposable lenses

Rather than rattling off the list of a patient's contact lens replacement options "Bubba" style, we can condense his options to one sentence: "We now have contact lenses that you replace from every day on up."

The first of these options (one-day replacement) is perhaps the most underused modality in the United States.

Daily-use lenses. Initially, the perceived benefit of these lenses was for patients who had giant papillary conjunctivitis (GPC) or whose compliance with cleaning and disinfecting was questionable. Unfortunately, cost seems to have become the primary limiting factor in prescribing this modality.

However, patients desperately want our best recommendations. We should emphasize that daily disposable contact lenses offer the most convenience, health, comfort and vision.

Two-week replacement lenses. With this schedule, the critical issue is the size of the contact lens supply. We would calculate one year's supply to equal eight boxes, but according to manufacturer data, it's only 5.2 boxes. That's because some patients don't follow recommended replacement schedules and others might develop a "commodity" view of the lenses.

Other options. The obvious benefit of monthly, or planned, replacement lenses is compliance, both to the replacement schedule and to the care of the lenses.

The quarterly replacement schedule offers us an increase in our prescription options (e.g., higher astigmatic corrections) while our patients may have an increase in contact lens care and in keeping track of the replacement schedule.

Interestingly, the quarterly replacement category seems to provide the highest degree of com pliance in my practice, with patients more consistently returning for their annual exams than in other modalities.

Silicone hydrogel lenses now seem to adequately address the risks of longer wearing schedules with previous materials. Despite the fact that patients are more likely to bring up their interest in this option, we still have a terrific education opportunity by including monthly extended wear into our discussion about lens options.

Try annual dispensing

With any disposable product, replacement habits are based on supply. A contact lens patient may adhere to a two-week replacement schedule until he gets to the sixth pair of lenses. He might overuse the sixth pair until he's ready to re-order, increasing the chance of complications. If none arise, then the patient might perceive that continuing to exceed the recommended replacement schedule is acceptable.

You should only offer "per box" pricing in the context of one year's supply. We should go beyond merely emphasizing our ability to offer diagnostic lenses to our patients (for lost or torn lenses). Consider emphasizing the following points to a patient:

• "One year's supply of contact lenses will give you all the lenses you need between now and next year's exam."
• "This package includes a rebate and free shipping, which is like getting almost [insert number] months for free."
• "One year's supply of lenses can cost as little as [insert price here] per box."
• "Although not likely, if your prescription happens to change within the year, we'll exchange any unopened boxes for lenses with your new prescription."

These points will reinforce recall efforts while detailing the benefits, convenience and cost effectiveness (without risk) of the annual dispense.

Conversely, if price is the only variable you offer, then patients will only consider that variable. When I discuss the benefits of annual dispensing with my patients, they're more likely to request the annual supply.

Aside from cost, convenience is also important to patients. Here's what you can do to keep the process convenient for them.

Keeping things convenient

For years, practice management gurus advised us to come up with reasons for our patients to return to our offices on a regular basis. The rationale was that as patients visit our office, we reinforce our relationship, have an opportunity to check their glasses and their record to see if they're due for their next exam.

The two-box dispense fit this bill nicely, providing four built-in annual visits to our offices. However, in just the past few years, there's been a paradigm shift. Now, if we're not meeting our patients with convenience, then we're losing them. Although cost is a consideration, the reason why patients started seeking eye care from mall locations was for convenience (e.g., location and hours of operation).

In fact, convenience has driven the contact lens market toward mail-order companies more than any other single factor, including price. The choice is to either complain or compete. To compete, do so on convenience first. Direct-to-patient shipping offers this opportunity.

Above all, keep your patients

In spite of these benefits, some patients might still choose to have someone else fill their lens prescription. If we want to keep our patients, it's critical that we provide the prescription without hesitation. For the ongoing health of our practices, keeping the patient is more important than dispensing the contact lens product. Additionally, our fees should reflect the emphasis of our expertise and services over the fees for the lenses.

Seize the chance to educate

We have another opportunity with disposable lenses: Patient education. As we educate patients about the benefit of various disposable lens options, we further increase our credibility and the value of our services to them. Two of the many educational opportunities are ultraviolet (UV) protection and name brand prescribing.

Facts about UV prescribing. Surveys have shown that while nine out of 10 patients would value UV protection in contact lenses, only one in 10 hears about it from us.

Name brand prescribing. As consumers we value name-brand recognition (a majority of buying decisions involves this factor), but as providers we often feel the need to prescribe proprietary lenses. Besides the fact that patients may potentially see this as disingenuous, it has now become easy for them to obtain the equivalent product from other contact lens sources.

Partnering up

Regardless of the name or profitability of a lens, our primary responsibility is to continue to fit the lens best suited for the needs of each patient. When all other things are equal, we should consider the companies that provide us with new lens technology.

But for them to do this, they need to make a profit. In return, we should focus on who is consistently expanding our prescribing options, driving new contact lens patients into our offices and continuing to support our profession with sponsorships, continuing education, practice manage ment tools and sales rep support. Such reciprocal support will offer us a future in contact lenses beyond anything we previously thought possible (e.g., made-to-order customization).

Do more than offer options

When it comes to disposable lenses, we need to identify the benefits to our patients, regularly educate them and actively offer them the special services we can provide in our offices. Or we can just offer them "boiled shrimp, battered shrimp, shrimp with lobster sauce . . . ."

Dr. Cohen is a past president of the Arizona Optometric Association and has lectured nationally and internationally on topics such as contact lenses, practice management and patient education. Reach him at doctormyeyes@qwest.net.