A Guide to Prescribing
Frequently Replaced Soft Lenses

BY RANDY McLAUGHLIN, O.D., M.S.
APR. 1996

If you haven't joined the frequent replacement campaign, don't waste time. It's a great practice builder.Since the introduction of daily, weekly, monthly and quarterly replacement schedules, complications such as giant papillary conjunctivitis, often caused by noncompliance have been dramatically reduced. Today, patients enjoy better eye health, comfort and convenience. How do you implement these programs into your practice? It's a lot easier than you might think.

DISPOSAL OPTIONS

The most frequently replaced contact lens and consequently the most convenient and safest form of lens wear is the daily disposable lens. At the initial exam, I give my patients a four- or five-day supply so they can replace their lenses daily until the next follow-up visit.

Despite the potential for noncompliance with this regimen, most patients follow the recommended daily disposal routine. I see my patients once a year -- I don't require a quarterly or six-month check-up for daily wear patients -- which is another advantage for them.

Patients who decide against daily disposal, usually choose one- or two-week disposal. In this case, I again fit and evaluate an initial trial pair. Many of my patients choose a two-week disposal schedule over one-week to save money.

Usually I'll order a six-month supply of lenses and have them shipped directly to the patient. At the end of six months, it's up to the patient to order the next six-month supply. I rarely recommend extended wear, so I impress upon patients in daily disposables that they must clean and disinfect their lenses just as they would traditional soft lenses, usually with a convenient all-in-one solution.

Many two-week disposable wearers tend to slightly extend the life of their lenses and don't order the second half of the year's supply before their annual exam. When this happens, I discuss why it's inadvisable and suggest a monthly or quarterly replacement schedule. Many patients are unaware of this option, so I explain how we can tailor the disposal schedule to meet their vision needs and budget. Most frequent replacement soft contact lenses (FRSCLs) are packaged four or six lenses to a pack for monthly or quarterly replacement. We stock all powers for same-day dispensing. A large inventory is not necessary because each parameter is reordered each day.

PRICING

Our skill in properly recommending a frequent replacement regimen depends on how we balance our patients' visual safety needs with their financial needs. Cost is what causes many patients to stray from the original replacement plan. I prescribe the most affordable plan, monthly or quarterly replacement, first, then, if patients agree, I upgrade them to a weekly or daily disposal schedule. Quarterly replacement costs under $90 and monthly replacement under $110. All boxes are priced comparably with mail-order.

For one- or two-week replacement, one box of six lenses is priced at about $25. Of course, both disposal schedules offer great convenience without weekly enzyming. It's helpful to explain to patients that the cost of unnecessary enzyme tablets shifts to the two-week disposal material charge, thus this schedule is not much more expensive than traditional lens wear.

Daily disposable lenses are the safest and most convenient lens regimen, but they are also the most costly, approximately $150 a quarter.

CONVENIENCE VS. PRICE

If your practice offers optimal convenience, you'll compete effectively with the lower-priced mail-order facilities. When one of our patients loses or damages a lens, we mail a replacement, usually from our trial lens supply, at no charge to the patient. Not only does this promote good will, but it also underscores how inexpensive the lenses are so they should be thrown away as prescribed.

Another attractive option for your daily disposable lens wearers is direct-to-patient delivery. In an attempt to discourage mail-order diversion, most daily disposable lens manufacturers have opted for this delivery system. This is very convenient for both the patient and the doctor. After initial trial dispensing, patients can return to have the lenses evaluated and then have the first three-month supply shipped to their selected address, which is often their work address.

INCORPORATING FRSCLS IN YOUR PRACTICE

Prescribing FRSCLs will in no way change the flow of your contact lens examination routine. In our office, we charge patients for a comprehensive examination (92004 or 92014), a refraction (92015) and a contact lens fitting (92310). The contact lens fitting charge depends upon the difficulty and follow-up chair time required.

It usually doesn't take much to convince patients of the benefits of replacing their contact lenses frequently. They perceive a greater value when they receive more lenses for a similar fee, and when they return for their annual follow-up visit, they're committed to regular lens replacement.

Dr. McLaughlin is assistant professor of clinical ophthalmology at The Ohio State University Department of Ophthalmology in Columbus, Ohio.