Contact Lenses in

CYBERSPACE

BY MEREDITH GILFOR
ASSISTANT EDITOR
JAN. 1997

A journey along the Information Superhighway could lead you to various sources of contact lens information. Explore these destinations, and decide if you should create a path of your own.

A growing number of contact lens manufacturers and associations are trying to entice you and your patients with their http addresses. Whether you're an Internet junkie or a novice Net surfer, you already know the age of point-and-click access to information is upon us. To investigate what's available to all surfers seeking contact lens information, Contact Lens Spectrum interviewed some of the most Internet-savvy eyecare professionals to date.

FOR THE PATIENT'S SAKE

One of the most important reasons you can't dismiss the Internet is because computer users and contact lens wearers share many of the same traits.

"The contact lens wearer and the computer user have almost the same demographics," said Cristina Schnider, O.D., M.Sc., director of professional relations and clinical affairs for Menicon USA, Inc. Dr. Schnider has been instrumental in the development of Menicon's Web site (still under construction) and she is also a member of Optcomlist, an e-mail exchange list for eyecare practitioners.

Through the World Wide Web, contact lens companies can reach patients directly, which many feel is a more cost-effective supplement to journal advertising than other forms of consumer advertising.

"It's overwhelmingly necessary that any serious business get involved. Otherwise, you're conspicuous by your absence," Dr. Schnider said. "Specifically for the RGP modality, the only way to drive the business is to drive patients."

To drive visitors to its Web site, Vistakon, a division of Johnson & Johnson Vision Products, Inc., offers a "Guide to Healthy Contact Lens Wear," the "Visual Reality" interactive sitcom and other snippets of contact lens-related information. "Visual Reality" is geared towards teen-age consumers, who represent "tremendous opportunity in the contact lens market," said Howard Purcell, O.D., director of professional affairs at Vistakon.

In addition to maintaining their own sites, many contact lens manufacturers, including CIBA Vision and Vistakon, sponsor programs or segments on other Web sites. Dr. Purcell sees the Internet as an educational resource, rather than an advertising opportunity. For this reason, he said, Vistakon tries to affiliate with organizations that promote education.

HOW PRACTITIONERS AND PATIENTS TAKE SEPARATE PATHS

To cover their entire customer base, contact lens manufacturers must design their sites to appeal to practitioners as well as patients. The only catch is that what's interesting to you is probably too technical for patients, and what appeals to patients is probably unexciting for you. Directing the appropriate visitor to the appropriate information is often accomplished through a password.

CIBA Vision's Web site contains three segments (Prosight, Onsight and Forsight) to appeal to three kinds of visitors (practitioners, patients and anyone else interested). The "Prosight Forum," which the company calls a "meeting place for the exchange of views and information," is limited to eyecare professionals and requires a password.

Vistakon's site, which offers continuing education, also requires a password (vistakon96) to ensure that only practitioners access it.

Eye On-Line (www.usa.net/eol), a "forum for eyecare issues on the Web for both eyecare practitioners and the general public," charges a fee to grant registered members access to restricted areas. The site also contains free information for the general public.

MEMBERS ONLY

Other practitioner-directed Internet endeavors that are sometimes password-protected include chat rooms, news groups and e-mail lists.

The RGP Lens Institute (RGPLI) hosts a monthly chat session on the second Tuesday of every month at 9:00 p.m. ET in the "Review On-Line" chat room of America On-Line. Here, up to 25 practitioners discuss a predetermined topic, moderated by Edward Bennett, O.D., M.S. Passwords are not required, but participants must be AOL subscribers to access the room, and only contact lens fitters are invited.

Scheduled topics for 1997 include "RGPs & Sports," "Problem Solving Made Simple" and "Advanced Bifocal Fitting," according to Carol Schwartz, O.D., M.B.A., who organizes the chat session. The first hour is dedicated to the topic and in the remaining time, the floor is opened for participants to present cases, ask questions or introduce a new topic. Participants write their questions or comments, and the text appears on everyone's screen with only a short delay. For each session, at least one expert on the key subject is present. Participants receive one free CLMA videotape of their choice for each session they attend.

The benefit to participating, said Dr. Schwartz, is that practitioners gain access to the experts within an environment that promotes an uninhibited exchange of information.

"It's the same feeling as going out for coffee with an expert after the lecture. It's great for face-to-face learning, but it's much more relaxed," she said.

A similar monthly chat session called "OcWired" is available through the Optometric Computing Secondary Site (www.webcom.com/optcom2), designed by John Warren, O.D., who is also the chat moderator.

"Internet chat is like a big conference because it's spontaneous and instantaneous," said Dr. Warren.

Drs. Schwartz, Warren, Schnider and numerous others also communicate regularly through Optcomlist. This is a mailing list offered through the Optometric Computing site (www.optcom.com), which is also the official site of the Southern Council of Optometrists. About 700 doctors from about 20 different countries receive roughly 100 e-mail messages a day from other members on the list, according to webmaster Walt Mayo, O.D.

The biggest advantage to communication on the Internet is the ability to view topography information and receive feedback from colleagues, said Dr. Warren. The Optometric Computing Secondary Site also contains a link to Dr. Warren's topography pages which contain actual case reports and accompanying topography maps.

Dr. Mayo's testimonial to the power of Internet communication includes a challenging case of an amblyopic child. After distributing the case on the Optcomlist, he received opinions from practitioners across the country ranging from O.D.s to chiefs of pediatrics at hospitals. He established an effective treatment plan based upon those responses.

Some alternatives to mailing lists and chat groups are news groups. A news group is basically a bulletin board where people post messages and other people post responses to the messages. A string of comments about a particular topic is called a 'thread.' Unlike the chat sessions, news groups are not instantaneous and may contain messages that are a few days old.

A good place to find contact lens-related threads is the sci.med.vision news group, according to Larry Bickford, O.D., creator of the EyeCare Connection and CyberLens site (www.west.net/~eyecare). Dr. Bickford visits this news group daily, which can be accessed a number of ways, including through the Deja News Web page (www.dejanews.com). At this site, search for 'sci.med.vision' and you'll get a list of threads, the dates they originated and the authors who created them. The big topic these days, Dr. Bickford said, is PRK.

The best source for contact lens information on the Internet is not on the Web pages, but in the chat groups and mailing lists, Dr. Mayo said. He considers the Web as an important vehicle for information about where to sign up for these communication groups.

TANGLED IN THE WEB

Simply typing the words 'contact lens' can be a very frustrating way to search for contact lens information on the Web. Regardless of what search engine you use, the response you'll receive will probably be saturated with lists of contact lens mail-order companies. It's easy to get swamped by thousands of entries that contain no useful information, forcing you to meticulously weed through until you finally surrender and turn off the computer, unenlightened.

SO YOU WANT TO BUILD A WEB SITE

Creating a personal home page on the World Wide Web is not particularly costly in either time or money, and it enables you to deliver valuable information about yourself, your practice and contact lenses via a powerful vehicle.

Many locations on the Internet offer doctors an opportunity to add their own home pages to a list of pages for other practitioners. Optometric Computing offers one for optometrists called OptWeb.

DoctorNet (www.doctornet.com), a free Web page service offered by ophthalmologist Robert Cykiert, M.D., is currently only available to M.D.s, but he says he has received so many inquiries that he is considering expanding it to include all health care professionals. Like many other practitioners on the Web, Dr. Cykiert first created a site because he thought it would be "neat." Later, he discovered he was getting referrals through his site. As a favor, he began creating home pages for his friends and colleagues, and found that it was not much more expensive to open the site up to others.

Managed care makes it particularly important for practitioners to establish themselves on the Internet, Dr. Cykiert said. Years ago, people had to rely on word-of-mouth or the phone book for information about practitioners. Managed care is forcing people to choose new doctors simply because they're on a certain plan. Patients are looking for more information about the practitioners they choose.

For people who can afford a personal computer, there's no cost barrier to creating a personal home page. You'll need a computer with a modem and a standard phone line, a subscription to an Internet service provider such as America On-Line or CompuServe, and the software program that converts your word processing file into "html," the language of the Web. Most providers offer unlimited Internet access for about $20 a month and for an additional fee, many will provide the software to create the site for you. You can often download free software, but you still must notify your provider, who will create the space on the Web for your page to be added.

Then, the only maintenance required is keeping it current. Peter Bergenske, O.D., Madison, Wisc., updates his site with a Web edition of his most recent office newsletter. He also includes contact lens patient information, his resume and even some poetry. EyeCare Connection, by Larry Bickford, O.D., contains a page with "Late Breaking News," which he is considering removing because it's too time-consuming to update. Sites with links to related sites are also time-consuming to update, he said, because new sites are always being created.

Regardless of what you include on your Web page, the key is to keep it fresh so that your visitors will want to return.

When faced with 30,000 entries from a particular search engine, Dr. Bickford recommends switching to a different one to refine your search. Different engines approach the search differently, and he named Magellan, Excite and Infoseek as some of his favorites. The difference is in how they retrieve information based on what you type in. Most search engines will list sites based on how frequently your search word appears in the page. Some, such as Lycos, list sites in the order of their relevance and display the site's percentage of relevance to the word.

When searching for a two-word subject such as 'contact lens,' it's helpful to use a search engine that allows you to modify the search. This means you can specify that you want to see only the entries that contain both the word 'contact' and the word 'lens.' Otherwise, your list of entries will also include all sites that contain the word contact, such as contact sports, as well as all sites with the word lens, such as sites about a camera lens. Different search engines have different ways of modifying, and it's up to the user to learn them. Dr. Bickford recommends reading through the help functions available on most search engines.

Creators of Web pages can skew their sites so the search engines will pick them up more readily. One way to do this is to bury a word at the top. Writing the words 'contact lens' 15 times at the top of the page in black on a black blackground would prevent the viewer from seeing it while allowing the search engines to place the site at the top of the list.

Many eyecare sites can 'hyperlink' visiters to other related sites on the Web. Using these links is a good way to find additional sites with information about contact lenses. Some of the sites that offer links to other contact lens-related sites are the Contact Lens Council (www.iglobal.com), the American Academy of Optometry (www.aaopt.org), Eye On-Line, The Indiana University School of Optometry (www.opt.indiana.edu) and other optometry schools, as well as many of the state optometric associations.

Once you find a site you'd like to return to, 'bookmark' it so that you can find it again without having to retrace your steps. Simply add it to your list of 'favorites' and you can build a collection of sites that are tailored to your interests.

Some experts predict that search engines will evolve to a point where they will be able to list only the sites that are geared toward your personal interests. These more sophisticated search engines are called 'agents,' and they will be able to store information about you and about what you like.

WHEN YOUR PATIENTS SURF

Even if you don't spend a lot of time on the Internet, many of your patients do. Contact lens information on the Internet comes from a variety of sources, some of which may not be ethical or accurate. Some mail-order companies, for example, will not fill contact lens orders without a prescription, while others require only the parameters listed on the patient's old box.

One-third of the contact lens orders Larry Bickford, O.D., receives through his CyberLens mail-order site are from patients without valid prescriptions or with prescriptions that have been forged, and this is one reason he doesn't promote this business. Dr. Bickford's site contains a vast amount of information geared toward patients including information about contact lenses in general and about the major issues of mail order.

"My original goal was for CyberLens to get contact lens wearers to go back to their eye doctors for follow-up care and armed with information so they can raise questions and become involved," Dr. Bickford said.

Another concern Dr. Bickford has tried to address with his site is the legitimacy of the information presented to patients on the Internet. "The information on the Internet is unregulated and it's difficult for the layperson to know what's accurate and what's not," he said. For this reason, he includes a page on his site with information about his education, clinical practice background and eyecare philosophy. He said that it's important for the people providing the information to establish credibility.

Accuracy of information is another incentive for companies like Vistakon to establish a Web site, especially when mail-order companies offer information about products.

"Everyone is using the name Acuvue or Vistakon," said Howard Purcell, O.D., Vistakon's director of professional affairs. "We want people to get the information from us so that we have a chance to make sure that they are getting the real story."

FILLING THE GAPS IN CYBERSPACE

Despite the growing number of contact lens opportunities available for Internet enthusiasts, most of the people we interviewed agreed that the full potential of this medium has not yet been achieved.

"The possibility for contact lens education on the Internet is enormous, but more people need to get involved," Dr. Schwartz said. "The contact lens community just hasn't tapped in to its potential yet."

One of the best ways to get more people involved is to create sites that give people a reason to keep coming back. In the future, Dr. Schwartz would like to see interactive sites where many things are happening, but the visitor directs the activity.

"The Internet is a tremendous educational resource to help spread the word of contact lenses and quality care," Dr. Purcell said, "but the key is to keep it fresh and new. If you see the same thing over again every time you visit a site, you'll ask yourself why you keep coming back."

Both Dr. Schwartz and Dr. Bickford would like to see manufacturers include a technical support database on their Web sites to replace telephone consulting.

"I'd be surprised if printed fitting guides even exist in a few years," Dr. Schwartz said. "The future on-line is fitting and consulting information."

Dr. Mayo has created a forum for today's eyecare surfers to voice concerns such as these. The International Association of Online Optometrists (IAOO) was established to "provide some framework for doctors who are heavily involved in the Internet to voice which direction they want this media to go," Dr. Mayo said. There are about 600 members internationally, who aim to help shape the future of optometry on the Internet. This will become increasingly more important because as more people get involved, new issues will develop. Dr. Mayo hopes the IAOO will aid in setting standards for some of these issues. CLS

Special thanks to all of the practitioners who contributed to this article.