DISPOSABLE LENSES
TODAY
BY CRAIG W. NORMAN, F.C.L.S.A.
MAR. 1997
Gone are the extravagant excesses of a decade ago. People in the 90s prefer small indulgences, and your patients may consider using single-use, daily wear contact lenses a well-deserved convenience.
Dateline 1988:
Vistakon announces the nationwide introduction of a new, single-use, soft contact lens -- wear them for up to one week and throw them away. Approximate patient cost: $400-$500 annually.
Contact lens practitioner's response: "Ridiculous! Patients won't spend that much money for contact lenses. And why would anyone ever want to throw away a contact lens after one week? Plus, most patients will be noncompliant and keep their lenses much longer than indicated."
Ultimate results: Disposable and planned replacement soft lenses have revolutionized the way contact lenses are being prescribed, worn and supplied. While some patients don't comply with lens replacement, most wear new lenses as directed.
Dateline 1996:
Vistakon announces the nationwide introduction of a new, single-use, soft contact lens -- wear them for one day and throw them away. Approximate patient cost: $600-$750 annually.
Contact lens practitioner's response: "Ridiculous! Patients won't spend that much money for contact lenses. And why would anyone ever want to throw away a contact lens after one day?"
Ultimate results: The verdict isn't in yet, but if history has taught us anything, one-day disposables will once again revolutionize the way contact lenses are being prescribed, worn and supplied.
Since the inception of soft lenses, we've encountered numerous challenges to patient success. These include managing lens deposits and films (often necessitating heroic measures to prolong lens life); solving solution-related hypersensitivities and allergic responses; and treating what seemed like an epidemic of giant papillary conjunctivitis. And all along, we've been concerned about the potential health risks when patients store their contact lenses in old, dirty and contaminated carrying cases.
What's the best way to eliminate these obstacles to successful contact lens wear? Simple -- replace the lenses as often as possible (and what could be more often than every day?) while eliminating all interaction with potentially irritating contact lens care products and storage cases.
OPTIMUM HEALTH AT A NEW AFFORDABILITY
What has been the barrier to replacing soft lenses on a daily basis? The answer again is simple -- cost. Until very recently, contact lens manufacturers haven't had the technology, capacity and high levels of quality control that would allow daily lens replacement to become a reality. Today's sophisticated manufacturing has greatly improved production efficiency while decreasing per-unit cost, encouraging us to re-evaluate daily disposables. (Fig. 1).
FIG. 1: VISTAKON'S DEERWOOD PARK MANUFACTURING FACILITY FOR THE 1-DAY ACUVUE DISPOSABLE LENS.
Today, Johnson & Johnson's 1-Day Acuvue is the only single-use, daily disposable available for national distribution in the United States. Brought to the eyecare marketplace approximately a year ago, the lens is presently available in two base curves, in myopic powers from -0.50D to -6.00D in quarter-diopter steps and up to -9.00D in half-diopter steps, and in plus powers from +0.50D to +6.00D in quarter-diopter steps. The lens is manufactured in the etafilcon A material and is packaged in 30-lens boxes.
The daily disposable field is likely to become more crowded soon. CIBA Vision recently announced that studies are underway in Norway on its single-use, daily wear disposable product, Dailies. And last year, Bausch & Lomb acquired the European manufacturing and lens technology called Award. This may be the lens that B&L ultimately launches in the U.S. market as a daily disposable.
COST ISSUES
Even though single-use, daily wear disposables appear to be an expensive contact lens alternative, don't prejudge a patient's ability to afford this lens type. Only the patient truly knows what he is able to spend. As market trend expert Faith Popcorn reports, people in the 90s are no longer interested in the extravagant excesses of a decade ago, but instead prefer small indulgences. Single-use, daily wear soft contact lenses seem to fall into this category.
When presenting contact lens options to patients, list the benefits of single-use lenses. Describe the increased comfort, the ease of use and the significant decrease in contact lens related complications. Remind them of how good brand-new lenses feel, and explain why you think this lens best suits their needs. Then, after a fair and balanced description of the benefits and features, quote your fee. You may be surprised at how receptive they are.
CANDIDATES FOR DAILY DISPOSABLES
The latest market analysis from Health Products Research, Inc., shows that there are approximately 29 million contact lens wearers in the United States, about 70 percent of whom wear soft lenses. Of the soft lens patients, about 16 million remove their lenses daily for cleaning and disinfection, while the remaining 4 million use them for extended wear.
Thus, there appears to be a real opportunity to convert many of these daily wear patients to a lens modality that's easy to use and provides a clean, fresh lens every time they insert their lenses. For these wearers, the thought of not having to worry about lens care and storage is very appealing.
Soft lens dropouts are also ideal candidates for daily wear, single-use disposable soft lenses. These patients have already demonstrated an interest in contact lens wear, and if not for their past difficulties with conventional soft lenses, they might still be contact lens wearers. The most common reasons why soft lens wearers stop wearing their lenses are lens discomfort, contact lens induced dry eye symptoms, low grade inflammation and the ongoing hassle of routine lens care. Most of these symptoms can be easily resolved by using a clean, fresh lens daily and eliminating lens cleaning and disinfection.
Another prime candidate is the part-time contact lens wearer. There are legions of patients who don't necessarily need or want to wear contact lenses every day, but definitely want to wear them periodically. Think of how much easier it is for the business traveler who can leave home his bottles of solutions and lens cases, for the golfer who can have crisp, clear contact lens vision for his game once or twice a week and for those who simply want to wear contact lenses for social events.
Rather than keep their contact lenses immersed in old solutions in dirty storage containers between wearing cycles, these part-time wearers are best served by a single-use, daily wear disposable lens.
|
COMPLIANCE
Most patients comply with their health care practitioner's recommendations. Sure, there are those who wear their one-week lenses two to three times longer than suggested, but they tend to be the exception, not the rule.
Our greatest concern with daily disposables is in the area of lens care, where there's a much greater deviation from proper use of solutions than in the actual wearing or replacement of the lenses. Think of how many of your patients disinfect with saline solution or rarely clean or enzyme their lenses as advised. There are simply too many steps involved in the lens care regimen for many patients to perform them correctly.
Drug stores, grocers and other retailers are heavily marketing private label solutions, presenting an even greater opportunity for noncompliance. When not properly educated, contact lens wearers can become confused when they shop for solutions, often thinking that all solutions are the same. Single-use daily disposables remove these concerns by eliminating the need for any lens care products for cleaning and disinfecting.
For single-use disposable wearers, as with all contact lens patients, there's no substitute for patient education. All office personnel -- doctors and staff -- should reinforce good compliance during fitting, follow-up and any future interaction with the patient.
ADOPT PROACTIVE REPLACEMENT POLICIES
When it's time for new lenses, many patients consider non-traditional sources for lens replacements. Why do they consider these options rather than their practitioner? Some will say it's purely a price or convenience issue, but in most cases, it's simply a communication issue.
After you've successfully fit a soft contact lens wearer with disposable lenses and provided the initial supply, who contacts whom about the need for new lenses? Do you call patients to remind them that it's time for a new supply? Or, do you wait for them to call your office?
It's vital to long-term practice success that this type of communication originates from your office. Use this as an opportunity to demonstrate your concern for ocular health and contact lens compliance. Have your staff reiterate your instructions pertaining to contact lens wear.
If patients mention that your prices are too high, ask them, "How much are your replacement lenses elsewhere?" Often, they confuse the cost of the lenses with the costs of the initial fitting and follow-up.
If convenience is an issue, have your staff describe the new direct shipment programs that the lens manufacturers offer. Make certain that your patients have no reason to look elsewhere for their contact lens professional care.
DIRECT SHIPMENT: CONVENIENCE FOR ALL
Direct shipment of soft lenses to a patient's home or office, a concept that has been available within our industry for some time, has finally become commonplace.
With this system, you can use daily disposable trial lenses to evaluate a patient's response to the modality, dispensing five to ten pairs during the evaluation period. After determining that a patient is a good candidate for daily disposables, you can have the lenses shipped to whatever location he desires.
The company ships the lenses via one of the major carriers such as Federal Express or Airborne, generally within one to two days of the order placement. The shipping box and the enclosed packaging slip lists your office as the return address. The packaging slip documents the lens parameters for each eye, so the patient can mark each box correctly. The manufacturer provides you with confirmation that the order has been sent.
While the manufacturers may charge a minimal shipping fee (approximately one-half of a regular overnight charge), they usually waive the charge for orders of four or more boxes of lenses.
What are the advantages for patient and practitioner? For the patient, avoiding a trip to the doctor's office just to pick up their replacement lenses is a big plus. Students can have their lenses sent to their college addresses during the academic semester, or to their homes during winter or summer breaks.
When reordering lenses, patients simply call your office and provide a credit card number. Within a day or two, they have their new lenses. Manufacturers store all of the pertinent information in a computer database, so placing a patient replacement order takes only a few minutes, mostly to verify the lens parameters and shipping address. Direct delivery also decreases your need to store and manage costly inventories.
Direct delivery can also be beneficial as a practice management tool. The manufacturers can include messages of your choice on the packing slip, and they can send reminders under your name to inform your patients that it's time to purchase new lenses.
Direct delivery is not limited to single-use daily disposable lens wearers. Manufacturers will ship any of their products in this manner. CIBA Vision even supplies a monthly report documenting the names, addresses and lens parameters of all patients who've had lenses shipped to them.
| ENVIRONMENTAL ISSUES |
| An issue that's raised periodically regarding single-use daily disposables is their impact on the environment. The concern is that there is the potential for a tremendous amount of waste material generated by the disposable lens packaging. Actually, daily disposables generate less waste than conventional daily wear lenses, according to Johnson & Johnson. There are no chemicals, bottles or lens storage cases, the blister packs are recyclable and the shipping box is biodegradable. |
PACKAGING PROGRAMS
Be flexible in determining purchase plans. Many different types of patients can use single-use, daily disposable soft lenses under varying wear conditions. For instance, most patients don't want to buy a year's worth of lenses at one time. Offering them three- or six-month programs makes more sense.
For part-time wearers, a 30-lens package for each eye may be sufficient. For a patient who wears soft lenses only once a week, this is about a six-month supply.
Another type of packaging that can be effective is "The Weekender Program," recently described by Neil Gailmard, O.D. This program offers a special discount to patients who have just received an eye exam, are purchasing a pair of eyeglasses and have demonstrated no interest in contact lenses. The program includes a contact lens evaluation by the doctor, training in lens handling, one follow-up visit with the contact lens technician and 30 pairs of daily disposables. Additional doctor visits are charged per visit, and patients can purchase additional lenses up to one year from the time of the comprehensive examination.
This program introduces maintenance-free daily disposables to patients who otherwise would not be considering contact lenses as an option. Creative purchase options such as this tailor contact lens systems for patients' needs and lifestyles.
PLANNED REPLACEMENT
Soft Lens Planned Replacement
The single-use, daily disposable contact lens has diaplaced its planned predecessor as the healthiest contact lens modality available. Yet, planned replacement will remain a viable option unitl the drawbacks of daily disposables- high cost and limited product availability- are resolved.
While it's true that new products and improvements in technology will drive down the price of daily disposables, annual cost may still be a barrier for some patients. In addition, new products are initially designed only for patients in the middle of the bell curve. often limiting access to low and mid myopes. Vistakon has only recently added plus powers to the 1-Day-Acuvue product line, while toric and bifocal designs are still not available. Thus, planned replacement is an important alternative for patients who are not candidates for daily disposable contant lenses.
A planned replacement schedule is also useful as a transition between conventional and daily disposable lens wear. For part-time lenms wearers, switching to daily disposables is easy and not especially costly since a 30-lens pack may last them several months. For patients who wear conventional lenses every day, switching to daily disposables represents a major change in both their lens wear philosophy and their budget.
Many patients view their lenses as prized possessions. Losing a lens is still traumatic for them, and it's often difficult to change this attitude. Contact lens technology has changed, and planned replacement is a beneficial way to introduce patients to the industry of today.
RGP Planned Replacement
The benefits of frequent contact lens replacement appl y to RGP lenses as well, and two RGP lens manufacturers have developed programs to encourage replacement of their products at regular intervals.
Paragon Vision Science's MaximEyes program allows you to prescribe FluoroPerm 151 for daily, flexible or extended wear with replacement usually every six months. The prgram is implemented through authorized labs, and offers three purchasing options. With Menicon U.S.A.'s Continuum program, you pay regular price the first time you order standard SF-P lenses for a particular patient, but every lens for that patient thereafter at six-month intervals is half price. The Continuum Plus program includes a three- or six-month supply of the Claris RGP lens care system.
While RGP planned replacement makes sense, it may take some time for practitioners and patients to embrace it, especially current RGP wearers who may have been following up to a three-year replacement cycle for years. Unlike thier soft contact lens counterparts, these patients don't usually readily sense the degradation of their lenses over time and may not initially perceive the benefits of six-month replacement. New RGP wearers or extended wear RGP wearers may be better isuited for RGP planned replacement.
If we decide to incorporate planned replacement of RGPs into our practice, we need to explain to patients the advantages to vision and ocular health. We need to plant the seed in their minds that the question is not whether they will switch to a planned replacement modality, but when they will switch.
JOIN THE REVOLUTION
Single-use daily disposable soft lenses are here to stay. In fact, as manufacturing costs decrease and technology becomes more sophisticated, they will become less costly and will become available in toric and multifocal designs.
Patient acceptance is high and lens induced complications are greatly reduced. Noncompliance is less likely to cause problems with more frequent lens disposal, yet 100 percent compliance is always the goal. Programs such as direct delivery to patients provide an efficient means of lens delivery while reducing expensive staff time and overhead costs.
In essence, the revolution in contact lenses is taking place today. What's next? The only frontier left is long-term extended wear. CLS
Craig Norman is director of the contact lens section at South Bend Clinic, South Bend, Ind. He is a fellow of the Contact Lens Society of America, an advisor to the RGP Lens Institute and a consulting editor for Contact Lens Spectrum.
![]({"src":"/media/05gnc4my/image-not-available.png","focalPoint":null,"crops":[{"alias":"thumbnail","width":1110,"height":700,"coordinates":null}]})