editor's perspective

Contact Lenses --Something to Talk About

BY JOSEPH T. BARR, OD, MS, EDITOR
APRIL 1998

The three Os -- ophthalmologists, opticians and optometrists -- typically don't recommend contact lenses to their patients. Some would argue they don't even wear them enough themselves. Recent market research indicates that only about one-third of spectacle wearers were asked by their eyecare practitioner about their interest in contact lenses. As reported by Sally Dillehay, O.D., M.S., excellent contact lens candidates who posed as spectacle wearers and asked about contact lenses in the primary care optometry clinics of North American schools and colleges were almost always disuaded from them. This, of course, rocked the schools, their contact lens educators, their administrations and the contact lens manufacturers. Why are practitioners avoiding these highly successful, low-risk devices? Why have the manufacturers had to go directly to the consumer for the past 15 years, paying patients with rebates in recent years, to prompt practitioners to prescribe contact lenses?

How about this hypothesis: O.D.s, who prescribe the majority of contact lenses, are not very good salespersons (except for a minority of contact lens gurus who have many happy patients and who make a nice living off of them), and the M.D.s have too many other things on their minds. The opticians, technicians and assistants who work for the doctors may never get to talk to patients about contact lenses, or when they do, it's too late. Independent opticians may not be very interested in broaching the subject either, for economic or training reasons. Hypothesis two: contact lenses really aren't successful enough or profitable enough to recommend. No study has documented the price of the failures -- only the profitability of the successes. So the subliminal perception of failure with contact lenses compared to the high success of spectacles causes practitioners to avoid the subject. Even if success rates are up and drop-out rates are down, the risk for failure (lost time and credibility) is still greater than with spectacles, at least in the eyes of practitioners.

Some blame managed care, vision care insurance and even disposable lenses for low profits, and thus low motivation to suggest contact lenses. Yet, much of contact lens service is outside of managed care, and at least one study shows that disposable lens patients (not just the one-box folks) are profitable. Is there really something wrong with making people happy with good vision using contact lenses even if you profit less? Some say it's not like the "old days of PMMA lenses where you could get hundreds of dollars per pair." But even then, most practitioners didn't recommend them. A good approach is to ask every patient if they're interested in contact lenses, though I realize I may be preaching to the choir here. Is it ethical and therefore desirable to inform all eyecare patients about all of their options? I believe so.