Disposable and Planned Replacement Lens Update

Now there are disposable and planned replacement options in almost every contact lens category.  Here's what you need to know as patients make the move into this modality.

BY Pamela Capaldi-O'Brien, BSc & Joseph T. Barr, OD, MS, Editor
JULY 1998

For patients under the age of 25, who comprise 60 percent of all new contact lens wearers, disposability and frequent replacement of contact lenses is all they know. But the adult generation needs to know too, and it seems that it is paying attention. Disposable and frequent replacement options have also been embraced by practitioners, who have forever looked to new technologies to provide their patients with the best care available. So while the conventional wear contact lens market continues to keep many patients and practitioners satisfied, disposable and planned replacement lenses are becoming the standard. Improvements in the options and availability of the products have given you a multitude of choices with which to ensure eye health, meet patient demands for convenience and cost, and allow yourself to build your contact lens practice.

One-Day Disposables

There's been a great deal of discussion about the single-use disposable lenses in the two years since Vistakon first introduced them. Despite varied acceptance of this modality, growing patient awareness is driving the market upward. Yet, many practitioners find that this option is too costly for their patients, an issue which has overshadowed its many benefits, including convenience, availability and improved ocular health.

The choice in daily disposables has widened. Vistakon's 1-Day Acuvue lens was the first in the market and continues to be the market leader. The company claims that 98 percent of wearers are very or extremely satisfied, with nine out of 10 patients replacing their lenses as directed. The lens has a Dk of 28 and is soft molded in 58 percent water content etafilcon A material.

The new Focus Dailies lens, manufactured by CIBA Vision, is a cast molded 69 percent water content nelfilcon A material lens with a Dk of 26. Targeted for full-time, daily disposable wear, Focus Dailies is primarily packaged in 90-lens packs, although 30-lens packs are available. The company states that Focus Dailies are inexpensive enough to permit full-time wear, and it estimates that 95 percent of patients are wearing the lenses as such.

Bausch & Lomb expects to launch SofLens One Day in the United States in the second half of 1998. This daily disposable lens is made from a 70 percent water content hilafilcon A material with a Dk of 33. One of its unique features is that part of the contact lens mold used in the manufacturing process actually becomes part of the packaging for the product.

Affordable Disposability

The issue that patients and practitioners alike always seem to come back to is the cost of disposability. Literally speaking, all lenses are planned replacement and disposable. You and the patient plan when to replace them. The question is, how often can you afford to throw them away? They all end up being discarded at some point in time.

Though the practitioners who we informally surveyed charge approximately $650 to $750 annually for a one-year supply of lenses and services, the introduction of the CIBA Vision Focus Dailies and the Bausch & Lomb SofLens One Day will undoubtedly change the equation. CIBA Vision has positioned its Focus Dailies at a cost to practitioners that's lower than the market founder, 1-Day Acuvue. The company attributes the lower lens cost to the streamlined manufacturing process, Lightstream Technology, which it predicts will bring the cost of daily disposables to $1.00 per pair per day. Bausch & Lomb claims that SofLens One Day will sell for about the same. These prices would cut the annual fee for disposables considerably, requiring practitioners to re-evaluate their profit margins and recalculate their annual package programs.

Vistakon reports that it currently does not plan to drop the cost of 1-Day Acuvue in response to competitive pressures, but claims that the additional cost buys many important options, including: a UV blocker, two base curves instead of one, a wide power range (plus and high minus), a proven track record and two-day delivery with no back order.

CIBA Vision plans to expand the power range of Focus Dailies and will no doubt work hard to fill the orders with quick turnaround. Its emphasis will be on expanding lens distribution to a wider base of accounts, followed by expanding the parameters.

Disposability for Astigmats

Frequent replacement programs (replacement usually every one to three months) have had a favorable impact on soft toric sales. In 1997, frequent replacement torics accounted for 39 percent of new toric fits. Up until a few months ago, there were no cost-effective disposable options to offer astigmatic patients. This has changed with the introduction by Wesley Jessen of the first and only disposable toric soft lens in the market, FreshLook Toric. Close on its heels is a two-week replacement toric from Bausch & Lomb. These products deliver improved convenience as well as ocular health.

FreshLook Toric is made from 55 percent water content phemfilcon A material, wet molded with orientation/inversion marks to ease rotation measurements for accurate fitting. The lens can be replaced one to seven days for flexible wear or at two weeks for daily wear, depending upon the practitioner's recommendation. Wesley Jessen's Toric ABC on-line fitting software calculates the prescription for torics when you enter in the spectacle prescription. The company claims that this software calculates plus cylinder to minus form and eliminates the need for vertex conversion calculations and overrefraction calculations.

Later this year, Bausch & Lomb plans to launch the SofLens66 Toric. This 66 percent water content, alphafilcon A material lens is approved and priced for two-week daily wear replacement. The Lo-Torque design of the lens provides rotational stability, optimal visual acuity and comfort. It also includes prism ballasting stabilizing geometry, a refined optic zone and a balanced vertical thickness profile.

Planned Replacement Torics

With the absence of a disposable toric lens in the market until recently, astigmats traditionally enjoyed convenience and improved ocular health through planned replacement torics. The newest lens to this market is Multiples Toric, by Sunsoft. The company recommends quarterly replacement for this 55 percent water content, front molded, back lathed, methafilcon A lens. Coming soon is the Frequency 55 Toric, a one-month planned replacement toric lens by CooperVision. Table 1 provides a list of the toric multi-packs marketed for planned replacement.

Disposability for Presbyopes

Vistakon's Acuvue Disposable Bifocal is expected to launch in North America in the fourth quarter of 1998, but is now available in limited markets. It is a simultaneous vision design lens with a light blue visibility tint (good for presbyopes) and a UV filter. Patient acceptance of the lens in premarket trials has been high. It seems to offer good visual acuity to early presbyopes with ideal centration and pupil size of lesser importance to successful fitting. However, reports indicate that bumping up the plus power for higher adds results in a degradation of distance visual acuity, which occurs in most simultaneous vision contact lenses.

The Possibilities

The combinations for disposable lenses seem endless, with multiple designs, replacement schedules and wearing schedules from which to choose. Then you must decide between clear lenses, visibility tinted lenses, enhancing tinted lenses and opaque lenses, and you can choose whether or not to include a UV blocker. The hundreds of options available can make your head swim, but a well-organized plan can make a difference. Having all of these possibilities creates the potential for confusion for the patient as well as for the practitioners and staff members.

How are practitioners managing the growing number of options? How are they positioning the lens choices with patients? What about inventory, direct shipping and mail-order options? We asked disposable lens gurus Craig Norman, C.O.T., F.C.L.S.A., Walter West, O.D., and Carmen Castellano, O.D., how they juggle all of these options while being able to make appropriate recommendations. They gave the following advice.

Planned Replacement Versus Disposable

So, how do you decide between planned replacement lenses and disposables? "More frequent replacement is better," says Dr. West, while Craig Norman stated that his practice is still very dedicated to monthly planned replacement. Dr. Castellano offers four options to patients: conventional wear (replaced every six months), planned replacement (replaced every two months), disposables (replaced every two weeks); and single-use disposables (replaced each day). Two of these three practitioners stated that they fit about five percent of their practice with single-use disposables, and these fits were for patients who were mainly part-time wearers. The choice of planned replacement or disposables continues to be a professional recommendation based upon various factors: ocular health, ocular condition and prescription, the patient's needs and economics.

Disposable Income

When charging for planned replacement and disposable lenses, which works better -- a one-year global fee, or shorter-term fees that depend on the number of lens packs patients receive? There was no consensus on which choice was best. The answer depends on the individual practice and the patient population, but these practitioners agree that an annual fee program motivates the patient to remain loyal to the practice. They encourage offering service agreements as well as a continuum of professional service.

Craig Norman, for example, charges monthly replacement patients an annual fee of $275 for the contact lens fitting, lenses, solutions and contact lens service visits (approximately two per year). He says that the benefit to having planned replacement patients on an annual fee schedule is the ability to monitor compliance. Plus, even if patients don't use the solutions properly, this system better assures the practitioner that they are using the proper solutions. The eye exam is covered under a separate initial fee.

Inventory, Direct Shipment, Mail-Order

Dr. West maintains an inventory of 1,600 multipacks, while Dr. Castellano keeps a relatively small in-office inventory but has his patients return to the office for a new lens pack. Craig Norman's practice enthusiastically encourages direct shipment from the manufacturers to the patient. Each approach has its advantages. With an inventory of such size, immediate availability is an obvious benefit for Dr. West. Dr. Castellano's preference to dispense lenses from the practice gives him another opportunity to touch base with patients, reinforce the need for follow-up care and monitor their on-going ocular status. Craig Norman says that he and his staff promote direct shipments from the manufacturers because it's easy internally so the staff loves it, it decreases in-office inventory, and it's convenient for the patient. Patients receive a six-month or one-year supply of lenses, depending on the wearing schedule and manufacturer shipping options and costs.

It's estimated that approximately 10 percent of contact lenses are purchased through mail-order, with the most likely lens type being disposables. Drs. West and Castellano say that they have noticed little impact from mail-order and that while they don't encourage mail-order replacement, they don't fight it. If a patient asks for his prescription, he receives it. Service agreements and annual fee programs keep patients returning to the doctor's office. According to Craig Norman, however, mail-order has had a "definite impact!" He states that patients request their prescriptions with greater frequency due to higher consumer awareness. The advertising and broader promotion from mail-order companies has convinced patients that this is an acceptable method for them to obtain lenses. He also says that educating the patient is critical. He recommends explaining to patients that it is not as important where they get their lenses as it is that they maintain good eye health and contact lens health.

"I think we'll see a trend to routinely pass out patient prescriptions in the next five years," he said. "Our fees are to diagnose, fit and follow up the contact lenses. There's a great deal of administrative time involved in providing ongoing contact lenses, and little profit. We make about $12 per eye providing single-use 90 packs of lenses. So for a three-month supply, we collect $25 for all of the staff time involved. It doesn't make economic sense."

One final comment by Craig Norman summed up the importance of professional service in marketing disposable and planned replacement to patients.

"In the past, private practitioners prided themselves on charging for services," he said. "The specialized knowledge and care provided sets them apart. I think that as private practitioners are becoming caught up in managed care, they are losing sight of this. It's the service and patient care that needs to be emphasized." CLS

Special thanks to Craig Norman, Carmen Castellano and Walter West for their contributions.

Note: Contact Lenses and Solutions Summary (CLASS), a yearly Contact Lens Spectrum supplement, provides a comprehensive listing of the disposable and planned replacement lenses currently available.

To receive references via fax, call (800)239-4684 and request document #38.

Pamela Capaldi O'Brien is the global coordinator for the International Association of Contact Lens Educators, based in Sydney, Australia.