Are You Making the Most of Your Disposables Income?

BY JENNIFER A. NG, OD & HARUE J. MARSDEN, OD
June 1999

Disposable and planned replacement contact lenses now offer an array of options for both practitioner and patient. Are you making the most of this resource?

In recent years, there has been a deluge of new disposable and planned replacement contact lens products. The advent of one day, disposable toric and bifocal contact lenses has increased practitioners' contact lens options. Approximately 37 percent of new fits in the U.S. soft contact lens market are conventional types, and 43 percent of current soft contact lens wearers replace their contact lenses less often than every 6 months. Disposable and planned replacement contact lenses offer you the perfect opportunity to increase the contact lens portion of your practice.

Daily Disposables

Daily disposable soft contact lenses give spectacle and RGP contact lens wearers the opportunity for occasional soft contact lens use without the hassles of cleaning, storing and maintenance schedules. This contact lens modality is ideal for sporting or social events when spectacles or RGP contact lenses aren't as practical. One day contact lenses are another valuable alternative for full-time soft contact lens wearers who easily build up protein deposits on their lenses.

The 1-Day Acuvue (Vistakon) was the first daily replacement contact lens available, but recently, CIBA Vision's Dailies and Bausch & Lomb's SofLens have also entered the market. At roughly $1 per day per pair, these lenses are becoming increasingly affordable.

Daily disposable lenses are the healthiest method of contact lens wear available to patients. Currently, daily disposable soft contact lenses make up about 1.5 percent of the market (roughly 500,000 Americans). An increase to 10 to 15 percent of new fits is projected for daily disposable contact lenses within in the next few years. Because daily disposable contact lenses eliminate cleaning and disinfecting steps, and are reasonably priced, they're likely to become a more mainstream contact lens modality.

Disposable Torics

In terms of new disposable and planned replacement contact lenses, toric lens options have really expanded. Improved disposable toric soft contact lenses have provided practitioners with a better tool for fitting astigmatic patients. New technology has created better optics, increased reproducibility and affordability. We can expect a significant number of refits with conventional torics, soft spheres and spectacles.

Among the 2-week disposable toric contact lenses are the FreshLook Toric (Wesley Jessen) and the SofLens66 Toric (Bausch & Lomb). Dr. Terry Tsang, an investigator in a FreshLook Toric study, found the FreshLook Toric to be easy to fit with good fit stability, vision and handling. Vistakon is working on its 2-week toric, Acuvue, which is expected to be released later this year. CIBA Vision's Focus Toric and Cooper Vision's new Frequency 55 Toric are the monthly replacement options. Overall vision, comfort and patient satisfaction have been very good with this new line of disposable torics contact lenses .

Disposable Multifocals

With a growing number of baby boomers being affected by presbyopia, more of them will be looking at all available contact lens options. Traditionally, presbyopic contact lens patients have been limited in their options for monovision, many having only varying success with soft bifocal contact lenses, spectacles and RGP bifocal contact lenses.

Currently, Vistakon's Acuvue Bifocal is the only 2-week disposable bifocal contact lens on the market. This new contact lens allows practitioners and patients to try bifocal contact lenses with minimal financial risk compared to previous soft bifocal contact lenses. I've had considerable success fitting patients with both full and modified bifocal approaches.

A successful contact lens practitioner explains his modified monovision approach, saying, "By fitting one eye for distance with a slightly lower add, and the other eye for an intermediate distance with an add, the patient receives binocular intermediate vision in addition to distance and near vision."

Sunsoft's Additions lens is a quarterly replacement multifocal contact lens with an aspheric, center-near progressive add design. The aspheric design is good for individuals with intermediate distance needs. As with any aspheric design, centration and pupil size are critical for success. The Additions multifocal contact lens has three add ranges offering correction up to +2.50D. Add A has a low add range of +0.75D to +1.25D, which is good for early emerging presbyopes. Add B has a range of +1.50D to +2.00D and Add C has a range of +2.25D to +2.50D, providing near correction for more advanced presbyopes.

The monthly replacement MV2 bifocal contact lens (The LifeStyle Company) is fit in the same manner as monovision. The LifeStyle Company's MV2 contact lenses are similar to single vision soft contact lenses, but they have a small central intermediate zone specific to the near and distant eye. The intermediate power in the distance lens is +0.50D over the distance lens prescription and -1.25D over the near lens prescription. Consequently, the patient has binocular intermediate vision along with distance and near vision.

Disposable Color Lenses

Patients with dark eyes who want a natural looking iris color change can now try Wesley Jessen's Colorblends, a new line of disposable opaque contact lenses that combine three distinct color patterns to simulate a more natural looking iris pattern. To produce a more natural appearance, the color of the contact lens around the pupil is hazel, and the surrounding iris color is either blue, brown, gray or green with a dark outer iris ring.

Patients who wear opaque contact lenses occasionally have complaints of flare when their pupil size increases in dim illumination. Try using a slit lamp with a cobalt blue filter or a Burton lamp to view pupil size in these patients. Educating the patient about occasional glare or flare at night is a crucial component for success.

Disposable Extended Wear Contact Lenses

A recent study shows that current contact lens wearers are very interested in a continuous wear lens. They want clear comfortable vision with little to no hassle. Bausch & Lomb's PureVision contact lens has just received FDA approval for 7-day extended wear. Made from balafilcon A, the contact lens has a Dk of 110. According to Bausch & Lomb, the new PureVision contact lens combines the excellent oxygen transmissibility of a silicone contact lens with the deposit-resistance of a hydrogel contact lens. The PureVision contact lens was also recently introduced in the marketplace as a monthly replacement contact lens. The annual cost of monthly replacement contact lenses is comparable to the annual cost of 1-week disposable extended wear lenses.

Practical Application

With so many new products on the market, are you making the most of the disposable or planned replacement portion of your practice? Service is the only method that practitioners can use to compete and differentiate themselves from mail-order and warehouse contact lens companies selling lenses at reduced prices in the marketplace. Encourage patients to enroll in frequent replacement programs, which include a comprehensive exam, fitting, unlimited contact lens related follow-up visits and solutions for one fee. These plans considerably reduce the price for a year's supply of contact lenses, making it more affordable for patients than if they purchase individual contact lenses or boxes. Initially, these service plans may appear to be a large expense, but by presenting a comparison of the amount of money spent on annual services and contact lenses purchased separately to the amount spent on a frequent replacement plan, patients will recognize the value that the plan offers them.

A successful Los Angeles contact lens practitioner is just one of many who makes frequent replacement plans available to his patients. He usually prescribes a 6-month supply of contact lenses. Under his service plan, patients are entitled to a comprehensive eye exam, a 6-month follow-up, unlimited contact lens related follow-ups, reduced sunglass and solution fees and also a free spectacle lens change if necessary. This L.A. practitioner says that optometrists need to emphasize service and vision care, as opposed to just selling contact lenses and other vision products. "Quality care is what builds patient loyalty, not the least expensive price on a box of lenses. Disposable lenses need to be coupled with a good recall system to ensure patient retention," he said.

A private practitioner from San Juan Capistrano keeps his exam and fitting fees separate from his contact lens fees. The comprehensive exam is a set fee, but the fitting fee varies, depending on the level of skill required. His toric and bifocal contact lens fitting fees are the same, regardless of whether the contact .lenses are disposable or conventional replacements. He calculates the cost of the contact lens plus shipping and taxes and generates a "cost plus" fee for the lenses. Then he calculates how much he needs to charge for chair time and adds it to the "cost plus" figure for a 1-year supply of lenses. He says that keeping the exam costs separate from the lens costs allows for better accountability, and that even though patients may occasionally go elsewhere for less expensive lenses, they'll return when they realize that the quality of the eye care is most important.

One large Beverly Hills optometric group practice charges separate comprehensive exam and fitting fees for disposable contact lens patients. The fitting fee entitles the patient to unlimited follow-up visits during the first 90 days. After those 90 days, all further follow-ups include a fee, depending on the complexity of the visit. One partner of this practice states, "Optometrists need to charge for their follow-up services. Other medical professionals charge for their time and expertise, and optometrists need to do the same. We provide a valuable service and we should therefore be compensated fairly."

Table 1 provides a summary of some characteristics of the new disposable and planned replacement contact lens products available on the market. These products are positive additions for both practitioners and patients, and should be considered as such. Patients get convenience, comfort and better health from frequent replacement contact lenses, and practitioners get better control of patient recall and reduced ocular complications. Because disposable lenses offer a multitude of benefits for both practitioners and patients, it's important to use them to their fullest capacity.

Dr. Ng is currently completing a residency in Cornea and Contact Lens at SCCO and is working part-time at a private practice in Rancho Santa Margarita, Calif.

Dr. Marsden is an assistant professor at SCCO and is a Fellow of the American Academy of Optometry. Her primary clinical responsibility is the Cornea and Contact Lens Service at the Optometric Center of Fullerton.