RGP MULTIFOCALS

Marketing RGP Multifocal Lenses in Your Practice

By Jeff Morrison, OD; Jack J. Yager, OD; Sonja Biddle, OD; and Doug Benoit, OD
October 2000

Most presbyopes are not aware that RGP contact lenses are an option for them.

Rigid gas permeable (RGP) multifocal aspheric and segmented bifocal translating designs represent a tremendous potential growth opportunity in any contact lens practice. These designs provide better binocular visual acuity at distance and near than monovision or soft bifocal lenses. Presbyopic patients are grateful and motivated to continue their activities without glasses. This is especially true of the baby boomers who have been wearing lenses for 20 years or more and are adamant about avoiding spectacle wear. These multifocal lenses help them feel as though they still have their youth and can resume their customary activities without visual compromise. These patients become a very enthusiastic referral source.

In essence, multifocal contact lenses are like an annuity. They help the practitioner make a reasonable profit while remaining the person truly fitting the lens. The patient recognizes the practitioner's abilities and perceives him/her as an expert. With so many laboratories offering marketing materials and liberal guarantee policies, RGP multifocals are easier than ever to market and fit.

The Power of Referrals

Word of mouth referrals are the least expensive advertising available. We are amazed at the number of patients that visit our practices because their previous practitioners indicated that multifocals lenses "have not yet been perfected" or simply "don't work." When patients leave our office after successful fitting of a multifocal lens design, they are going to tell their friends, family and co-workers that these lenses do exist and you are the one who helped them. In essence, the prescribing doctor is perceived as an expert, most likely because other practitioners in the area will not or can not fit them. A large referral source in our practices are those practitioners who do not desire to fit multifocals or do not have the tools for multifocal fitting in their practices. The bottom line is that patients do not want to sacrifice or compromise quality of vision or visual freedom by using some other mode of correction. Once successfully fit into multifocal contact lenses, they often become loyal followers and great referral sources.

Translating designs can provide higher add powers for presbyopes.

Aspheric multifocals typically work well for computer users.

Marketing Multifocal Lenses to the Public

Begin by letting all your current patients know that you fit multifocal lenses. As many patients are not even aware that this option exists, don't ever assume that ongoing and repetitive marketing of these lenses is not necessary. When patients contact the office for an appointment, ask if they are interested in contact lenses. The new presbyopic patient may be surprised to hear that this is an option. A well-trained staff member can then discuss this option and how successful it has been in your office.

In-office brochures and a continuous loop video educating patients about the benefits of contact lenses, specifically multifocal lenses, is beneficial. Your local Contact Lens Manufacturers Association (CLMA) member laboratory can provide you with these and other patient and practitioner educational resources on RGP multifocal contact lenses. An office newsletter to patients is an excellent source for information on multifocal contact lenses. Likewise, radio is a great outlet to educate the public about effective and successful methods of correcting their visual needs, including RGP multifocal contact lenses.

Presenting the Multifocal Option

We discuss all options with the patient, including over-spectacles, monovision and multifocal contact lenses. When presenting multifocals, we explain to patients that for the last 40 years or so, they have been using both eyes at every distance of viewing. When given these different options, they typically select multifocals. In our practices, we begin with multifocal lenses in over 80 percent of presbyopic contact lens wearers. They are aware that we can refit them into monovision at a later time if desired, but few actually change. When we use monovision, it is often in existing RGP wearers who are just entering presbyopia. Even in these cases, it is not unusual to refit them into a multifocal design once their presbyopia increases.

What About the First Time Contact Lens Wearer?

Obviously, the established single-vision RGP wearer makes the transition to multifocal contact lenses more easily than the first-time wearer. The new wearer not only has to adapt to contact lens wear in general, but over time may have heard negative comments about adaptation from friends, family, etc. Use "softer" terminology such as "lens awareness" or "lid sensation" when describing adaptation to a new wearer. A topical anesthetic is also beneficial at the fitting visit to help new wearers overcome their apprehension. Surprisingly, RGP multifocals are often more comfortable than conventional spherical RGPs because of limited movement with the blink recommended with aspheric multifocals and the thin upper edge present with segmented translating bifocal designs. One of the keys to multifocal RGP success with this population is patient education. If the patients are properly trained in both what to expect from these lenses and proper care and handling, success will likely occur. Inform patients that these are dynamic pieces of plastic that move on the eye, not remain stationary like spectacles. They need to understand that achieving a good fit is very important and may necessitate a lens change or two prior to achieving this goal. If they are patient and motivated to be spectacle-free, success can be achieved.

Profitability to the Practice

The fee for multifocal lenses is often close to twice that for spherical lenses. However, multifocal RGP lenses are a definite profit center in our practices. Make sure the fees are appropriate for the time that you spend with the patient. Higher multifocal fees do not discourage motivated patients. When you consider what younger patients pay for refractive surgery and the fact that the presbyopic patient base often has a higher level of income, the fees are often a secondary consideration. Seeing without glasses is the primary goal. Psychologically, those individuals who pay the higher fee are more motivated to succeed. The cost of multifocal contact lenses often does not differ significantly from progressive spectacle lenses. If the fees are discouraging to patients, this may reflect upon their individual motivation and may make spectacles a more viable option.

We have to occasionally refund partial fees and/or change an individual to another modality, but a greater than 80 percent success rate is possible. Your patients should be aware of this. This modality can be a definite profit center in your practice. These patients have friends who may be experiencing problems with spectacle wear or monovision, and once you successfully fit them into RGP multifocal contact lenses, they will tell many of their friends how much they love the visual freedom they are experiencing.

Diagnostic Sets in the Practice

Although it is possible to fit aspheric multifocal lenses empirically, diagnostic lenses optimize success. Fitting sets allow you to quickly determine how the lenses are performing, the lid-to-lens relationship and seg height position (if applicable). Keep, at minimum, two to three diagnostic sets in your practice. This could include two different types of aspheric multifocal lens designs and, at minimum, one segmented or translating design. For recommendations as to what lenses to use, contact your laboratory.

Typically, aspheric multifocals are indicated for:

• Patients who are not good translating candidates (low positioned lower lid, flaccid lids)
• Frequent computer users who benefit from the intermediate vision provided by these designs (with absolute presbyopes, one lens may have to be over-plussed slightly to achieve optimum near vision)
• Participants in sports such as soccer, basketball, and racquet sports in which aspheric lens displacement is rare
• Patients who prefer the thin lens design they had with their previous spherical RGP lenses

A traditional disadvantage of aspheric designs has been in ability to provide high add powers. Several of the aspheric multifocal designs introduced in recent years are available in add powers that effectively provide +1.50D to +2.00D near power. Translating designs are optimal for patients with critical vision demands and any add requirement.

The Future of RGP Multifocals

With the aging population increasing, incorporating multifocal RGP lenses into the practice is both bright and exciting. If you are not currently fitting these lenses, contact colleagues who are for advice, attend continuing education on multifocal lenses, contact the RGP Lens Institute website (www.rgpli.org) and/or contact your laboratory for advice and information. In this time of increasing competition for patients, helping the presbyope who wants to be eyeglasses-free and does not desire refractive surgery (or reading glasses) is an opportunity to seize. These designs can add excitement to the daily routine and offer clinical challenges. They are an incredible profit center in this time of managed care cut-rate vision plans. A good time to expand your RGP multifocal patient base is now. You will see the difference it makes in your practice. 

Dr. Morrison, a member of the RGPLI advisory panel, is in Private practice in Colby, KS, emphasizing specialty contact lenses and anterior
segment diseases.

Dr. Yager is in private practice in Orlando, FL, specializing in contact lenses. He has lectured worldwide on contact lenses and acted as a consultant and/or clinical investigator for
several contact lens companies.

Dr. Biddle is in a group practice in Dover, DE, where she has specialized in contact lenses for the last 10 years.

Dr. Benoit, a Diplomate of the Cornea & Contact Lens Section of the American Academy of Optometry, practices in a multi-sub-specialty ophthalmology group in Concord, N.H. He lectures frequently on all aspects of contact lenses and external disease.