The Contact Lens Epidemic
Trends in the contact lens industry lead one practitioner to rethink conventional wisdom.
By Irwin Azman, OD

Disturbing trends in the contact lens profession have caused me to take a second look at the overall way we prescribe contact lenses and work with our patients. They include:

• The growing number of contact lens patients leaving our practices.
• Patients with contact lens complications. Why?
• Contact lens competition.
• The move toward deregulation of plano opaque contact lenses.
• Contact lens care quickly moving under the control of managed care entities.

Three-question Survey

In an informal, verbal contact lens study conducted over the past three years, information obtained supports the need for us as professional eyecare providers to come together both for our patients and our practices.

The survey posed three simple questions to optometrists. The data was collected from over 300 optometrists while attending optometric conventions and visiting various optometric offices.

Question 1:
Do you enjoy fitting contact lenses?

Over 90 percent of those surveyed said they didn't enjoy fitting lenses because:

• The ability to make more money from eyeglass patients.
• Contact lens patients are seen as disloyal.
• Too much chair time.

Question 2:
What is your workhorse contact lens and why?

Vistakon Acuvue 2 and Ocular Sciences Biomedics 55 were prescribed most frequently for the following reasons:

• Good pricing on contact lenses.
• Rebates and perks from manufacturers.
• If patients are happy, why change lenses?
• All lenses are pretty much the same.

Question 3:
What tests do you perform in a contact lens exam vs. a routine eye exam?

• Keratometry
• Nothing different

Due to the results of this ongoing study, I have personally begun to ask myself the following questions I now pose to you:

• Why should our patients be loyal?
• Why shouldn't non-prescription lenses be deregulated?
• Why shouldn't there be a move to deregulate all sphere disposable lenses?
• Why should we charge extra for a contact lens examination?
• Are we doing what's truly best for our patients, or are we simply doing what's easier, faster and cheaper for ourselves?
• Have we become nothing more than a "shoe salesperson" in disguise?

Before you read further, I would ask you to stop for just a moment and reread the above questions. Answer them in your own mind. If you truly believe patients should be loyal, are angry about potential deregulation and don't want lay people prescribing contact lenses, then I might ask:

• What are you doing to prevent these things from happening?
• What are you doing to keep your patients loyal?
• What are you doing to build your contact lens practice?

If you're waiting around for some managed care entity or insurance company to make a difference, I can assure you it isn't going to happen. Change occurs only when each of us is willing to take that first step.

Contact Lens Ethics

It's scary to think that some of our colleagues are fitting certain contact lenses because of low cost, perks, or ease of fitting. They may be using refractive error and K readings as the only information for making a decision about what patients put directly on their eyes. What does that say about us as professionals? Should we not be giving our patients the best we have to offer? Shouldn't it be a true "experience" to come to our practice for a holistic contact lens examination instead of a 'move 'em in, fit 'em out" approach? No wonder lay people think they can do just as good a job, if not better than us!

Those who call themselves eyecare practitioners should provide the highest level of care not based on what's the cheapest, who is offering the best perks and rebates or because it's easier to keep a patient in the same lens. The "if it isn't broke, don't fix it" approach does not work in the contact lens field. It simply can't, not if we really care about our patients.

Practitioners should begin practice each day by reminding themselves of the AOA philosophy: "Our goal as a clinician is to design a contact lens from a physiologically adequate material that will have minimal mechanical impact on the corneal surface while providing the required optical correction." (Optometric Clinical Practice Guideline Series: Care of the Contact Lens Patient)

We, like any other healthcare professional, should act in the best interest of our patients at all times. We must place the clinical need of the patient first, not our own self-interests.

In order to achieve this goal, it means a little extra time and a little more effort on our part. It means taking time to understand our patient's needs. Asking the right questions will provide us with the information we need in order to make an educated decision about the best contact lens for each individual patient. In return, the patient will feel we truly care about him and his visual health.

I believe patients come to us for our expertise ­ not just because they're looking for someone to prescribe contact lenses. Think about it for just a moment: if you're buying shoes, you don't really care who the salesperson is, but if there is something wrong with your eyes or you need contact lenses, you want the best. We have only one pair of eyes.

Keeping Our Patients

So I have to wonder, after we evaluate a patient, treat him of all underlying disease and then fit him with the appropriate lens/program, what happens to that contact lens patient? Why doesn't he come back? If we are truly offering the best, why are so many contact lens patients looking to buy lenses elsewhere after the initial examination?

Perhaps we don't take enough time to show we truly care about the contact lens patient. We show we care by actively listening to our patients, by securing information about medications, contact lens history, existing medical conditions, lifestyles and yes, even taking the time to obtain records from previous practitioners. That's when patients become loyal ­ coming back through our doors.

We also show we care by using all the tools at our disposal and performing all the appropriate eye tests, such as slit lamp evaluation with the proper illumination, complete corneal evaluation, vital stainings, lid evaluation and a willingness to fit any lens that will meet the patient's total eye health needs. Quality, holistic eye care ­ it's in the AOA creed.

We also show we care by taking time to treat and control all underlying diseases that involve tears, the cornea and lid before prescribing any contact lens, and we do this without fear of losing the patient. This is probably the first and most important step in total quality contact lens/eye care with patient education a close second.

All of our best-laid plans will go for naught if the patient isn't educated frequently about his personal eye health relating to contact lenses and accessories:

• What solutions to use and why.
• Why a particular lens has been prescribed including:

• Dk value
• Handling
• Optics
• Dehydration rate

• When to use eye drops and why
• Timely replacement of lenses and why
• The need for regular check-ups and when
• The best disinfection system and why
• Wearing schedule and why

Things that seem very simple and straightforward to us are not so simple for the patient.

Because I believe patient education and regular follow-ups to be critical to overall eye health, I do not think it in the best interest of most patients to prescribe a year's supply of lenses and/or solution. Too many changes can occur in a year's time. In addition, patients need re-education and help maintaining optimal visual health.

Think about prescribing a supply of lenses and solution that is appropriate based on the patient's need for future exams ­ quarterly, bi-annual or in some cases, more frequently. Check for corneal health, lid status and changes with the patient's lifestyle, medications, the environment, health or anything else that might impact the overall contact lens experience. Finally, research has found that many contact lens patients will not return to your practice if sold a year's supply of lenses!

Make no mistake about it; contact lens patients will buy their lenses and/or solution online, at discount stores or at the local drug store if there is not regular follow-up.

Don't fool yourself into thinking your patients are not being targeted by the 1-800s of the world. They are! What's worse, patients are leaving private practices in droves, thinking it's cheaper and more convenient to purchase contact lenses and solution elsewhere. But what's the real definition of "cheaper?" When one thinks about what the contact lens practitioner brings to a contact lens patient, one should think about value. Value is not just about price. Value is about cost, quality and service...all rolled into one. It's not about cost. These are the elements that will never be offered by a discount outlet store!

If we as contact lens practitioners want to continue providing the highest quality contact lens care, it is incumbent for each of us to frequently ask ourselves: "What drives my contact lens prescribing decisions?"

Any rebate, better pricing or incentive to choose one contact lens over another lens because of a small dollar contribution made by certain companies or managed care entities should horrify us as professional contact lens practitioners. It's sad to think that some companies truly believe they can actually buy us.

As regulations within the insurance industry begin to change, and they will, remember this: Any conflict of interest, incentive or form of inducement, which threatens our first priority to the clinical need of the patient, is unacceptable and will ultimately lead to the failure of the private contact lens practitioner and could put the patient in danger.

Take the Challenge

In order to prevent such a situation, I challenge us all to unite as professional contact lens practitioners. Don't let managed care take over our profession the way it has many others. Don't let people who do not understand our practices or our patients dictate ­ what equipment we use, lenses we prescribe, tests we use and how much time we spend with each patient. Most importantly, don't let managed care tell you what you're services are worth ­ the fees you have to charge.

Don't ever give up the good fight. Again, I ask you: What will you do to ensure the health and viability of the private contact lens practitioner's practice? Step one is to provide the best holistic, quality eye healthcare possible. When we prove ourselves, we will no longer be concerned with questions like deregulation, loyal patients and managed care encouraging the use of certain lenses because of pricing issues. Nor will we have to concern ourselves with the "shoe salesperson" selling contact lenses in a mall kiosk. In return, our practices will thrive. We will once again enjoy contact lens patients. They will demand our services and will not look elsewhere to fulfill their contact lens needs.

The time has come. It's now or never. Don't wait for someone else to fix the industry. If each one of us does not do his or her part to take charge of our patients and our practices someone else will take care of it for us.

Dr. Azman is in private general optometric practice in Maryland. He is a 1977 graduate of Illinois College of Optometry and a member of the American Optometric Association Contact Lens Section.