You might think that a successful contact lens patient would be ours to keep forever. Not necessarily so. As Alfred North Whitehead so aptly put it, Ideas don't keep. Something must be done about them. When the idea is new its custodians have fervor�

All contact lens fitters have experienced the initial excitement of a virgin contact lens wearer transform into a litany of complaint and apathy. So if we're to retain our contact lens patients and keep them coming back, we must continuously spark their fervor.

The first step in sparking ongoing patient interest in contact lenses as their primary vision correction device is to inspire your staff. If your employees are not proselytes about your ability to fit and manage any kind of contact lens case, how can your patients be believers? Devote yourself to training your staff about contact lenses in general, and specialty lenses in particular.

Routine staff meetings are the best opportunities to regularly review contact lens topics. It's not very reassuring to a patient calling with a contact lens question to have the conversation regularly punctuated with, Please hold while I find out. Make certain your staff is familiar with the common spherical lens brands, materials and designs. They should know about lenses that correct astigmatism and their various iterations: soft, GP and hybrid GP/soft designs.

Teach your staff about presbyopia and the contact lens alternatives for correction: distance correction with near spectacles, monovision and multifocal lenses. Make them aware that orthokeratology is an alternative to laser vision correction for treating myopia. Finally, enlighten your staff about the many innovative fitting techniques available that make virtually any vision condition amenable to contact lens correction.

Your staff is also essential to your contact lens retention strategy because they can more casually allay patient fears associated with contact lens wear. It's no secret that patients have significant misinformation and apprehension concerning the safety and convenience of contact lens wear. This has been fed in no small part with the recent lens care product recalls and the Fusarium keratitis outbreak. Keeping patients confident and comfortable takes patience and time; time your trained staff is best able to devote.

It's not just apprehension concerning convenience and safety that your staff should be prepared to manage. The fear of failure with lens wear is also a significant issue. Regardless of materials and technology improvements since the introduction of soft lenses in the early '70s, the attrition rate among contact lens wearers has consistently remained at about 20 percent. Caution your staff that two out of 10 patients will give up lens wear unless they make every effort to forestall failure. This is where you must focus the staff's patient education. There should be no compromise on the importance of lens hygiene, the significance of sticking with the prescribed care solutions, the respect for lens wear limits and the inviolability of the lens discard cycle. This attention to detail should not only be part of the initial new fit education; it should be integral review at all return visits.

Retention isn't only a face-to-face strategy. Empower your staff to be your contact lens patient advocates. They should be available to handle patient phone inquiries as well as to discuss problems. I'm not suggesting that staff diagnose or treat contact lens problems, but they should be prepared to triage so that your practice can deal with simple lens care or lens wear problems efficiently to the patients' satisfaction. In addition, kindness is perhaps the least expensive patient retention tool. There will be times in a lens wearer's life when incidents and accidents occur that require our help. It may be the emergency run-dry on solutions, the torn last lens or the difficulty scheduling the contact lens exam within the one-year contact lens prescription expiration. As long as the behavior is not repetitive or abusive, the free lens or care kit, or that little extra consideration can be the passport to long-term patient loyalty.

After your staff, the next responsible party in a successful patient retention strategy is the practitioner. It's not possible to retain your contact lens patients if you don't have at your disposal tools necessary to satisfy all their needs.

Expect your loyal long-term patients to go through eye and vision changes. They may experience an increase in myopia or hyperopia. They may develop astigmatism sufficient to affect their vision. They will become presbyopic. In order to keep them successfully wearing contact lenses you'll have to be prepared to make ongoing changes. Making those changes will require different fitting approaches and different lens designs. A one-lens-fits-all approach will not keep them coming back.

Take contact lens correction of astigmatism as an example. Do you fit only one astigmatic contact lens design? Does a painter create with just one brush? Does a mechanic rely on only one wrench? In order to attract and keep astigmatic patients you should have at your disposal at least three different astigmatic lens designs: a uni-parameter design (one base curve and one diameter); a variable base curve design for corneas that may require steeper than normal lenses or for when lens sensation may be an issue; and a dehydration resistant design for the heavy computer users and dry-eye middle age patients.

A similar approach to presbyopic retention applies to multifocal contact lenses. I'd be shocked if any practitioner is 100 percent successful prescribing only one style of ophthalmic progressive lens. Different lenses have specific design elements that can improve success for a specific patient. The same holds for multifocal contact lenses. You should have at your disposal three alternative multifocal designs: a fixed, distance-center design appropriate for early presbyopes and for presbyopes who have less critical near vision requirements; a reverse centrad design (one lens center-distance, the other center-near) for patients who require more critical balance of distance and near; and a dehydration resistant design for the evaporative dry eye patient.

You can apply the same patient retention methodology to simple spherical lens correction. Every patient who has astigmatism of 0.75D or less could wear a spherical lens. Wouldn't it be great, and simplify our lives, if there was one lens that would work for all cases? Logic and experience tell us it's not possible. An appropriate arsenal for spherical correction should include mid-water and high-oxygen transmission lens designs. In addition, the arsenal should include not only pure spherical designs, but also an aspheric design as well as a dehydration resistant design for dry eye patients.

You should take the same approach with all other contact lens categories. I'll spare the repetition. You get it. Clearly, attracting and retaining GP wearers, patients who have irregular corneas and patients who use corneal reshaping requires diverse tools.

Tools alone, however, aren't sufficient to retain your contact lens patients. We all have diagnostic lens fitting sets we bought and never use. You have to be daring to try new approaches to contact lens wearing challenges. There are lots of special and custom design lenses available that may be better suited than the branded products for an individual patient. Don't be put off by the generic or custom fabricated brand. Some of these specialty lenses may be the best patient pleasers. Try the new silicone hydrogel materials on patients interested in safe continuous wear even if you, personally, don't believe in continuous wear. You should try the hybrid GP/soft designs for high astigmatism and irregular corneas. How else to test success and satisfaction? By all means, however, retain a healthy dose of skepticism and an abiding belief in the materials and methods that have made your patients delighted in the past. Just because a contact lens design is new doesn't necessarily make it better.

New approaches take time and money to master. Some may be costly failures, but in the end your patients will not fail to appreciate your efforts on their behalf. Think of your favorite restaurant. Sure it may have a specialty that you return for regularly, but the wise chef continues to develop new dishes. It's the potential of experiencing something new and satisfying among the familiar that keeps you returning.

New materials and methods will definitely help, but it's your diagnostic and troubleshooting skills that will help retain your patients. Always try to anticipate contact lens-related problems. As you make your routine slit-lamp observations, don't look for the obvious but for the subtle suggestion that may become an obvious problem later. If you observe a dry pre-lens tear film, anticipate end-of-day dryness and prepare a recommendation. If you note a change in astigmatism, demonstrate the potential improvement in visual acuity with an aspheric or astigmatic lens. Often it's minor incremental improvements that most satisfy patients and keep them returning.

It's also important to realize that patients aren't always accurate reporters of their lens wearing experiences. Some patients erroneously accept their discomfort or poor vision as a normal part of contact lens wear. Surprise them with your forensic abilities. Even in the absence of complaints, ask patients about lifestyle or vocational situations, systemic medications or environmental situations that may affect successful contact lens wear. Even if the information they supply isn't always helpful, patients will appreciate your interest in their success and realize that your knowledge of contact lens care is superior.

A sure way to have patients wander is to adopt the if it ain't broke, don't fix it strategy. Even if it's not broken but is worn or obsolete, change it while you can control the conditions, for surely the old and worn will fail at the most inopportune time. If everything is perfect and your patient is happy, don't be afraid to make new recommendations.

Even the most satisfied patients want to know about options that may make their contact lens wearing experience more satisfying. The patient may elect not to act on your recommendation presently, but he will appreciate the recommendation nonetheless. Beware the most devastating statement a patient can make about your contact lens management skills: My doctor never told me about that.

So far, contact lens patient retention has been referred to as a unilateral approach to motivating the contact lens patient to return. The flip-side of contact lens patient retention is to keep yourself motivated to have the patient return. Undoubtedly, it's difficult to keep motivated if it's not profitable to keep the contact lens patient coming back. The conventional wisdom propounded by many practicing practitioners and implanted in optometry students is that fitting contact lenses is less profitable than selling glasses. Nothing could be further from the truth. Various studies have demonstrated that the more frequent return and repurchase cycle of contact lenses makes them far more profitable.

If adequate profitability prevents you from avidly retaining contact lens patients, you have a simple fix: raise contact lens management fees. Studies have demonstrated that patients rarely leave a practitioner because of fees. Just as with new materials, don't be afraid to try new approaches. Raising fees presents a simple cause and effect relationship. A rise in fees raises patient expectations of satisfaction. Concurrently, it forces delivery of more satisfying services.

Retaining your contact lens patients requires creating an office environment in which contact lenses and contact lens wear is imbued with the fervor of excitement and innovation. It's not the lenses. It's the staff. It's the practitioner's commitment. It's the patients' success and delight that will keep them coming back again and again.

Dr. Klein is in private group practice in Fort Lauderdale, Fla. He is the founding editor of Optometry Today, an adjunct professor of Optometry at the Pennsylvania College of Optometry and a council member of the Contact Lens and Cornea Section of the American Optometric Association.