Contact Lens Spectrum

As optometrists decide on the emphasis and direction of their practices, many are influenced by a popular assumption: Dispensing spectacles is more profitable than dispensing contact lenses.

No data have been readily available to assess or support this viewpoint. We decided to test this assumption collecting and analyzing the appropriate data from our own patient files in Port Macquarie, Australia, general optometric practice.

In Australia, only 4 percent of the vision correction population are selecting the contact lens alternative. In our own practice, this proportion was found to be 7 percent. More interesting was our discovery that these patients contribute far more than this 7 percent to gross annual practice fees (see Table 1).

To thoroughly investigate the question, the files of 50 spectacle patients and 50 contact lens patients were selected at random. Each of these were then evaluated for all activities in a 2-year period.

These activities included consultations, examinations, spectacles or contact lenses dispensed, progress visits, care solutions, and repairs- anything that involved practice time or expense. Files were then also compared for numbers of new patient referrals, patient loyalty, and contribution to practice growth.

The total fees for the average patient in each group are summarized in Table 2. Also included is the average number of consultation periods required for each patient. Each one of these consultation periods represents the time for a regular routine examination.

The figures demonstrate that contact lens patients can certainly be expected to contribute more fees to the practice ($574 vs. $215 per patient for our practice). On the other hand, they also consume more chair-time (5.1 vs. 1.4 consultation periods).

A good way to look at these results is to compare the average fees generated per consultation period. This calculation, exhibited in Table 3, shows CL wears to bring in about two-thirds the amount received from eyeglasses wearers per consultation.

A reasonable conclusion from these figures is that, while contact lens patients contribute 167 percent more in total fees over a period of months or years, they provide an average of 27 percent less for each consultation period. If a practitioner is developing his practice, the larger fee contribution from contact lens patients will be a significant advantage. If, instead, the practice is fully developed and all chair-time is committed, higher average fees are indeed realized with spectacle patients. This conclusion, however, ignores the importance of contact lenses in a full service practice for patients and professional satisfaction.

We then broke down the fees generated for each group in the 2-year evaluation into those arising from professional time and those from supply of visual aids (see Table 4). We found similar ratios for both groups: a 21:79 mix of professional fees to visual aids for spectacle wearers, and 24:76 mix for CL wearers.

Proportions of Total Practice Size (table 1)

	Spectacles	Contact Lenses
Patient Numbers	93%	7%
Annual Gross Fees	82%	18%

Fees and Time Over a 2-Year Period (table 2)

	Spectacles	Contact Lenses
Average Fees Per Patient	$215	$574
Average Consultation Periods	1.4	5.1

Average Fees Per Consultation Period (table 3)

Spectacles	Contact Lenses
$154	$113

Mix of Professional and Dispensing Fees (table 4)

	Spectacles	Contact Lenses
Professional Fees	$45	$135
Visual Aids	$170	$439
Ratio	21:79	24:76

Patient Attrition (table 5)

Spectacles	Contact Lenses
8%	2%

Patient Referrals (table 6)

	Spectacles	Contact Lenses
Proportion Referring	16%	40%
Number Referred	12	35

Practice Growth (table 7)

	Spectacles	Contact Lenses
Study Baseline	50	50
Attrition	-4	-1
Referrals (2yrs)	+12	+35
Total	58	84

Growth (2yrs)	+8	+34
Growth Rate	8%	34% per annum

Compounding Growth Rate (table 8)

Year	Spectacles	Contact Lenses
Baseline	50	50
2	58	84
4	68	150
6	79	271
8	92	486
10	106	873
Total Compounded Growth	+112%	+1,646%

It is well understood that not all patients will return to the same practice for their next visit. The reasons are many and include moving, death, and dissatisfaction.

The long-term expected rate of patient loss is usually considered to be about 20 percent. To compare this result in our study, patient files were evaluated only for a time double the length of the recall period. Those not responding to recall within this period were considered lost. Contact lens patients showed a 6 percent lower attrition rate than spectacle wearers (see Table5).

Patient retention is one element of the equation for practice growth. Another element is referrals made by existing patients which bring in new patients. Table 6 presents both the proportion of patients who were referring, together with the total number of patients referred by them, in the 2-year period. The contact lens patients referred 23 more patients to our practice than the spectacle patients, and over twice as many CL wearers than eyeglasses wearers made referrals.

The overall picture of practice growth arising from the two original patient groups can be summarized by adding the referrals and subtracting those lost by attrition. This result, delineated in Table 7, shows that the CL patient group grew by 34 patients while the eyeglasses group grew by only 8 patients. (See figure 1.)

This difference in practice growth rate is further highlighted when the results are compounded over a longer period. Table 8 and Figure 2 demonstrate this difference when projected for 10 years. The 10-year extrapolation shows a theoretical increase of 823 contact lens patients, with a practice growth rate of 1,646 percent for this group.

Practice Growth
(Baseline: 50 patients per group, tracked for 2 years)

PATIENTS
90
80
70
60
50
40
30
20
10
0	Spectacles	Contact Lenses
VISUAL AID
Figure 1. Contact-lens-wearing patients referred 35 new patients to the practice, compared to only 12 referred by the spectacle-wearing group.

In this study of detailed patient records, a difference was confirmed in the additional time necessary to generate contact lens fees compared to those for spectacle feed. On the other hand, the study indicates that contact lens patients will go on to become larger overall contributors to practice health and income.

Contact lens patients are found to have lower attrition rates (by 75 percent), a higher proportion referring new patients (250 Percent) and they refer more of them (292 percent). The picture for practice growth is consequently far brighter for the contact lens aspect of optometric practice.

Apart from the contact lens practice growth rate at more than 4 times the spectacle level, there are certainly many other reasons to include contact lenses in optometric practices. These include: