Article Date: 5/1/2012

Evolving Practice Trends & the Value of Building a Successful 1-Day Practice
Contact Lens SPECTRUM®

Evolving Practice Trends & the Value of Building a Successful 1-Day Practice

Continuing the 1-Day Trend with 1-DAY ACUVUE MOIST Brand Contact Lenses for ASTIGMATISM

W. Lee Ball Jr, OD: We know that innovation is very important for eye care professionals. It brings value to our patients and to our practices. We also know that word-of-mouth is our best form of advertising, and that when we make patients happy and exceed their expectations, they return to us for care and refer others.

As your partner in providing vision care to patients, VISTAKON is committed to innovation. This year marks our 25th anniversary and there have been many milestones in vision care during that time. Today, we are pleased to bring you a new innovation in contact lens technology: 1-DAY ACUVUE® MOIST® Brand for ASTIGMATISM.

Historically, the market for daily disposable contact lenses has been relatively flat, with some small fluctuations; but something changed in March 2010 (Figure 1). That is when we saw a dramatic increase in the utilization of daily disposable contact lenses. What is driving this aggressive growth? Well, you are. Eye care professionals are starting to embrace daily disposables, increasing utilization to almost 20 percent of new contact lens dispenses and making daily disposables the fastest growing segment within the contact lens category (GfK; 2011).

Figure 1. Daily disposables are the fastest growing segment within the contact lens category. Between March 2010 and June 2011, the percentage of new wearers wearing daily disposable lenses climbed from 8 to 19 percent.

We've invited three practitioners who are on the leading edge of this wave to discuss why they are strong advocates for daily disposable contact lenses, how they use them in their practices, and how continued innovation in this category will advance contact lens practice.

First, let's take a look at the future of the daily disposable market. We have seen a significant uptick in utilization of daily disposable contact lenses in the United States. Will we continue to see growth?

TIPPING POINT

Mitchell Cassel, OD: I see this trend continuing, especially as more practitioners embrace daily disposables and become comfortable presenting them to patients. I can foresee a time when the market share for daily disposables in the United States will approach the 55-percent market share they have in Asia (Nichols, 2012).

Stephen Cohen, OD: Daily disposables have been widely accepted as the modality of choice in Japan. The Japanese have a vibrant lifestyle and a tremendous interest in health and wellness. Once we eliminate cost — or perceived cost — from the equation, there is no question that the new technology is better, so we can anticipate the same acceptance here as in Japan.

Charissa Lee, OD: In the United States, we like to think we're technologically savvy and ahead of the curve, but in this particular market, we're behind. I believe we're at a tipping point, however, and in the realm of contact lenses, daily disposables will emerge at the forefront.

Dr Cohen: Daily disposable lenses provide the best combination of comfort, convenience, health, and vision. Since “new” is generally viewed as better, daily disposable contact lenses are the logical go-to first lens. Once I got past my own hesitation, primarily around cost, daily disposables went from my logical first choice to my actual first choice.

For “difficult-to-fit” patients, daily disposables can be a problem solver. Issues such as end-of-day dryness, buildup on lenses, decreased comfort and vision over the lens life cycle, and solution sensitivities, can be addressed with a daily disposable lens. With the addition of 1-DAY ACUVUE MOIST for ASTIGMATISM, we can address these issues for our toric patients as well.

Dr Cassel: Daily disposable lenses are always my recommended first choice contact lens modality for many reasons. Besides the obvious health, comfort, convenience, profitability and so on, patients immediately recognize the differences of practices that are promoting the latest in technology.

Difficult oblique toric patients and high cylinder patients are amazed at the immediate visual acuity and comfort.

Dr Lee: Daily disposable lenses are part of every conversation that I have with contact lens wearers. I feel obligated, as their eye doctor, to discuss the benefits of a single-use lens, despite their “perceived cost.” Now, with the advent of 1-DAY ACUVUE MOIST for ASTIGMATISM, we can also provide high quality vision to even our pickiest astigmatic patients.

In the United States, we like to think we're technologically savvy and ahead of the curve, but in this particular market, we're behind. I believe we're at a tipping point, however, and in the realm of contact lenses, daily disposables will emerge at the forefront.
Charissa Lee, OD

Dr Ball: Let's discuss the new daily disposable technology that will help practitioners continue the momentum.

HEALTHY LENS WEAR

Dr Ball: Dr Cassel, you have a robust contact lens practice. How have daily disposables helped you build this successful practice?

Dr Cassel: From a patient's perspective, I am prescribing a lens that will promote health and deliver comfort, convenience, and clarity of vision, and that is a winning formula. From my perspective, 1-DAY ACUVUE MOIST for ASTIGMATISM is easy to fit and stabilizes quickly, which saves chair time. What's more, working with innovative products keeps me in the forefront of the field and gives me a competitive edge.

Dr Ball: How do you highlight the health benefits of daily disposables (Figure 2) when discussing them with patients?

Figure 2. The Efron Grading Scales can be used as a teaching tool to show patients the importance of adhering to their contact lens wearing schedules.

Dr Cassel: I use the Efron Grading Scales for Contact Lens Complications (Efron, 1998) as a teaching tool to point out what normal eyelids and conjunctiva should look like (Figure 2). I explain how replacing contact lenses on a daily basis will help maintain healthy eyes, whereas, less frequent replacement can result in a buildup of oils and protein that can cause dryness, discomfort, and possibly some of the more serious complications illustrated on the Scales. Promoting eye health and compliance with a lens replacement schedule are important.

Dr Ball: Dr Lee, what are your thoughts on the health aspect of daily disposables?

Dr Lee: I also use the Efron Scale to help explain to my patients why they should change their lenses as prescribed, and I often use an analogy to describe how proteins and lipids behave on the eye. I tell patients, “Proteins and lipids are there to protect your eyes, and much like egg whites, they're supposed to be clear and runny and flow out with the tear film. When you have a contact lens on your eye, the proteins and lipids adhere to the lens, and that's OK, but when the proteins start denaturing or ‘cooking,' that's what causes problems.” At this point, I usually show the photos of papillae and giant papillary conjunctivitis on the scale. I go on to explain that the longer we keep using the same lens, the more “scrambled” these proteins become (Subbaraman et al, 2010). This can eventually lead to complications, but when lenses are replaced every day, that is not a concern.

From a patient's perspective, I'm prescribing a lens that will promote health, and deliver comfort, convenience, and clarity of vision — and that's a winning formula. … working with innovative products keeps me in the forefront of the field and gives me a competitive edge.
Mitch Cassel, OD

I also tell patients that when they replace their lenses every day, they do not have to worry about care solutions, solution interactions, lens cases, or case contamination. In one study, researchers found 76 percent to 92 percent of contact lens cases were contaminated with microbes (Willcox et al, 2010). Daily disposable lenses eliminate that issue.

LIFTING PERCEIVED BARRIERS

Dr Ball: If we believe daily disposables are the healthiest contact lens modality, why not prescribe them?

Dr Cohen: It's not a matter of why someone wouldn't prescribe them — it's why we don't prescribe them. I believe there are two main factors. One is the perception that patients won't be interested in the daily disposable modality. Studies seem to dispute that. In my practice, and in the practices of many of my peers, more than 7 of 10 patients are interested in a new contact lens that might be healthier for their eyes, and more than 60 percent would be willing to pay more for a contact lens that would provide that additional benefit.

The second factor is our tendency to diagnose our patients' checkbooks; in other words, our perception of whether or not they can afford something. The key is to provide the best possible opportunity for healthy lens wear. So, to answer your question, I don't know a good reason why we wouldn't prescribe daily disposables. I think we would all agree that replacing a contact lens more frequently is a healthier option.

Dr Lee: Another factor is availability. In the past, we may not have prescribed daily disposables for some patients because their lens parameters were not available. With the introduction of 1-DAY ACUVUE MOIST for ASTIGMATISM, we have new tools in our toolbox to address these unmet needs.

Dr Cassel: I have found that correcting just 0.75D of astigmatism can make a huge difference for a patient (Figure 3).

Figure 3. The left slide represents what “masked” astigmats who have been given the spherical equivalent of their sphero-cylindrical prescription would see -2.00/-0.75 X 180 (with -2.25D sphere). At right, it's clear that correcting even just a small degree of astigmatism can make a big impact on a patient's clarity of vision.

It's like focusing a camera, and it has a “wow” effect. We now have a better opportunity to not only meet but exceed our patients' expectations.

Dr Cohen: That is critical. We have become a society of superlatives. You can't be a star. You have to be a superstar. You can't give 100 percent. You have to give 110 percent. We live in a high-definition world. By correcting that low amount of astigmatism — which we always hoped was masked with a spherical lens — and providing exceptional vision, we will make a big difference.

In addition, research confirms that nearly half of all patients who require vision correction have astigmatism in at least one eye (Young et al, 2011) (Figure 4). In the past, we could only fit a daily disposable lens on the nonastigmatic eye and possibly fit a 2-week ACUVUE OASYS Brand Contact Lenses for ASTIGMATISM on the astigmatic eye. Now, we can fit each eye with the appropriate daily disposable lens.

Figure 4. The wide range of parameters available for 1-DAY ACUVUE MOIST for ASTIGMATISM enables practitioners to offer the daily disposable modality to more patients.

When discussing UV protection and contact lenses with parents, I tell them I'm looking to protect their child's eyes 40 to 50 years from now. I am demonstrating a level of concern and attention that is beyond what they may be looking for at that moment.
Stephen Cohen, OD, PC

BLINK STABILIZATION

Dr Ball: Dr Lee, what is the technology behind 1-DAY ACUVUE MOIST for ASTIGMATISM that sets this lens apart from others in the market?

Dr Lee: For me, it is the BLINK STABILIZED Design (Figure 5). I love educating patients about the benefits of this lens and its design. I tell them, “It's almost like there is a ramp in the middle of the lens, which helps position it on your eye between your eyelids. The thicker part of the lens sits in the open area of your eye. So when you blink, you're blinking the lens back into place. If the lens is misaligned, you just blink and it goes right into place. That's why your vision with these lenses is so stable.”

Figure 5. The BLINK STABILIZED Design of 1-DAY ACUVUE MOIST Brand Contact Lenses is the same successful technology used in ACUVUE OASYS Brand Contact Lenses for ASTIGMATISM, but optimized for the daily disposable modality.

Our patients have active lives, and their eye movements are dynamic. They are doing saccadic and versional movements when looking from the computer to their desks or from the road ahead to their side-view mirrors when driving. This lens fits their lifestyles (Figure 6).

Figure 6. The forces that act upon a lens will influence how it is positioned on the eye.

Dr Cohen: Many people in Arizona play golf, and they appreciate a lens that stabilizes with each blink, particularly when they are addressing the ball and putting. Many people like to watch golf on TV. If you're wearing a toric contact lens that's controlled more by gravity and you lie down on the couch to watch TV, your vision may become distorted. This lens adjusts for changing positions.

Dr Cassel: Another benefit for practitioners who are accustomed to fitting ACUVUE OASYS Brand for ASTIGMATISM is that the fitting characteristics of 1-DAY ACUVUE MOIST for ASTIGMATISM are the same. You typically receive the same axis alignment; however, I still carefully fit each patient to ensure exacting findings.

SUPERIOR COMFORT

Dr Cohen: We know the number one reason why patients stop wearing their contact lenses is dryness (Rumpakis, 2010; Richdale et al, 2007). The 1-DAY ACUVUE MOIST for ASTIGMATISM lens addresses this issue. Similar to the 1-DAY ACUVUE MOIST spherical lens, it has LACREON Technology, whereby a moisture-rich wetting agent is permanently embedded in the lens. Thanks to this feature, the coefficient of friction is decreased to provide sustained comfort throughout the day with less irritation to the cornea and under the lids (Sheardown et al, 2006). This leads to more stable vision throughout the day.

We have about as many contact lens dropouts in a year as we do new lens wearers, so in the contact lens industry, we're dealing with a zero-sum game. We need something that will help us retain patients in contact lens wear. By addressing the end-of-the-day comfort issue, which is primarily due to dryness, LACREON Technology can help us keep more patients in their contact lenses and grow the market not just maintain it.

Dr Ball: Dr Lee, how do you discuss comfort with patients?

Dr Lee: I love to reinforce the benefits of a daily disposable, by asking, “How do your contact lenses feel on the very first day you wear them? How would you like to have that new-lens feeling every single day?” That is something patients may never have thought possible.

60-SECOND FIT

Dr Ball: How has this new technology brought convenience to your patients and to you as a practitioner?

Dr Cassel: The 1-DAY ACUVUE MOIST for ASTIGMATISM lens is designed in such a way that it can reduce chair time. It stabilizes so quickly — in 60 seconds — that there is a “wow” effect almost as soon as you apply the lens.

For the first time, I can select a lens from the fitting set, apply it and know quickly whether or not it will work for my patient. Patients realize the value of that, and it translates to a conversion for them. It has been very effective.

Dr Lee: This lens is absolutely the fastest settling lens that I have seen. It just rotates right into place.

Dr Cassel: In the past, when we would fit any type of specialty lens — toric lenses in particular — the patient has had to sit for 15 to 30 minutes before we could assess the vision and fit.

The 1-DAY ACUVUE MOIST for ASTIGMATISM lens saves a tremendous amount of time, not only for practitioners but also for patients. In addition, after a rapid stabilization, what the patients sees is what the patient will continuously see throughout the day. It's very reassuring to know that consistency exists!

Dr Lee: Whoever designed the fitting set did a great job, because you can look from across the room and see if you have a particular lens. Many parameters are now available immediately in our offices.

Dr Cassel: The fact that we can fit 1,500 different prescriptions with 1-DAY ACUVUE MOIST for ASTIGMATISM is phenomenal. There are 12 different axes and four different cylinders with minus powers from plano to –9.00D and plus powers from +0.25D to +4.00D. With all these parameters for astigmatic lenses, and the parameters of the spherical lenses, I can fit 95 percent of my patients.

UV PROTECTION

Dr Ball: Dr Cohen, how do you discuss UV radiation with your patients? What is the benefit of having a product with UV protection?

Dr Cohen: When it comes to contact lenses, this is a huge — and often missed — opportunity. We know that UV radiation can damage the internal structures of the eyes, and we know light enters the eye through the cornea. This is particularly important for our pediatric patients. When discussing UV protection and contact lenses with parents, I tell them I'm looking to protect their child's eyes 40 to 50 years from now. I am demonstrating a level of concern and attention that is beyond what they may be looking for at that moment. We believe that about 80 percent of lifetime exposure to UV occurs by age 18 and that a child's annual dose of UV radiation is three times that of an adult (Stern et al, 1986). For these reasons, I recommend what I call the triad of UV protection: a hat with a brim, wraparound-style sunglasses or sunglasses with wide temples, and for those who wear contact lenses, a UV-blocking lens.

INNOVATIVE PRODUCT = PRACTICE GROWTH

Dr Ball: Dr Cassel, you have had an opportunity to test drive 1-DAY ACUVUE MOIST for ASTIGMATISM. How does the availability of a daily disposable toric lens help you grow your practice?

Dr Cassel: Having this new lens means success for my patients and for me. It brings more patients into my practice, such as contact lens dropouts, patients who have dry eyes, patients who never realized I have the parameters to fit them. Younger children can wear these lenses comfortably, and their parents are really embracing the lens. After properly educating parents, these lenses are professionally advised and most often prescribed.

Dr Cohen: Without question, this lens has exceeded my expectations. In my practice, we have had tremendous acceptance and enthusiasm among our patients. They are enthusiastic about being able to replace lenses on a daily basis. I have found there is no better way to demonstrate the benefits than with our younger patients. Because we can fit a lens with which parents can be comfortable, they don't have to worry about care solutions or contaminated lens cases, and the potential for problems associated with them, because the children will apply a new lens every day.

Remove phrases such as “you might,” “you could,” and “maybe” from the conversation and replace them with “This is what you need.” Prescribe the lens … Reassure patients that you know they came to you for your professional advice, and this is what you are advising.
Mitch Cassel, OD

There has been very little pushback from parents when I recommend daily disposable contact lenses for their kids, because when it comes to our kids, we are usually willing to do more than we might for ourselves. Good parents sacrifice for their children, and what they want is the best possible health, the most convenience, and whatever will require the least amount of time and concern for them with the lowest potential for complications. I tell parents there is nothing better for your children to reduce complications and give them the best possible vision than having a brand new lens every single day. I tell them this is what I would do with my children. I think we often try to be objective and say, “Here are the different options.” Yet when it comes to our kids, we ask, “What would you do if he were your child?” I tell parents I would be putting my own child into daily disposable contact lenses.

I have also found that parents relate these benefits to their own needs or those of family members or friends. For example, I recently fit a child with 1-DAY ACUVUE MOIST for ASTIGMATISM and while I was fitting him, his mother said, “You know, my husband can't wear toric lenses. He has astigmatism, and he's had problems.” She scheduled an appointment for her husband while she was still in our office.

Dr Ball: Dr Lee, how can a daily disposable lens help grow our practice base?

Dr Lee: Exceeding our patients' expectations is key. We live in a fast-paced world, where communication can be instantaneous and widespread. Word can travel very quickly via the Internet on sites such as Facebook and Yelp. When you can offer patients an exceptional product, you have an advantage.

ADDRESSING GREEN CONCERNS

Dr Ball: Dr Lee, you practice in California. Do your patients have any concerns about how daily disposables will affect the environment?

Dr Lee: Californians do tend to be concerned about their carbon footprints, and I get this question at least once a week. It is certainly a concern, because when something is being thrown away every day, it can be perceived as a burden on the environment. I use the analogy of a tissue versus a handkerchief. Patients agree that for sanitary reasons, they prefer to use a tissue.

As for the lenses, a 3-year supply is equivalent to the amount of plastic in one 240 mL bottle of care solution. In this context, the impact is minimal.

PRACTICE PEARLS

Dr Ball: If you could provide one piece of advice, one practice pearl, to our colleagues, what would it be?

Dr Lee: Start putting 1-DAY ACUVUE MOIST for ASTIGMATISM lenses on eyes. Not all of my patients with astigmatism are wearing daily disposable lenses, but the real turning point for me was when I started offering patients these lenses to try. When they go home and wear them, they feel the difference and they experience the convenience. There are real opportunities among kids and part-time lens wearers.

Dr Cohen: Any time you have something new, you may not be sure how to get started. I would say, “Begin. The rest is easy.” Begin by engaging patients in the conversation by telling them, “We now have a technology that allows you to wear a brand new lens every day.” Then, as Dr Lee mentioned, look for opportunities among part-time wearers and kids. People who travel frequently really enjoy having a lens that does not require them to carry around care solutions. People who may only want to wear contact lenses for special occasions are also good candidates. The key is to find a way to tell patients the option is available and then, as both my colleagues said, put the lenses on their eyes.

Dr Cassel: I agree that you have to put the lens on as many eyes as possible. Get comfortable in your delivery, and before you know it, you will have people telling you what they want. I would also add that you have to instill confidence in your staff and your associates. Remove the words “you might,” “you could,” “maybe” from the conversation and replace them with “This is what you need.” Prescribe the lens. That is important. Reassure patients that you know they came to you for your professional advice, and this is what you are advising.

Dr Cohen: That is a great point. Those are powerful words: “My recommendation is …” If you describe all the contact lens options — 1-day, 1-week, 2-week, 1-month, 3-month — and the patient says, “Well, what do you suggest?” you realize you just spent a lot of time for nothing. We often complain that we don't have enough time to talk to patients about all the options available. Here is an opportunity to reduce that to simple terms, “I recommend the daily disposable lens because it provides the best combination of comfort, convenience, health, and vision.” That sums it up and saves a tremendous amount of time.

CONTAGIOUS ENTHUSIASM

Dr Ball: Dr Cassel, how do you talk to your patients about daily disposable contact lenses?

Dr Cassel: You have to be enthusiastic and believe in the product. You have to translate the daily disposable concept as value to the patient. The patient has to realize from a health perspective that this is the winning formula. When you communicate properly, you will win over the patient. Get comfortable in your delivery, and before you know it, you'll have many patients converting to this modality, especially once they realize there's value beyond the obvious health benefits.

Dr Cohen: Dr Cassel's point about enthusiasm cannot be overstated. When you get excited about something in your practice, your patients get excited about it, too. Our patients want our best recommendations, and they are likely to follow them.

Dr Cassel: Remember, too, that the best form of marketing is via that person sitting right in front of you. Your patients will communicate immediately to their friends and families.

Dr Ball: What if patients push back to your recommendation of daily disposables? How do you respond?

Dr Lee: What we haven't addressed yet is cost, and as Dr Cohen mentioned, that is really our issue as doctors. Our patients come to us for our expertise as eye care professionals. When we talk about the best contact lens — the lens we would prescribe for our kids or other family members — most of us would choose a daily disposable. We don't necessarily have to have the cost discussion in the chair — our staff can support us in that way — but when you take care solutions out of the equation, it comes to a $10 to $15 a month difference. So, for $10 to $15 a month for better comfort and fewer complications, it really is a no-brainer.

Dr Cohen: The annual cost of care solutions could be $100 to $150 a year in addition to the cost of the lenses. With the current pricing structure minus the rebates that are available, patients could get a 6-month supply of daily disposable lenses with no out-of-pocket expense. Will people want to pay more to get something that we consider the healthiest modality? In my practice, we've found that with each step we take, there's very quick acceptance by patients. Practitioners tend to be the ones who create the inertia.

BRING VALUE TO YOUR PRACTICE

Dr Ball: Thank you for this excellent discussion and for sharing your knowledge and practice pearls on how to build a successful and robust daily disposable contact lens practice.

As we have said, innovation brings value to your patients, and it brings value to your practice. With BLINK STABILIZED Design, sustained comfort from LACREON Technology, 60-second fits, the widest parameter range of any daily disposable astigmatic lens on the market, coupled with Class II UV protection, 1-DAY ACUVUE MOIST for ASTIGMATISM is a technology that will help you provide the best contact lens-wearing experience for your patients. CLS

Fair Balance:

ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from VISTAKON® Division of Johnson & Johnson Vision Care, Inc., by calling 1-800-843-2020 or by visiting www.jnjvisioncare.com.

UV Statement:

WARNING: UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses because they do not completely cover the eye and surrounding area. You should continue to use UV-absorbing eyewear as directed.

NOTE: Long-term exposure to UV radiation is one of the risk factors associated with cataracts. Exposure is based on a number of factors such as environmental conditions (altitude, geography, cloud cover) and personal factors (extent and nature of outdoor activities). UV-blocking contact lenses help provide protection against harmful UV radiation. However, clinical studies have not been done to demonstrate that wearing UV-blocking contact lenses reduces the risk of developing cataracts or other eye disorders. Consult your eye care practitioner for more information.

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Contact Lens Spectrum, Volume: , Issue: May 2012, page(s): 4 - 11