Contact Lens Spectrum September 2013
All in the Contact Lens Family
Biofinity contact lenses are increasingly used by eye care practitioners. Learn how Biofinity can help increase profitability and patient satisfaction in your practice.
Dr. Smick: Today, we’ll discuss what’s important to us as contact lens practitioners, what’s important to our patients as contact lens wearers, and how we align the two perspectives. We’ll explore the rising popularity of the monthly modality and discuss why we, and so many of our colleagues, are switching patients from 2-week to monthly replacement lenses. We’ll share tips on fitting and managing patient expectations, and we’ll discuss the impact of the Biofinity family of lenses on our success.
Let’s begin by discussing what factors we consider when selecting a lens for a patient.
Begin the Discussion
Dr. Smick: Dr. Lo, what is your thought process when advising a patient who wants to wear contact lenses? How do you decide on a particular lens for a particular patient?
Dr. Lo: I try to connect with patients to understand what they’re looking for in vision correction. After my clinical examination, I review the patient’s prescription and think about what I can offer that will satisfy his visual needs.
Dr. Smick: Dr. Reeder, how do you start a conversation about contact lenses with someone who’s wearing eyeglasses?
Dr. Reeder: I ask, “Are there times in the day or the week that you wish you could see without glasses?” That question usually opens up a contact lens discussion. Based on the patient’s interest, prescription and eye health, I make a recommendation.
Dr. Smick: What questions do you ask to learn the patient’s goals?
Dr. Reeder: I try to determine if patients want contact lenses to complement their eyeglasses or to replace them. I may ask, “Do you want to wear contact lenses a few days a week, for social situations or specific activities, or do you want to wear them 16 hours a day, most days of the week?” Knowing the patient’s mindset and motivation is important, especially when we get into multifocal lenses.
Monthly Makes Sense
Dr. Smick: All of the members of this panel prefer the monthly replacement modality over the 2-week modality. What do you like about the monthly modality, Dr. Lo?
Dr. Lo: I find patients are more likely to replace monthly lenses on time, because that replacement schedule makes sense to them. We pay our mortgages in monthly installments; we pay our bills once a month; we have monthly subscriptions to magazines and online services. It’s an easy conversation and an easy scheduling concept.
Dr. McIntyre: Several years ago, I began shifting patients who were wearing 2-week lenses to the monthly modality, because I found most were replacing their lenses every 4 to 5 weeks.
Dr. Smick: Do patients readily accept this change?
Dr. McIntyre: Yes. I explain that I’m going to prescribe a lens that’s approved for the replacement schedule they’re already following. That seems logical to them.
Dr. Reeder: The schedule is easy to remember — new month, new lens — and it’s healthier. I tell patients, “This is the better way to wear a contact lens. This is a more durable, deposit-resistant lens and you can wear it safely and comfortably for daily wear for a month.”
Dr. McFerron: I’ve also found that patients who are wearing monthly lenses come in for their annual examinations sooner than those wearing 2-week lenses.
Dr. Reeder: I agree. I haven’t done a formal analysis, but I believe I see patients wearing monthly lenses, on average, every 13 months. I may not see patients wearing 2-week lenses for 18, 20 or 24 months.
Dr. McIntyre: The annual examination is important not only for contact lens care but for eye health in general. It enables us to detect eye diseases sooner, which means patients can receive treatment sooner, potentially preserving their vision.
A Healthy Switch
Dr. Smick: Do you engage your patients in choosing a lens?
Dr. Lo: Yes. I think that’s how we build trust. When I recommend a lens and explain how it will meet a patient’s needs, he understands that I was listening to him. That’s a powerful message to convey to a patient.
Dr. Smick: When you see a new patient who has been wearing 2-week lenses, and you want to introduce him to the monthly modality, how do you start that discussion?
Dr. McFerron: I explain why I think the lens he’s wearing isn’t the best one for him. Perhaps it doesn’t fit well or it’s not made from silicone hydrogel. I’ve found patients are keen on the latest and best technology, so I always mention that the lens I’m recommending is the most up-to-date technology.
Dr. Lo: It’s important to explain the benefits of the newer technology, whether it allows more oxygen through to the cornea, is more comfortable or works better for high prescriptions.
Dr. Smick: Dr. McIntyre, when you want to recommend a new lens, how do you start that conversation with a patient?
Dr. McIntyre: I use several tools to help with the conversation. I have a graph that shows oxygen transmission through a contact lens from a low of 18 Dk/t to the highest level available. I show the patient where his lenses are on the graph and where I would like them to be. I also show patients their corneal topography maps. My new favorite tool is the specular microscope. A patient may think he’s doing well, but if my view of the endothelium indicates otherwise, I use that as an opportunity to discuss switching to a different lens.
Dr. Smick: Sometimes we’re unaware that patients are having problems. Perhaps they’re asymptomatic but not able to wear their lenses as long as they’d like. How do you uncover those issues?
Dr. McIntyre: Veteran contact lens wearers tend to accept some discomfort or inconvenience, and it’s not until we ask specific questions that they admit to having these problems. Just last week, a patient told me everything was great, but when I asked if she could wear her lenses all day or into the night, she told me she couldn’t wait to take them out after work. She admitted she had some dryness, but didn’t think I could do anything about it. If our conversation had ended at, “How are you doing?” and “Great,” the patient would still be wearing the same lenses and having the same problem.
|With such a broad range of lens types and parameters, I can move back and forth within the Biofinity family of lenses with ease. I can prescribe a sphere for one eye and a toric lens for the other, or I can move a patient from a sphere to a multifocal, and he doesn’t have to adjust to a different material. Using lenses from the same family helps speed the fitting process for me and the adaptation process for patients. It’s a huge advantage. —Dr. McIntyre
Dr. Smick: Why do you choose Biofinity lenses for your patients?
Dr. Lo: For me, initial comfort is, by far, the most important aspect of the Biofinity lens.
Dr. McIntyre: With such a broad range of lens types and parameters, I can move back and forth within the Biofinity family of lenses with ease. I can prescribe a sphere for one eye and a toric lens for the other, or I can move a patient from a sphere to a multifocal, and he doesn’t have to adjust to a different material. Using lenses from the same family helps speed the fitting process for me and the adaptation process for patients. It’s a huge advantage.
|The Biofinity multifocal lenses are very easy to fit due in part to this technology. I like the idea of a lens for the dominant eye and one for the nondominant eye. I have flexibility to provide good visual acuity at all distances, whether I’m fitting an early presbyope or someone with advanced presbyopia. Patients benefit from and appreciate that their vision is truly balanced at near, midrange and distance. —Dr. Lo
Dr. McFerron: I agree. The first silicone hydrogels were high-modulus lenses, and I’ve found patients who tried those lenses are reluctant to try silicone hydrogel lenses again, because they remember the discomfort they experienced in the past. CooperVision has created a lens material with high Dk, high water content and low modulus, so patients can enjoy the benefits of silicone hydrogel in a comfortable lens. I explain to these patients that their past experiences were with first-generation silicone hydrogel lenses, and Biofinity is a newer generation.
Dr. Smick: What about end-of-day comfort? Patients are using their computers more, they’re getting older, and dryness can be a problem.
Dr. McIntyre: What I’ve always liked about Biofinity lenses is that they’re comfortable at the beginning of the day, the end of the day, and even at the end of the month.
Dr. Smick: Lens manufacturers have tried different approaches, such as using plasma coatings or special ingredients to keep their lenses wettable, in an effort to enhance comfort. How important is the natural wettability of the Biofinity lenses?
Dr. McIntyre: I think it’s wonderful. I was thrilled with the Biofinity lenses right from the beginning. People are impatient. They want their lenses to be comfortable right away, so they can get on with their lives. They can do that with the Biofinity lens.
Dr. Smick: Biofinity’s Aquaform Technology utilizes longer siloxane chains, resulting in less silicone incorporated into the lens materials. Less silicone results in an optimum modulus, creating a softer and more flexible lens. It also creates a naturally hydrophilic silicone hydrogel lens by forming hydrogen bonds with water molecules to lock water into the lens, staying moist without additives, coatings, surface treatments or internal wetting agents. The result is a lens with high oxygen transmissibility and a high water content that minimizes deposits. Do you explain this technology to your patients when you’re fitting them, at least as it relates to comfort?
Dr. Reeder: It depends on the patient, but, yes, if someone wants more information, I explain the technology. Even if I don’t go into detail, I always explain the benefits of the naturally wettable Biofinity lens, especially end-of-day comfort.
Dr. Smick: Speaking of technological advances, Biofinity multifocal lenses have Balanced Progressive Technology. Dr. Lo, what are the advantages of this technology?
Dr. Lo: The Biofinity multifocal lenses are very easy to fit due in part to this technology. I like the idea of a lens for the dominant eye and one for the nondominant eye. I have flexibility to provide good visual acuity at all distances, whether I’m fitting an early presbyope or someone with advanced presbyopia. Patients benefit from and appreciate that their vision is truly balanced at near, midrange and distance.
Dr. Smick: At what age do you start discussing presbyopia and vision correction options?
Dr. McFerron: When people start needing reading glasses, they often think they can’t wear contact lenses any more. That’s why I begin discussing presbyopia and multifocal contact lenses as early as age 35. “This is your future,” I say, “but it doesn’t mean you have to stop wearing contact lenses or that you’ll need reading glasses all the time. You have options.”
Dr. Lo: I agree. I feel it’s my role to explain presbyopia to patients who are approaching that age. They’ll get there. We all will, and I like to plant the seed.
Dr. Smick: Is it better to start patients with multifocal lenses earlier rather than later?
Dr. McFerron: I think the sooner patients start wearing multifocal lenses, the easier the adaptation process becomes.
|Easy Route From Monovision to Multifocals
Dr. Smick: Now that we have confidence in a multifocal — the Biofinity multifocal — many of us are encouraging patients who are wearing monovision to switch. How do you facilitate that change?
Dr. McIntyre: I tell patients that if they were coming to see me for the first time, I would be fitting them in a multifocal, because I believe it’s a much better modality.
Dr. Smick: What do you do to help with the conversion?
Dr. McFerron: I want patients to have a good initial experience, so when someone has been wearing monovision, I recommend that he stop wearing his lenses for a few days to allow the brain to shift back to its normal state before we try the multifocal lenses. I’ve found that when patients take some time away from monovision, the switch to multifocals is easy.
Dr. Smick: Dr. Reeder, how do you explain vision with multifocals versus monovision?
Dr. Reeder: If patients have been wearing monovision for a while, they know one lens is for distance and one is for near. I remind them that monovision doesn’t help their intermediate vision and that they may be more compromised than they realize at midrange. I explain that we can restore vision at midrange with multifocals, and I suggest we try some diagnostic lenses, so they can see for themselves. To prepare them for the possibility of several trials, I tell them every diagnostic lens I try today to get the best balance will save us a return visit down the road.
Dr. Smick: How do you explain the adaptation process?
Dr. Reeder: I tell patients it’s a different way of seeing, because you’re looking through multiple powers at the same time, and the brain has to adapt to that simultaneous vision.
Dr. Smick: How do you ensure that patients are happy with their distance and near vision? Do you talk about striking a balance?
Dr. Reeder: I try to find out what’s more important to the patient. Someone who’s in sales and driving a rental car looking at road signs will have different priorities than someone who’s reading text on a computer all day. I also talk about striking a balance, and I explain that I can change any of the lens powers independently of the others to achieve the best distance and near vision.
Dr. Smick: How do you demonstrate vision through multifocal lenses?
Dr. McFerron: Many practitioners have a habit of flipping on the acuity chart for distance and starting there. I’ve found the “Wow!” factor is better when patients look at their cell phones first.
Dr. Smick: Do you do anything differently during the trial period for multifocal lenses?
Dr. McIntyre: I’ve extended the trial period for multifocals from 1 week to 2 weeks to allow the brain time to adapt.
Dr. McFerron: A 2-week trial is key. When I started giving patients 2 weeks to adapt to their multifocal contact lenses, my success rate went through the roof.
Dr. Smick: How do you instruct your patients?
Dr. McFerron: I tell patients, “I want you to wear these in your real life and come back and tell me when they work and when they don’t work, so I can address those issues.” I don’t ever want patients to think there’s nothing else I can do if the first lens we fit doesn’t work.
Dr. McIntyre: Setting expectations is key. In fact, I wrote a “multifocal expectation sheet,” which patients take home with them to reinforce what we tell them in the office. It reiterates the benefits they’ll enjoy, such as more comfortable viewing at the intermediate distance, and it explains there may be times, such as when driving at night or when reading very small print, when they may want to use their eyeglasses or supplement the contact lenses with readers. The expectation is absolutely crucial, so we try to set that. (For tips on converting patients from monovision to multifocals, see “Easy Route From Monovision to Multifocals” above.)
Family of Lenses
Dr. Smick: Keeping patients happy and healthier in their contact lenses means we must adapt to their changing needs. What are the benefits of having a family of lenses from which to choose?
Dr. Smick: Can you meet most of your patients’ needs with Biofinity lenses?
Dr. Reeder: Yes. With the high sphere powers, the cylinders around the clock, and the axes in every direction, we can fit quite a spectrum of prescriptions with Biofinity lenses.
|With the high sphere powers, the cylinders around the clock, and the axes in every direction, we can fit quite a spectrum of prescriptions with Biofinity lenses. —Dr. Reeder
Dr. Smick: Fitting sets can influence our efficiency and success. How do you use your fitting sets, and how important are they?
Dr. Lo: It’s crucial to have fitting sets with a large range of parameters. Although having a patient come back to the office isn’t the end of the world, I’d rather have lenses available while the patient is in my chair at the first visit. What’s great about the Biofinity fitting set is the many variables we can work with to meet our patients’ needs.
Dr. Reeder: The ability to put diagnostic lenses on a patient and have him go out in the real world to test them right away is a great advantage.
Dr. Smick:How important is it for patients to be able to purchase an annual supply of contact lenses in your office?
Dr. Mclntyre: When my patients purchase an annual supply of lenses in our office, I feel confident they’ll be less likely to stretch the life of their lenses and more likely to come in on time for their annual examinations, if for no other reason than to get more lenses. It’s a healthy habit. It’s also healthy for the practice. I’ve told my staff the future of the practice could depend on how good we are at providing this service. If patients leave our office with a pair of lenses or a 3-month supply, we know they’ll be shopping elsewhere, and if they’re shopping online, they’re likely to be referred to practitioners who are in the vendor’s system, so we could lose patients.
Dr. Smick: Having a wide range of parameters in your fitting set and being able to offer an annual supply in the office are two ways to offer patients a high level of service while also increasing profitability.
Dr. McFerron: Also, because the Biofinity fitting sets are inclusive, we don’t have to order diagnostic lenses as often, which takes staff time. We’re also less likely to need to bring a patient back — and use another examination slot — because we didn’t have a lens in his prescription. Patients appreciate the convenience, and we operate more efficiently, which drives profitability.
|Regarding Fit Sets
|Because the Biofinity fitting sets are inclusive, we don’t have to order diagnostic lenses as often, which takes staff time. We’re also less likely to need to bring a patient back — and use another examination slot — because we didn’t have a lens in his prescription. Patients appreciate the convenience, and we operate more efficiently, which drives profitability. —Dr. McFerron
Dr. Lo: Profitability is also linked to referrals. Of all of the lenses I fit, the Biofinity multifocal lens draws in the most new patients.
Prescribe with Confidence
Dr. Smick: In summary, what do you think are the most important advantages to prescribing Biofinity lenses?
Dr. Lo: The characteristics of the Biofinity lens — the comfort, the fit, the range of parameters for myopes, hyperopes and presbyopes — together create a win for patients and for me in terms of efficiency and profitability.
|I think that says it all: Biofinity lenses take the stress out of fitting contact lenses, and they just work. —Dr. Smick
Dr. Reeder: I appreciate the convenience, the fitting ease with the diagnostic set and the comfort.
Dr. McIntyre: Fitting Biofinity lenses reduces the stress of fitting contact lenses because I can prescribe them with confidence.
Dr. McFerron: I would add that Biofinity lenses are easy to fit, and in my practice, they work every time.
Dr. Smick: I think that says it all: Biofinity lenses take the stress out of fitting contact lenses, and they just work. ●
Contact Lens Spectrum, Issue: September 2013, page(s): 3 - 7