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�
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.
Provide the Inspiration
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.
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.
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.
Essential Staff Education
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.
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.
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
Tools for Success
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.
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.
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.
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.
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.
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
Don't Be Afraid to Change
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
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.
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.
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.
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
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.
Gauging Your Motivation
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.
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
The Keys to Retention
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.