Article

CONTACT LENS SUBSCRIPTION SERVICES

Are subscription services here to stay or going away?

Alternative distribution of contact lenses means that contact lenses are sold to patients by sources other than their eye-care professional. The methods by which patients are able to obtain contact lenses have greatly changed during the past few years.

TYPES OF SUBSCRIPTION SERVICES

Historically, patients had one option when it came to purchasing contact lenses, and that was to buy them in the office directly from the practitioner. More recently, there are several other routes that patients can take.

Non-Office Optical Retail Initially, if patients choose to not purchase contact lenses from their eye-care practitioners, they typically would take their contact lens prescription to an external optical resource and fill it there (for example, a corporate optical chain).

Big Box Stores The next development was in the growth of “big box” optical retailers along with some large pharmacy chains that also would sell contact lenses to consumers who provided a valid prescription from their eyecare practitioner.

Online Retail Subsequently, online contact lens retailers began to grow. Direct-to-consumer marketing by these online retailers greatly increased consumer awareness by suggesting that their prices were significantly lower than those provided by the consumers’ eyecare professional. These online retail sites also emphasized the convenience of allowing consumers to order their contact lenses from the comfort of their computer or phone at any time and on any day of the week.

HOW THESE SERVICES WORK

All of these alternative distribution options discussed so far ostensibly required a valid prescription from an eyecare practitioner. Unfortunately, in reality, many cases have been reported in which contact lenses were delivered without a valid prescription. Or, if prescriptions were requested by the alternative delivery entity, fulfillment would incorporate “passive prescription validation.” Passive verification occurs when practitioners do not verify the validity of a contact lens prescription within a certain time period and, therefore, the entity assumes that the prescription is valid and, as such, fills the order.

Most recently, a new and more challenging threat to the practitioner/patient relationship has come into existence. With this new model, alternative distribution entities do not require a valid contact lens prescription from a practitioner. Instead, these companies employ licensed practitioners who will fill the contact lens prescriptions based on virtual “eye exams.” There is much debate as to whether “eye exam” is an appropriate term to use when referring to these online vision apps; many believe that the online exams are inadequate and claim that they do not provide enough information to allow practitioners to determine patients’ eye health status as it relates to contact lens wear. Some will also argue that the information obtained does not allow practitioners to determine whether a lens is properly fitting on an individual patient’s eye. In addition, with the online exams, some practitioners may not be able to assess patients’ eye health in general as it pertains to the anterior segment, the posterior segment, and to external disease and oculomotor function.

Some online retailers who in the past would, at minimum, formerly request a valid contact lens prescription from eyecare practitioners are now also moving in the direction of taking physicians out of the equation. These retailers also are either partnering with companies that have developed online apps for vision evaluation or are developing their own. So far, the outcomes of these efforts have allowed alternative distribution entities to provide contact lenses from the major contact lens manufacturers. This too is changing.

The most current development involves alternative contact lens distribution entities finding overseas contact lens fabricators that are willing to produce exclusive contact lens designs. The first entrants into this niche are using older contact lens material technologies; however, others are already looking toward state-of-the art contact lens materials and surface treatments that are intended to challenge even the most advanced materials and designs provided by the major manufacturers.

Most efforts in this area by the alternative contact lens distribution entities are targeted toward single-use daily disposable lenses as opposed to reusable contact lenses. It is evident that the trends in this area will continue to grow and develop. Available contact lens materials and designs will continue to improve along with the ability to use virtual medicine to provide diagnostic services. These factors are important to consider when making the decision as to how to successfully manage a contact lens practice in the future.

EXAMPLE OF A SERVICE THAT ENGAGES THE EYECARE PRACTITIONERS

WHAT IS INCLUDED?

  • Annual membership includes a comprehensive eye examination, contact lens fitting, and a 12-month supply of contact lenses.
  • Book annual appointments and ship the prescribed contact lenses to patients.
  • Appointment with an eyecare practitioner is based upon patients’ availability and preferred location. The service will book with a patient’s existing practitioner, if desired.
  • All major soft lens brands are covered, including toric and multifocal designs.
  • There are no substitutions or changes without a new prescription.
  • When membership and prescription are close to expiring, patients are contacted and are scheduled with their previous practitioner.
  • There are no contracts or ongoing agreements.

CHALLENGES CREATED BY ALTERNATIVE DISTRIBUTION ENTITIES

These entities are here to stay and will grow in number. Expect to also see an increase in the percentage of consumers who will use them. The technologies (both diagnostic and therapeutic) that will be required to seriously challenge traditional practitioner/patient relationships will also get better and better. However, here are several strategies that practitioners can use that can help them retain and even build their contact lens practice.

1. Use of a Service for Which Practitioners Play an Important Role One of the ways that a new third-party company can successfully engage practitioners in the process is to have them involved at every step of the process. This includes both providing the fitting and resultant contact lens prescription and providing a comprehensive eye examination. An overview of such a service is provided in the sidebar on this page.

2. Differentiate Your Practice Practitioners should realize that these competitors want to concentrate on the most commoditized elements of eye care such as daily disposable contact lenses and spectacle eye wear. Those practices that have continued to concentrate their efforts and find the majority of their income sourcing from these areas are at greatest risk to fall prey to the new competition.

However, those practices that have emphasized medical eye care services, specialized advanced contact lens services (such as irregular cornea management, presbyopic contact lens management, and contact lens treatment options for progressive myopia management) or other eye-care areas that require specialized professional services (such as binocular vision therapy, low vision rehabilitation, etc.) are in a much stronger position to survive and thrive.

Therefore, the importance of prescribing contact lenses that can’t be disrupted should be greatly emphasized to be successful. That being said, we all still have many patients who may want to obtain contact lenses from alternative distributors. It is important to take a proactive approach in this area and to work with those companies that value the physician/patient relationship and incorporate those paradigms into the business model.

While practitioners are all quite aware that there is a segment of the contact lens-wearing population that does not value the importance of high-quality professional eye care, many practitioners in response adopt a “They are not our patients” attitude. Instead, practitioners can offer patients a wide variety of options for their purchase of contact lenses while still maintaining high standards of professional care regardless of where the lens purchases are made.

3. Provide Conveniences to Your Patients That Rival Disruptors’ As a profession, practitioners have often been late to the game as far as adapting to modern patients’ desires. Part of the reason why online sight tests and prescription robo-signing have taken off is that they are more convenient than going to the office is. Unfortunately, this convenience sometimes comes at the cost of quality. Physicians must continue to change to provide conveniences to modern patients while still providing top quality.

Are you still calling your patients to communicate? No one wants to talk on the phone anymore. Texting is now officially the preferred communication tool.1 Is your office texting patients to schedule appointments and to solicit reviews? There are companies that provide this service to practices by making cost-neutral changes to your existing infrastructure.

One of the reasons why online contact lens middlemen (resellers) have proliferated that is patients can order their lenses outside of normal business hours. Now, there are multiple services that provide this convenience to eyecare practices. That said, any practice would be remiss if it did not offer the option of purchasing contact lenses online through its website. Even if it is a distributor that processes the online orders, it should be with the practices’ oversight, ensuring that lenses are never substituted or processed incorrectly.

4. Supportive National Organizations The good news is that there are powerful forces on a national scale that are fighting for patient care. President John F. Kennedy once said, “the only thing necessary for the triumph of evil is for good men to do nothing.” Therefore, becoming members of these organizations can only help the profession as a whole.

For example, the American Optometric Association (AOA) is one of the driving forces defending eyecare practitioners’ rights to not be bypassed during the ordering process. The AOA has been tireless in fighting for the interests of both the practitioners and the patients. Practitioners can help by reporting those companies that are not following the law. For example, when you see illegal behavior by unscrupulous companies, problems should be reported to StopIllegalCLs@AOA.org; the AOA’s Contact Lens & Cornea Section (CLCS) collects these cases to be reported to legislators and regulatory agencies.

The newest national organization is a consortium named The Health Care Alliance for Patient Safety (also referred to as the APS). The APS is an advocacy organization and was established to prioritize health and safety in policymaking related to the eyecare industry. The APS will be bringing forward two key pieces of legislation in 2019. To stay up to date on APS’s activities, follow them on Facebook, LinkedIn, and/or Twitter.

5. Use Your Time with Patients to Educate Them There was a time in the past when dedicated physicians would check patients for serious problems without explaining what they were doing. Those times have passed. Now, it is imperative to communicate better with all patients. “We are checking your pressure because glaucoma is one of those conditions that you would never know you have until it is too late. With this test every year, we can predict whether we have to worry about this.” “You’ve seen these images of the back of your eyes...each year when I see you, we are looking for any problems that may be lurking and asymptomatic.” If patients have a family history of disease or any other pertinent medical issue, take the time to explain it.

Give your patients a reason to come see you every year. The pearls that they pick up during their visits each year have value that an online disruptor cannot duplicate. While seemingly simplistic and intuitive, practitioners can never repeat the care and compliance basics (such as do not sleep in lenses; no water should ever touch lenses; change storage cases monthly, wash storage case with soap and water, air dry face down; and rub monthly lenses) to their patients too many times. And don’t forget to go over storage solutions each year.

STAY INFORMED

It is also important to keep up-to-date on the alternative distribution companies. This is beneficial to both know what is occurring in the industry and how it can potentially impact your practice. Knowing this information also allows practitioners to answer their patients’ questions and, in turn, to educate them.

Patients are already being bombarded with marketing messages suggesting that their eyecare practitioner isn’t needed and that the products that these companies are selling are a great alternative choice. While practitioners still have the patients in their chair and before they are lost to these disrupters (until they experience a contact lens problem), practitioners need to make a point to educate their patients about why coming in for annual care is in their best interest.

Proactively point out the differences in the products that you as an eyecare expert chose versus the ones that patients are considering selecting on their own based on slick marketing or a seemingly low price. Practitioners should be vocal about their positions as contact lens experts and provide their patients with the best options. Don’t simply re-prescribe the same dated technology and expect patients to show up year after year. Present patients with innovative technology that will enhance their contact lens experience.

The next component is to identify what—beyond the appeal of a better wearing experience—attracts patients who are choosing to use these alternative vendors. There is often a component of perceived value and convenience. All eyecare practitioners should actually go through the process of buying lenses from these online vendors. They should take notes as to what they liked and disliked about the experience. For the things that they liked, is there a way to implement them into their practices? For example, a subscription model in which patients pay monthly. For those features that they weren’t fond of, how can the practice’s online buying experience be different?

LOOKING AHEAD

What can practitioners look forward to in the near future that could benefit everyone who wants to be successful in providing the best contact lenses and contact lens care to their patients? Certainly not-for-profit advocacy is important, but the wins are going to come from for-profit businesses that align patients and practitioners. When exploring how to move forward as eyecare practitioners, look for companies that will never violate the practitioner/patient relationship. CLS

REFERENCES

  1. Howe N. Why Millennials Are Texting More And Talking Less. Forbes. 2015 Jul 15. Available at https://www.forbes.com/sites/neilhowe/2015/07/15/why-millennials-are-texting-more-and-talking-less/#2c2b300d5975 . Accessed May 1, 2019.