Contact Lens Economics

Reality Check: Patients Don't Want Contact Lenses

contact lens economics
Reality Check: Patients Don't Want Contact Lenses

The most successful contact lens practitioners I've ever met are those who understand one basic premise: None of their patients wants to wear contact lenses. What they really want is to see better. These patients have chosen contact lenses over eyeglasses or refractive surgery to correct their vision. But if one day, they learn a magic wand, potion, pill or elixir can accurately, quickly and safely turn their 20/400 vision into 20/20, you can bet they'll want it.

Recognizing that patients wear contact lenses because they want to see better — not because they want to wear contact lenses — leads to the logic branch that they want to see better all the time, not just some times. Eyeglass wearers and LASIK patients are no different. They all want great vision 24/7/365. In 22 years of practice, I've never had a patient tell me, "Dr. Gerber, I want clear vision only some times."

With this basic understanding, is it any wonder a recent CIBA Vision survey1 regarding attitudes about continuous wear contact lenses showed that patients yearn for it? Perhaps not, if you think in terms of people wanting continuous vision as opposed to continuous wear. "Vision" is what people want and "wear" is what they must do to achieve it.

So, for the rest of this article I'll be using the term continuous vision instead of continuous wear.

Still not convinced your patients want continuous vision? Then you're not asking the right questions.

The Right Questions

How you dig for information about your patients' preferences and how they wear their contact lenses influences how they answer your questions. This, in turn, colors your perceptions about continuous vision.

I often hear practitioners say, "I've asked my patients if they want to wear their contact lenses while they sleep, and most of them say 'no.' So, I don't see any need for a continuous wear contact lens." Their perspective is skewed by how they ask this question.

Asking patients if they'd like to wear their contact lenses while sleeping is no different from asking someone who wears spectacles if he'd like to wear them while sleeping. It may seem like splitting hairs, but there's no functional benefit to sleeping with eyeglasses or contact lenses. Instead, ask the question from a different perspective. Try, "Would you like to wake up and see?" or "Would you like to be able to see all the time?" Virtually all patients will answer yes to these questions.

Wearers Weigh In

In fact, the 2005 CIBA Vision survey of 2,625 soft lens wearers found that the number of patients who sleep in their contact lenses continuously for more than 7 nights had doubled in the last 3 years.

This same survey also found 46% of those polled would like to wear their lenses overnight, and 54% of those want to do so most nights. Why the increase if they don't want to sleep in their lenses? It's that fine line between wanting to see and wanting see continuously.

Other insights from the survey show that about one in five (18%) soft contact lens wearers sleep overnight in their lenses at least some of the time, and most who sleep in their lenses over-night do so frequently — 20 nights per month on average.

Do you think these aren't your patients because your patients answer "no" to, "Do you ever sleep in your contact lenses?" Instead ask them, "How many nights per month do you sleep in your contact lenses?" Asked in a straightforward, non-accusatory manner, patients are more likely to be honest about their lens-wearing habits, and you'll get a better grasp of what they want and need.

Benefits of High Dk/t

Most patients (71%) feel it's not a good idea to sleep overnight in contact lenses. Yet, the number of patients wearing soft lenses continuously for 8 nights or more increased from about 900,000 in 2002 to 2 million in 2005.1

Are we obligated to provide this alternative for patients just because of these statistics? Of course not. Our job isn't to enable "risky behavior." However, what these data suggest is that we may need to revise our idea of what constitutes "risky behavior" for contact lens wearers.

We know the risk of losing best-corrected acuity from sleeping with high Dk/t silicone hydrogel lenses is less than that from refractive surgery2 yet we don't see ourselves as enabling refractive surgery patients to take an unnecessary risk.

Surveys are telling us some patients will sleep in their contact lenses, regardless of what we prescribe. Knowing this in advance, the astute practitioner will prescribe the best possible lenses for overnight wear.

Study after study has shown that extended wear lenses with higher Dk/t values are a healthier choice compared to those with lower Dk/t values. What's more, the CIBA Vision study found that 66% of soft lens wearers indicated they accidentally fall asleep or nap while wearing their lenses at least once a month for an average 6 nights a month.

As responsible eyecare practitioners, why wouldn't we give all of our patients the extra margin of safety that higher Dk/t lenses provide?

Practice-building Opportunity

Given this latest information about patients' attitudes, it appears many of us are missing a chance to build our practices. Indeed, the 2005 CIBA Vision study found that only 32% of patients were told by their doctors they could sleep overnight in their lenses.

One of the many tenets of successful marketing is "give the people what they want," and it appears that about two-thirds of us aren't doing that.

It's time to start connecting the dots between sound clinical practice and patients' desires and recognize the realities uncovered in this study. Namely, regardless of what we want patients to do, they're sleeping with lenses anyway.

With the health benefits of higher Dk/t lenses, a great practice-building opportunity awaits those willing to discuss this modality with appropriate candidates.

Remember, continuous wear isn't for every patient, but continuous vision is.

Dr. Gerber is the president of the Power Practice, a company offering consulting, seminars and software solutions for optometrists. You can reach him at (800) 867-9303 or


1. CIBA Vision 2005 U.S. Consumer Usage & Attitude Study.

2. Schein OD, McNally JJ, Katz J, et al. Incidence of microbial keratitis among wearers of a 30-day silicone hydrogel extended wear contact lens. Ophthalmology. 2005;112:2172-2179.