A Modern Approach for Today’s Visual Demands
For hours a day, patients’ eyes are fixed on electronic devices they replace every few years. Give them the same level of technology for their eyes.
Evidence of the explosion in digital devices is all around us, but less obvious perhaps are the ways in which to help our patients respond to the unique visual challenges this revolution poses. Many of our contact lens patients spend much of their workday using a computer and a significant amount of time outside work on a computer or other electronic device – often amounting to 10 or more hours a day.1 These increasing amounts of screen time are consistent with the reported high rates of electronic device ownership among American adults, with 88% now owning a cell phone, 61% a laptop computer, 18% a tablet computer and 18% an e-reader.2
DR. MARSDEN: We know patients are spending long hours every day on computers, tablets and smart phones, which decreases the blink rate,3 contributing to physiologic dryness. It’s also important to note that these patients have high visual demands for these tasks. This is now our world. How does it affect our choice of contact lens and how we keep patients in those lenses?
DR. GIEDD: We’ve been recalibrated to a high-definition world. We need to read 10-page documents on our smart phones. Our TVs show us every blade of grass and every whisker, and that’s the resolution we expect from our eyes. The proliferation of personal technologies has changed patients’ symptoms and raised their visual expectations, which in turn has changed our job.
We have to take this into account when we make our recommendations. In terms of contact lenses, this means the best contact lens modality in a daily disposable, and a glare-reducing optical design that delivers the quality of vision our patients expect.
DR. GEFFEN: Think about how accustomed technology users are to “trading up” when devices get markedly better every few years. For patients with that mindset, changing contact lenses every few years makes sense, too. And I’m a true believer in offering patients new products every 3 years because in year four, they start getting complacent and ordering lenses online to avoid exam fees.
DR. MARSDEN: It’s like a cell phone contract. We can’t wait to get the new phone every 2 years because there’s so much added to the device. Yet as practitioners, most of us don’t recommend changing eye wear, contact lenses or solutions as technologies improve. Why is that? What does it take to recommend a change?
DR. GEFFEN: Many optometrists don’t realize that patients are leaving practices and dollars are lost. I think most of them would start making these changes right away if they saw how inaction affects the bottom line.
DR. MARSDEN: Part of awareness is knowing how much our patients use digital devices. I used to ask about their “computer work,” but found that patients only provide their work hours. They can double that if they’re gaming at home, using a tablet or spending a good amount of time on a smart phone. Do you ask your patients about screen use?
DR. GEFFEN: We ask how many hours per day are spent on a computer, video games and smart phones. Additionally, in my exam room I no longer use a near point card. I say, “Pull out your cell phone,” because that’s what they want to see, and I want to make sure they can read their cell phones with the contact lens I prescribe.
Filling a Need
DR. MARSDEN: We need to address two primary demands for patients who spend time using screens: excellent vision and relief from dryness symptoms caused by lowered blink rates. How do we do that?
DR. DUROCHER: Dryness is inevitable. With screen use, the contact lens is exposed to the air more — potentially increasing lens dehydration, resulting in a feeling of dryness and decreasing the quality of vision. In these cases, I prescribe a lens like the Biotrue® ONEday (Bausch + Lomb) that has an outer surface that mimics our lipid layer of the tear film to help prevent dehydration. Dehydration of this unique lens material is minimal and this helps maintain excellent optics throughout the day. Patients are going to feel comfortable as they use their electronic devices, and the aspheric optics will deliver excellent vision.
DR. GEFFEN: We’ve taken patients who have dryness complaints as a result of digital device use and put them in the Biotrue ONEday lenses. Many of these patients didn’t think they could successfully wear contact lenses because of the dryness. It’s been an eye opener for me to see how successfully I’ve been able to meet the needs of these patients with this lens.
DR. MARSDEN: So, a daily disposable product like Biotrue ONEday is your answer for many of these patients?
DR. GEFFEN: In my experience, these lenses allow us to provide patients with everything they need, in a way that makes sense for people who embrace newer, better technologies. We’re in the middle of an exciting time in terms of contact lens innovation. The major manufacturers have all committed to the daily disposable modality, and we have great lenses on the market.
And for a practice like mine — daily disposables are the only way to go. I’ve found that Biotrue ONEday is an innovation that may change the whole industry and give us an excellent opportunity to keep patients in clear, comfortable lenses.
DR. MARSDEN: Specifically, is there an advantage of using Biotrue ONEday for visual performance benefits in high computer-use environments?
DR. GEFFEN: I’m in a biotech rich area of the country, and our practice is loaded with engineers who spend 8 or 9 hours a day looking at a digital screen, and then go home and look at their computer or TV for another 4 hours for fun. We’ve found that with the Biotrue ONEday lens, not only are their eyes feeling moister than they did with other products, but patients also have less visual complaints.
By not drying out, this lens maintains a pristine level of aspheric optics for crisp, clear vision throughout the day, even if patients stare at a monitor all day long. The lens wettability makes it stable throughout the day, and the fact that its surface mimics the natural lipid layer of the eye provides comfort throughout the day that’s unsurpassed. Patients are happy and they send their friends to our practice.
DR. MARSDEN: How do you demonstrate the difference to patients?
DR. DUROCHER: You’ve got to let them experience it. Let them try it and see if their experience matches your expectations.
DR. RUMPAKIS: Experiencing the new technology is very important. All of us would say, “I had a great phone 5 years ago, but I couldn’t go back to it because my new phone lets me do so much more.” But you can’t make the comparison unless you experience both phones. The same goes for contact lenses. Once you allow patients to experience what the new technology actually does for them, that’s what really delivers value. And cost is no longer an issue. The lenses cost more, but there’s value added because it’s a better product.
DR. MARSDEN: Oustide the United States, daily disposable utilization is high. Why isn’t the modality embraced here?
DR. RUMPAKIS: I participated in launching the first-generation daily disposable lenses nearly 20 years ago, and we’re still talking about how to convince our colleagues that it’s the preferred modality. I’ve never understood why ODs, who have no trouble up-selling a spectacle lens to a premium progressive lens, won’t make the same recommendation to upgrade contact lens technology to a daily disposable.
DR. DUROCHER: I think some of our colleagues believe daily disposable lenses are too expensive for their patients, and they don’t want to have what they perceive to be a difficult conversation. They would rather leave things as status quo. That’s why contact lenses have become a commodity Let’s say you take a patient out of an old lens with so-so performance that affects their comfort and lifestyle and put that patient into Biotrue® ONEday. You explain why the lens is so much better, lay out your expectations and let the patient wear the lens and see how it performs. This is medical device decision making. This is not a commodity. And daily disposable lenses have many features that help demonstrate that.
DR. MARSDEN: From what we’ve discussed, there’s a clear financial downside to the commoditization of contact lenses. If we want to convince ODs to use daily disposables, could financial benefits be the key?
DR. RUMPAKIS: You can increase profits by prescribing a daily disposable product, or you can decrease profits when patients leave your practice because they’re unhappy in their lenses. Patients eventually won’t come back, and you often won’t know why or get another chance with them. Anticipate and fulfill their needs while they’re in your chair and they’ll stay there.
DR. GEFFEN: Right. And the profitability of fitting a daily disposable lens is much higher because patients return more often. In 10 years, a daily disposable patient is back nine times, compared to eight visits for monthly lenses and six times for 2-week lenses. We collect all service fees and get the chance to check patients’ health and ensure they continue to enjoy a safe and comfortable contact lens-wearing experience, so that they don’t drop out of contact lens wear.
Solution Selection Can Make or Break Success
DR. MARSDEN: We’ve talked about patients’ needs and how important it is to offer them the best correction, like high-tech one-day lenses. How important is the contact lens care solution to maintaining clear, comfortable vision and curbing dropouts in your patients who use frequent replacement contact lenses?
DR. DUROCHER: The multi-purpose solution is very important. It needs to prevent dehydration. Biotrue multi-purpose solution uses the same lubricant naturally found in the eye, hyaluronan, which helps contact lenses maintain moisture levels for up to 20 hours.*
Biotrue® MPS Provides High Patient Satisfaction
To evaluate patient satisfaction with Biotrue MPS, Bausch + Lomb conducted a patient survey during which 1,065 independent ECPs switched daily wear patients from their usual multipurpose solution (MPS) or peroxide lens care system to Biotrue MPS. To assess satisfaction compared to their customary lens care product, the subjects were asked to complete an Internet questionnaire after using Biotrue MPS. Questionnaires were completed by 8,638 subjects who used Biotrue MPS for at least 4 days.
After switching to Biotrue MPS, 96% of all subjects said they were satisfied with Biotrue, and 90% said that Biotrue was more comfortable than their habitual lens care system. In addition, 88% preferred Biotrue MPS to their usual lens care system, and the same percentage said that they intended to continue use of Biotrue after the study. Similar remarkable results were reported regardless of lens brand or habitual MPS solution.
DR. GIEDD: A multi-purpose solution change alone can have a huge impact on our patients’ experiences. It can actually keep patients in contact lenses. The choice matters, and the time we spend educating patients and specifically recommending a lens care solution pays off. Simply recommending a better care product reduces dropouts without adding a lot of chair time or expense for the patient.
Many doctors and patients disregard the role of solutions in the patient’s overall experience. Patients need to understand that our recommended solution will make their eyes more comfortable than “just any solution,” both upon lens insertion and throughout the entire day of lens wear. In my practice, I always recommend Biotrue multi-purpose solution for frequent-replacement lenses. It really can take a patient who has been struggling or suffering and turn the experience around very easily for both doctor and patient.
DR. MARSDEN: More talking means more chair time. From a practice management standpoint, what’s the return on the time you invest in explaining why you’re prescribing a certain lens care product?
DR. GEFFEN: It’s really not, in my mind, a huge investment in time. You have the patient in the chair and you’re talking to him already. I ask what solution he’s currently using. The answer is often something I never recommended, which tells me I need to go over the importance of solutions every time I see him. For the health of a patient’s eyes and to keep him in contact lenses for many more years, I need to take those 40 seconds once a year.
DR. MARSDEN: Patients see a plethora of solutions in the drugstores. Which one do you recommend for your patients?
DR. GIEDD: Over the past 3 years, I’ve found that Biotrue multi-purpose solution delivers the whole package of what patients need. It has an excellent disinfection profile and a very biocompatible, bio-inspired moisturizing agent — hyaluronan — that resonates with patients.
DR. MARSDEN: How do you explain that to patients?
DR. GIEDD: Briefly, I say, “This is designed to work like your eye. It matches the pH of your healthy tears, and has hyaluronan so it feels good when you put it in, and more importantly, the comfort extends throughout the day. The hyaluronic acid stays with the lens and keeps you comfortable for more hours of wear.” I’ve never experienced such loyalty to a lens care product as I’ve seen with my patients who use Biotrue multi-purpose solution.
DR. MARSDEN: If we’re seeing those results, why aren’t we seeing more doctors emphatically recommending a contact lens solution? We’re very comfortable prescribing a drug to treat a disease, but many of us are apprehensive about prescribing a solution that could fix a patient’s symptoms.
DR. DUROCHER: That’s my thinking. If I want to recommend a glaucoma treatment or a contact lens care system, I make the recommendation. I don’t think contact lens solutions need to be any different.
DR. GEFFEN: The problem is that some doctors don’t realize that their most powerful words are “I recommend.” Patients are in our chair because they’ve paid for our service and they want to hear what we recommend. They don’t want us to give them three different contact lens solutions and say, “Use what’s comfortable.” If they wanted trial and error, they wouldn’t come to us.
DR. RUMPAKIS: I think that many of our colleagues have an inherent fear of failure with patients, so they don’t want to put their reputation behind a recommendation. Instead of saying, “I’m really confident that this is going to change your experience with contact lenses,” they hold back a little, or they direct patients to the contact lens technician. I’ve also sat in many exam rooms where doctors don’t know the new products or haven’t read the literature, so they prescribe what they’re comfortable with or stay with the lens or solution the patient is already using to create as little disruption as possible.
Reducing Dropout with Biotrue® MPS
Daily wear contact lens patients who habitually used multi-purpose solutions (other than Biotrue MPS) and reported intent to imminently dropout of contact lens wear because of comfort and dryness complaints were recruited to participate in a recent study4 to determine whether Biotrue multipurpose solution (MPS) could significantly reduce the likelihood of daily wear contact lens drop out. The patients were switched to Biotrue MPS and continued to use their usual contact lens brands with Biotrue MPS for 2 weeks, before and after which they completed an online questionnaire.
Of the 153 daily wear (silicone hydrogel and hydrogel) patients who completed the study, 93 subjects who had the highest propensity for discontinuation of lens wear were included for further analysis. Of those 93 subjects, 80% of subjects reported they would continue contact lens wear after switching to Biotrue MPS for 2 weeks. Eighty-six percent of all subjects reported that Biotrue MPS made their lenses more comfortable and 87% stated their lenses felt more moist throughout the day than their usual MPS. Online interviews were conducted with 73 of the study participants 6 months after completion of the initial study, of whom 93% responded that they were still wearing contact lenses at least once per week.
Biotrue multi-purpose solution is a unique and innovative solution that was designed to work like the eye. Despite using the market leading lenses and solutions, most patients intending to dropout of contact lens wear due to discomfort and dryness reduced their intent to drop out after trying Biotrue MPS. In fact, the use of Biotrue MPS eliminated the consideration of dropping out in more than half of all study subjects. Patient satisfaction and retention in contact lens wear may have a significant impact on the lifetime value of a patient to the practice and willingness to remain with and recommend a particular eye care professional.5 Recommending Biotrue MPS may help minimize the risk of contact lens dropout.
DR. DUROCHER: That’s unfortunate, because it really devalues the experience for the patient.
DR. RUMPAKIS: I agree. It de-emphasizes the medical device nature of the contact lens and ignores the fact that we really can manage a patient’s experience with them.
DR. MARSDEN: When we do recommend a multi-purpose solution and explain the reasons why to patients, then I’ve seen patients become evangelists, telling friends what I prescribed and why. Those friends think, “My eyes are dry Why didn’t my doctor recommend that solution?” And then those patients begin thinking about changing doctors. It all begins with explaining why I recommend it.
DR. RUMPAKIS: If you want a patient to follow your recommendations, you need to tell them clearly what you want them to do, and tell them why you want them to do it. Most of us are great at telling what but we sometimes forget the why. The why is what makes the recommendation effective, and part of that explanation is you reiterating patients’ complaints, which makes it personal to them.
DR. GEFFEN: The explanation is a key to making a strong recommendation. You need to say, “I recommend this system. Here’s why: It’s more wettable. It’s going to provide better end-of-the-day comfort. I’ve had 3 years of experience with Biotrue multi-purpose solution, and it makes a difference for my patients.”■
*Results of in vitro study performed to evaluate the release of wetting agents from various silicone hydrogel materials (balafilcon A, senofilcon A and lotrafilcon B) over a 20-hour time period. Lenses were placed in Bausch + Lomb standard lens cases (or hydrogen peroxide neutralizing cases) and soaked for 8 hours in respective lens care solutions. Hank’s balanced salt solution (HBSS) was dripped over the lenses at a rate that approximates tear secretion in the human eye as determined by Reddy I, et al. Ocular Therapeutics and Drug Delivery. The solution that rinsed off the lenses was collected at set time periods over 20 hours and the surface tension was measured using tensiometry. The surface tensions of the rinse solution collected were then analyzed versus the surface tension of the control (rinse solutions collected from lenses pre-soaked in HBSS) using a t-test and a p-value ≤ 0.05. This data represents the number of hours across which a consistent statistical difference in average surface tension could be detected between surface tension of HBSS and the surface tension of the rinse solution from lenses that had been soaked in various lens care solutions for all three silicone hydrogel lens types tested.
1. Ipsos OTX and Ipsos Gobal @dvisor. Socialogue: If You’re Awake, Chances Are You Are Well-Connected. Available at: http://www.ipsos-na.com/news-polls/pressrelease.aspx?id=5725.
2. A closer look at gadget ownership. Vision Monday; Aug. 13, 2012.
3. Patel S, Henderson R, Bradley L, Galloway B, Hunter L. Effect of visual display unit use on blink rate and tear stability. Optom Vis Sci. 1991;68(11):888-892.
4. Merchea M, Doktor M, Rah M. Reducing contact lens dropout by changing lens care solutions in at risk patients. Poster presented at the 2013 Annual Meeting of the American Academy of Optometry.
5. Rah MJ, Lewis, N. Positive attitudes towards a novel MPS leads to positive perceptions of the recommending ECP. Poster presented at the 2011 Annual Meeting of the American Optometric Association.