Contact Lens Dropout
Decisions that impact the bottom line must come from the top.
Eye care professionals (ECPs) are constantly faced with the challenge of solving dryness and discomfort complaints for their contact lens patients. These complaints are often cited as major factors in the discontinuation of contact lens wear.1-6 In 2010, Contact Lens Spectrum reported that 16% of contact lens wearers permanently dropout of contact lens wear each year.7 Even with advances in lens materials such as the introduction of silicone hydrogels, contact lens dropout rates have remained remarkably unchanged, with estimates still ranging as high as 30%,1,4 which is reflected by revenue loss in practices over time.
Dropout Rates and Reasons
DR. MARSDEN: Dr. Rumpakis, you recently published research that reveals a kind of ambivalence, from a practical standpoint, about what happens in clinical practice with contact lens dropouts. What did you find? Can you talk about the dropout-related threats we might face in practice?
DR. RUMPAKIS: Well, it’s interesting. I did my research in 2009 and the article was published in January 2010.1 When you think about the economic changes going on in that period, you can see that we’re looking at a vastly different world today.
There used to be a long-standing idea that we had 10% of our contact lens wearers dropping out at the same time that we were getting a 10% increase in new contact lens patients.
Many thought the contact lens market was flat, and that the lack of growth would kill it off.
I was asked to determine why the contact lens industry was flat, and I said, “I don’t believe that 10% statistic.” I decided to challenge it. I built a website for an online survey to evaluate the contact lens dropout rate around the globe. The U.S. data showed that the contact lens dropout rate was almost 17% overall in the first year of wear.1 In the data aggregated since that initial question to include multiple-year scenarios, I see a vast range in dropout rates from 16% to 30% per year.
DR. MARSDEN: In our clinical practices, we all have some level of dropouts, and some of us track them. Do you think most practitioners are aware that they’re losing 16% to 30% of their contact lens wearers per year?
DR. DUROCHER: I think most doctors are absolutely unaware. I travel and lecture all over North America and have many conversations with practitioners. I always ask the question, “How well do you think we’re doing with contact lenses today?” And almost every time, they say, “We’re doing great. Lenses are better than they’ve ever been, patients are happy. They’re staying in their lenses.” But the numbers tell a different story.
DR. MARSDEN: Any discussion of dropouts includes some reference to the difficulty of measuring them. Why has this person left? Could I have prevented it? But before we address that, we first have to know why it’s crucial that we retain that patient.
Dr. Rumpakis, your research addresses the issue about revenue loss. What is the financial impact of contact lens dropouts from an annual standpoint and for the lifetime of a patient?
DR. RUMPAKIS: Estimates vary, but let’s say one patient represents about $275-375 per year in purely optical-related services, not including potential medical revenue. Using a financial function to figure out the lost future value of that opportunity, the practice stands to lose a median value of $21,000 per patient over that patient’s lifetime within the practice. That’s significant. We must try to retain every patient in our practices.
I’m truly convinced that patients put up with a high level of discomfort because they don’t know it’s abnormal. They think being a contact lens wearer means they have to suffer with a certain amount of discomfort before they report it as being a problem.
—John Rumpakis, OD
DR. DUROCHER: And that’s just a direct effect. The indirect effect is huge. The word of mouth referrals lost, the friends and family you won’t see because you didn’t do well.
DR. GEFFEN: That’s just one patient, too. If you see 3,200 patients a year and 25% of your practice is contact lenses, that’s 800 patients. If you lose 10% per year, that’s 80 patients. Multiply that revenue loss by 80 patients per year, and you’ll feel the impact.
DR. MARSDEN: Why do you think patients are dropping out? Is it discomfort? Dryness? A visual response? Is there a single driving force, or do patients drop out for different reasons?
DR. GEFFEN: Well, we’ve read for many years in the literature that the number one reason for dropout is discomfort, and I would argue that the discomfort is mainly end-of-day dryness. When you have a patient who tells you, “I can’t wait to come home from work and rip my contact lenses out,” you have a problem. That patient will wear her glasses to work one day and think, “This isn’t so bad.” We’re fooling ourselves if we think this patient is going to keep coming back to us if we don’t address her long-term comfort issues. She’ll end up in somebody else’s office.
DR. GIEDD: When we ask if patients drop out because of problems with comfort or vision, we ignore just how intertwined those two things are. Patients’ blurred vision at the end of the day may be related to lens dehydration or other problems. Even if they’re not experiencing a physical sensation of discomfort, they often describe their visual problems as discomfort.
DR. RUMPAKIS: And I don’t think they know how to rate discomfort. I’m truly convinced that patients put up with a high level of discomfort because they don’t know it’s abnormal. They think being a contact lens wearer means they have to suffer with a certain amount of discomfort before they report it as being a problem.
DR. MARSDEN: With so many patients who don’t complain of any problems, we need to be proactive and not let patients get away. We try to ask the right questions and extract the details, and then we tell them that we can actually improve their vision or comfort. They might need a re-fit to a new daily disposable lens or we might prescribe a new multi-purpose solution. Patients are thankful because we solve problems they didn’t realize they had, and the modality boosts the bottom line because daily disposable contact lenses have the highest profit margin.
Furthermore, in my experience, daily disposables are a modality that encourages self-recall. I have certain patients who have never purchased a lens product from me, but they come religiously every 12 months for their daily disposable lenses. I appreciate them coming in because now I have healthier patients and increased compliance.
DR. RUMPAKIS: In our study, the average time a patient stayed with a practitioner was 24 years. People stay with a practitioner who keeps up with technology and genuinely cares for them. If patients don’t have that perception, they leave. And practices don’t like to face the negative impacts. They don’t like to admit failure. Patients just disappear and practitioners don’t know why.
DR. GIEDD: Many of our colleagues don’t necessarily profit on the sale of optical goods, but there is tremendous value to them as well. Contact lens patients are your best source of revenue for services. They come back to you more often than spectacle wearers for comprehensive exams and for the management of other problems.
Before Patients Drop Out
DR. MARSDEN: If we don’t want patients to reach the dropout stage, we need to address dropoff. We need to step into that continuum before patients decrease wear time. How can we identify the potential for dropoff before it occurs?
DR. RUMPAKIS: I think that to shut down dropouts, practitioners need to realize that dropout is real and it exists in your practice, whether you want to admit it or not. That’s the only starting point for success in stopping dropout — realizing that you have a problem.
DR. DUROCHER: Early detection and treatment are key for our glaucoma patients, and the same thing is true for potential contact lens dropouts. You’ve got to detect the problem and stop it before it even starts.
Even when we work to ask the right questions, we may not be able to identify dropoff if patients aren’t talkative. I think that when we’ve had patients in the same lenses for a few years, it’s best to have them try a new product. Even if they think everything is fine, the new lenses and solutions can show them something different. By anticipating needs and updating the treatment technology, we’re creating a great deal of value.
DR. GEFFEN: In my practice, Biotrue® ONEday daily disposable contact lenses have really been the answer for dropoff and dropout of spherical patients in my practice. The lenses satisfy my patients’ needs with excellent optics and end-of-day comfort. They’re happy, and they refer their friends. Contact lens complications have declined, and so have dropouts.
DR. MARSDEN: Do you ever try to get patients who have dropped out to return?
DR. RUMPAKIS: I think many practitioners either don’t know how to mine their database to find these patients or they’re not interested enough in identifying these patients so they can reach out and communicate the new technologies that are available.
DR. GEFFEN: But there’s always that patient in the chair who checked “Yes” next to “Have you ever tried contacts?” on the intake form. That is a golden opportunity to say, “Things have come so far. Would you consider test driving new lenses today?” When I put the Biotrue ONEday lens on patients, they see amazingly well. There’s a definite “wow” factor. Patients say, “I don’t even feel these lenses. They’re amazing.” They come back in a week and say they keep forgetting the lenses are in. It’s great to hear. ■
1. Rumpakis J. New data on contact lens dropouts: an international perspective. Rev Optom; January 2010.
2. Evans VE, Carnt NA, Naduvilath TJ, Holden BA. Factors associated with drop out from silicone hydrogel contact lens daily wear. Invest Ophthalmol Vis Sci. 2008;49:E-Abstract 4839.
3. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. 2002;22(6):516-527.
4. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007;26(2):168-174.
5. Chalmers RL, McNally JJ, McKenney CD, Robirds SR. The role of dryness symptoms in discontinuation of wear and unscheduled lens removals in extended wear of silicone hydrogel lenses. Invest Ophthalmol Vis Sci. 2008;49:E-Abstract 3088.
6. Young G. Why one million contact lens wearers dropped out. Cont Lens Anterior Eye. 2004;27(2):83-85.
7. Nichols JJ. 2010 annual report on dry eye diseases. Contact Lens Spectrum; January 2010.