Retention, upgrading and communication with contact lens patients

Dropout and upgrading

Contact lenses are a significant, and growing, aspect of business for all the practitioners that we spoke to.

Neil Hilton, optometrist and owner of Hakim Group’s Bennett and Batty Opticians in Liverpool, explains that, while it varies across his five practices, between 20% and 25% of a practice’s turnover coming from contact lenses is his aim. He said: “The practice I work at most often has the highest contact lens database. It’s always had a big database, and we’ve built on that, and fortunately we’re seeing growth over all the areas.”

COVID-19 highlighted “how important our contact lens database and direct debit base is,” and “kept us afloat, especially in the practices that have got the higher percentage of turnover,” Hilton said.

He added: “Our focus is to try and grow our contact lens databases, and they are growing, which is great. It’s good from the category point of view – there’s growth across all five practices.”

When it comes to growing the contact lens side of the business and reducing dropout, Julie Clarkson, Simon Falk Eyecare, identified three key reasons that explain why patients do not persist: comfort, vision, and handling.

She finds that clear communication with individuals is the best way to provide support and thus avoid dropout. With new wearers she performs the teach herself, and then gives patients her email address along with written instructions so that they can contact her at any point. If they don’t get in contact, she follows up with a phone call within two weeks, to try and avoid dropout within the first month.

Clarkson emphasised, though, that new wearers are not the only ones at risk: sometimes, patients who have been wearing contact lenses for five years can drop out too, often unexpectedly.

Reminder letters and aftercare appointments are key to avoiding this, she said: “We’d like to see them every six months in practice, or we could have a video call to chat through the changes: what’s on the market, what they are currently wearing, and what is out there for them that might be better.”

She added: “The key is communication: marketing, reminder letters, seeing them, and talking to them.”

With comfort and dryness often cited as blockers for contact lens wear, do practitioners believe that there has previously been something missing from the one-day silicone hydrogel market?

Vinod Mistry, contact lens optician at Camden Contact Lens Centre, believes that in terms of optical design, material and modulus, manufacturers should look at contact lenses more like an eyeball, in order to make them more successful.

Mistry added: “What is important is the 12-hour mark. When patients reach 12 hours, that’s usually when they feel the lens. I believe that lenses shouldn’t be felt, no matter how long you wear them.”

When it comes to review and potential upgrading, contact lens optician at Dominic Tunnell Opticians, Theresa Salmon, pays particularly close attention to how her patients use their lenses: whether that’s part-time or flexible wear, very occasional use, or full-time.

“My approach to upgrading is, is it required?” she said. “I would base it first on a subjective response, asking those questions of the patient.”

Key questions are around comfort, if anything has changed since the patient’s last visit, whether they have reduced their wear time, and if their vision is as good as they had expected. She also checks dryness, tear film, and lens edge staining. She noted that it is also important to note how long they have had their lenses in before the appointment.

Salmon said: “Within this I’ve also realised that if you consider a long-term wearer, they might be concerned that you’re about to tell them their lens wearing days are numbered, because some people have this belief that there's a finite number of years that they can use lenses for.”

Because of this, she said, “sometimes people might not tell you the full story.”

Concluding the session means giving clear reasons for the recommendation that is being given, Salmon said, because, “I would much rather upgrade the lenses than start counselling the patient on reducing wear time.”

She added: “Make sure the patient knows that, if there is any reason that their lenses are less good, we have a solution to that issue.”

Clarkson brings up the subject of upgrading in every appointment, letting patients know that there are newer products available. She said: “I think it’s a must, because some people are in old materials that think they are comfortable. Until you actually offer them something else, they don’t necessarily know. It’s always a discussion to have.”

Hilton pointed out that, “from a clinical and governance point of view, we have a responsibility to do this anyway. Patients don’t know what they don’t know, and it’s up to us to educate them and show them what’s new on the market. They might think that their current lenses are comfortable, until they’ve tried something else.”

Patients don’t know what they don’t know, and it’s up to us to educate them and show them what’s new on the market

In terms of the progression in technology, he likens upgrading contact lenses to getting a new phone: “You wouldn’t want to pick up the same phone for five or six years, and I think it’s the same principle.”

Hilton is quick to point out, though, that patients might not always be better off, “and in that case, if they end up in the same lens and they’re happy, that’s wonderful. But I think it has to be an informed decision.”

He tied the issue of upgrading to patient retention, “because the patient is happier: they’ve got the confidence in you as a practitioner that you’re always going to give them the best lens on the market for them.”

Hilton added: “It’s one of my favourite bits of the job – when new kit comes out and new lenses come in, I’m always really excited to try them.”

For Mistry, having a contact lens scheme with aftercare appointments built in means patients are regularly able to view the new technology and contact lenses that are available. It puts them in a mindset where that they should always be looking at new options, he explained: “We have a very busy contact lens clinic. Usually, patients are the first to ask me if I have anything new that they can try.”

Because the technology is always improving, patients rarely find that their new lenses do not perform as well as their old ones – and when “Bausch + Lomb ULTRA® ONE DAY came, this was no different,” Mistry said.

He also emphasised the value of letting patients trial and use more than one type of lens: “Here, contact lenses are almost treated like shoes – you can use the lens that works best for whatever you’re going to use them for. We give people the opportunity to try lenses and see what they’re good for.”

Experiences of Bausch + Lomb ULTRA® ONE DAY

When discussing their experiences of Bausch + Lomb ULTRA® ONE DAY for their patients, the practitioners were effusive about the lens’ Advanced MoistureSeal® Technology, as well as its easy handling – all of which has been apparent from patient feedback. It’s something, Clarkson said, which “makes my job more satisfying – helping people.”

Salmon emphasised that, on inserting the lens, patients report that they can’t feel it at all. “With most lenses, it doesn’t matter how good they are, there’s that initial sensation, however short-lived,” she said. “This is when this ComfortFeel Technology is kicking in. The hours of comfort are excellent. People can wear the lens for as long as they want to during the day, which is down to the Advanced MoistureSeal® Technology, and low modulus of material.”

She also highlighted the lens’ ‘crisp and stable’ optical performance, which can be an important factor in success with lenses for those with significant prescriptions.

Salmon said: “When my patients say that I’m a star to be able to find them a lens that feels as good as this, that makes me feel really good.”

When my patients say that I’m a star to be able to find them a lens that feels as good as this, that makes me feel really good

Hilton, who regularly tries new technology, has found that 95% of his patients who are already in high quality contact lenses have converted to Bausch + Lomb ULTRA® ONE DAY after a trial – because “they’re that good.”

He said: “Patients will try them and I won’t hear much from them, and every single one has come back and said, “absolutely awesome, can I swap over to them?” It’s been really pleasing to see that. It’s probably the first lens I’ve ever tried with such an approval rating from the patients.”

Mistry agreed that comfort on insertion is a key factor in his patients choosing to stick with the Bausch + Lomb ULTRA® ONE DAY.

“Most patients couldn’t feel anything, so once you get to that level, you’ve already got the ball rolling,” he said. “That low modulus on the lens means I am confident to even give them to a first-time patient. When we were doing insertion and removal teaches, patients who have never worn lenses before found them easy to put in and out.”

He added that the Bausch + Lomb ULTRA® ONE DAY was equally as easy to remove at the end of the day as it was to insert, and that the lens kept performing after the 12-hour mark, which is when most patients start to experience discomfort.

Salmon said that she would consider any patient for Bausch + Lomb ULTRA® ONE DAY, provided the prescription was available, “but for a new wearer, I would actively recommend them as a new lens because of the handling.”

She added that fitting a new patient with Bausch + Lomb ULTRA® ONE DAY means that “in 12 months’ time you won’t be thinking about offering an upgrade, because you’ll already have them in an excellent lens.”

Communication and lifestyle

When it comes to starting the conversation around lenses and the potential need for them, Hilton will discuss social occasions and lifestyle, whilst always being aware of other alternatives: “I’m a big advocate of trying several visual solutions for each patient,” he said. “Not everyone is going to be suitable, so obviously for those with high astigmatism I wouldn't mention Bausch + Lomb ULTRA® ONE DAY at the moment. There might be other alternatives.”

He pointed out that many patients do not even know that they might be suitable for contact lenses, “and all of a sudden you throw this curveball in, and I think a lot of patients quite like it and are quite keen to try it.”

He added that having a trial bank is useful for comfort trials, and that practitioners should remember that they can always offer lenses as an add-on or an alternative for occasional use, alongside their spectacles – something that has worked well for his practice.

“It’s lovely to offer the patient that alternative visual solution,” Hilton said. “We have a lot of part-time daily wearers initially, and then we tend to find that they get used to the lens and love wearing them and then that builds and builds. I’m really keen to introduce contact lenses.”

Mistry also finds focusing on lifestyle is important, particularly when his patients’ lives might be changing.

He explained: “One of our patients is now retired. He used to wear multifocals the majority of the time, but now he likes to go for walks in the Peak District. He wants to appreciate the distance more than he has done in the past, so we’ve used Bausch + Lomb ULTRA® ONE DAY in the dominant side and kept the other eye with a multifocal. That combination works really well for him.”

He added: “A lot of our patients work in offices. They’ve all got air conditioning, and a lot of patients struggle with that, so we found that this type of lens works well. Lifestyle is an important thing.”

I can give them all the technology and all the spiel in the world, but on the eye it is the most comfortable thing

How easy is it to explain the technology behind contact lenses to patients?

Clarkson believes it is important to “use quite simple terms, and not too much jargon.”

“I would explain the technology, the Advance MoistureSeal® and ComfortFeel Technologies, how that relates to them,” she said. However, “The main thing is to show them, so a well-stocked fitting bank and trial pairs really do prove to them that this lens is a lot more comfortable. I can give them all the technology and all the spiel in the world, but on the eye it is the most comfortable thing.”

Outside the testing room, Salmon recommends making dispensing staff as aware as possible of how comfortable lenses can be, and how they can increase a feeling of freedom – by fitting them with contact lenses themselves, if possible.

She also recommended making full use of account managers to deliver product training to the staff, helping to “give them a wider view on what lenses use can do and the differences – and then perhaps they’ll gain a greater understanding of how contact lenses can transform people’s lives.”

Hilton has a final word on how building use of contact lenses can be beneficial to a practice’s business. “This is a really good reason to promote contact lenses,” he said. “People focus too much on spectacle sales. They think it’s this big one-off sale, but when you break it down the recurring revenue from contact lenses is what pops the money in the till before you open your door in the mornings.”

For more information on Bausch + Lomb’s ULTRA ONE DAY contact lens, visit its website.