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HomemibusinessConnecting the Dots in Optometry

Connecting the Dots in Optometry

Steve Jobs, co-founder of Apple, has always aspired to lead his industry by foreseeing consumer trends. “Skate to where the puck is going” he says, “not to where it has been”. He does this by connecting the dots. Trusting the dots will somehow connect going forward. Like his story of dropping out of college to take up calligraphy and years later using it to develop the first fonts on the Apple Macintosh. Today, the upstart Apple has taken the crown from Microsoft1.

So what dots can we connect in optometry? Here’s what I’ve noticed:

Retail Trends

Clive Peeters in Receivership

Offering contact lenses has protected them against slow spectacle sales and they’re getting the annuity of ongoing cash flow as wearers keep buying.

Competition in optometry is strong and many practices are hurting. Finding ways to preserve margins is challenging. Reading that electrical and whitegoods retailer Clive Peeters is in receivership reminds me it will be tough for any retailer that isn’t big enough to compete on price, or niche enough to focus on service.

Discounting eventually catches up with you, especially during a slow down. Although what about that annoying jingle?

JB Hi-Fi is Booming

Although in the same market as Clive Peeters, JB Hi-Fi is a totally different story (2009 turnover up 27 per cent to AUD$2 billion and net profit up by 45 per cent2).

Like Apple, JB Hi-Fi targets well and aligns to changing customer needs. They adopt technology early. In 2007 they were the Apple iPod Seller of the Year. Unlike other whitegood sellers, who flog anything, JB focuses on ‘consumable entertainment’. Small items, bought regularly, creating a flow of cash payments, which are less affected by business cycles (people are now lining up outside JB Hi-Fi for Apple’s new iPad).

Contact Lenses Booming

Practices who incorporate contact lenses as routine are telling me the same story. Offering contact lenses has protected them against slow spectacle sales and they’re getting the annuity of ongoing cash flow as wearers keep buying. Put on top of this the consumer’s insatiable want for technology, contact lenses make more sense than ever.

Contact Lens Trends

Morgan et al. International CL prescribing in 20093 is the crystal ball for contact lens fitters. Reporting on more than 25,000 new contact lens fits from 28 countries, it highlights the gaps in the market:

Full-time Wear

Australia has the lowest amount of full-time wear in the developed world. Part-time wear (three days a week or less) is at 33 per cent versus only 10 per cent for New Zealand and three per cent for the U.S. Do your wearers have ‘permission’ to go full-time?


Contact lenses are under-represented here, with only 16 per cent of new fits in monovision or multifocal lenses (14 per cent in 2008, 10 per cent in 2004), compared to 46 per cent of the population being presbyopic.4 New Zealand fits are at seven per cent. Demand will increase as presbyopia increases to 49 per cent by 20203 and the total number of presbyopes doubles by 20405. Think about fitting contact lenses to every 40 year old and upgrading existing presbyopic contact lens wearers. Presbyopia is common but debilitating.


Toric lenses continue to be under-represented with 46 per cent of patients needing cyls,6 but only 23 per cent fitted with torics, versus 25 per cent in New Zealand and 35 per cent in USA. It is now easy to give astigmatic patients the vision they deserve.

Soft Lens Experts

In 2009, 99 per cent of Australian new fits were soft, versus 84 per cent in 2004. I can hear the Australian pioneers of orthoK and modern RGP fittings shooting me down, but these numbers suggest there are plenty of successful contact lens practices not using RGPs.

Talking to Emmanuel Calligeros from EyeCee in Newtown, Sydney, technology has finally caught up with us. “Fitting soft toric and multifocals used to be like a lottery. But now, pretty much, you put a lens on and eight out of 10 times the first lens works,” he says. That’s an easy way to build loyalty in a patient group that sees their eyes as special.

Emmanuel sums it up; “Patients come in telling you they have ‘a stigma’ and instead of correcting them or saying ‘so does about half of the population’, you can maintain the mystery, but without the hassle of a difficult fit.”

Finally, “claims about restricted parameters are ridiculous. Just as an example, a single toric design has as many as 2700 different permutations. It’s no longer who can you fit but who you can’t,” says Emmanuel.

Practice Management Trends

British author and poet Rudyard Kipling (best known for The Jungle Book) once said: “Words are, of course, the most powerful drug used by mankind.” The same is true in the practice of optometry.

In coordinating post-launch contact lens evaluations, I’ve spoken with hundreds of practitioners and I see two types. The first fits lenses with confidence, gets the patient out the door and gets the best results.

The second fits lenses like an experiment, tries three, four, seven diagnostic lenses and ends with fewer conversions.

If you ask about the ideal patient for a particular lens, the first will give a broad definition – anyone wearing multifocal spectacles – and the second will be narrow – occasional wear for social or work but not both. These are real examples I’m quoting. Both find technical drawbacks, but the first group quickly works out how to present products positively.

Andrew Hogan is an optometrist at Optomeyes in Hobart and a part-time ABC radio broadcaster. He thinks communication is the key with presbyopes. “Technically, multifocals are not that hard to fit. It’s the mindset of the patient you need to manage. You need to keep patients well informed during the trial period. Not every lens they try will work, but every lens they try will help the practitioner to arrive at a successful fit. It’s a journey.”

A journey Andrew believes is worth refining to increase your success with presbyopes. “Give them more reassurance during insertion training, use silicone hydrogels only, so it doesn’t matter if they end up sleeping in lenses and do quick short follow-up appointments.” Furthermore, remember that presbyopes might be older, but they’re not retirees. “I just get patients to pop in for a quick adjustment. That way the whole process is pretty quick and you don’t get to a point where they forget why they started.”

In connecting the dots for you, think about how you can skate ahead and make your optometry service more special for your patients. Take notice of what the data is saying about where the biggest opportunities are.

Like JB Hi-Fi, be an early adopter of technology and you’ll soon learn how to handle it. Sure, everyone can offer the basics of contact lenses, but it’s the torics and multifocals that have the most potential to help you stand out. Keep it simple and maintain the mystery!

Jenny Saunders is an optometrist and medical writer who consults for the ophthalmic and medical device industries.

Making Multifocals Easy For Patients: Andrew Hogan

Case Study No. 1

I recently fitted a patient in Strahan, the beautiful seaside town on the west coast of Tasmania. This 65-year old woman had been wearing silicone hydrogel (SiH) spherical lenses as monthly continuous wear for a while. She was using monovision, but had started to have problems with the quality of her reading vision. She was thinking of going back to spectacles.

I said that while I agreed that she would be successful in multifocal specs, why not give multifocal contact lenses a try? She was extremely excited, as she had never heard of such things! I fitted her with a pair of soft disposable multifocal lenses, and confirmed that her distance vision was okay. I loaned her a pair of low plus reading glasses (in case the multis did not give good enough near vision). Now, Strahan is a four-hour drive from Hobart, where I usually practice. I visit the Medical Centre there only once a month. Over the next month, the patient rang me to describe how her lenses were performing, and I would post her a new lens for one or both eyes, to improve things. She would report on how the new lens worked (or didn’t).

When I returned to Strahan four weeks later, her vision issues were sorted. I reassessed the fit and ocular health, and she ordered a supply. A nice result, and technically, didn’t take much chair time at all.

Case Study No. 2

A busy professional guy from Hobart had just become presbyopic. Again, he was a spherical SiH wearer. I refitted him with multifocals, aiming to give good distance vision (so they were at least as good as his current lenses) and he went out the door.

Over the next two weeks, he simply emailed me his experience, what was clear, what was blurry. Based on this, I changed his lens powers; he collected the new lenses during his lunchbreak, and kept me further informed by email.

I reviewed him in two weeks, and he was happy. He ended up with lenses that gave him good vision on the computer at work, and for driving. He wore low plus reading glasses over the lenses for very close work.

At the beginning he thought he would only be able to see distance with contacts, and would need the over-specs for all near tasks, so for him, it was a big win!

Expert Tips on Contact Lenses

Emmanuel Calligeros’ Toric Tips

  • Don’t prejudge patients. Let them see what the correction of a low cylinder can do.
  • You’re the professional so no comparative trials and charge professional fees.
  • Update the refraction and remember to allow for vertex distance if it’s >4DS.
  • Although much less common these days, look for rotation. Measure it accurately and adjust according to the LARS rule (rotates left, add the amount to the lens axis, rotates right, then subtract). Remember the next lens will mislocate too – but this time you’ve compensated for it.
  • For blurred vision, if it’s constant, change the Rx, if it’s fluctuating, change the design.

Andrew Hogan’s Multifocal Tips

  • Recommend multifocal contact lenses to patients as the presbyopia is emerging.
  • Explain upfront – what to expect visually, what to expect during the trial and that it may take a couple of appointments.
  • Get lenses on, check vision is safe and get them out the door.
  • Be sensitive when teaching insertion and removal – they can’t see at near!
  • Fine-tune over a few quick appointments so it doesn’t drag on.
1. ‘Upstart Apple steals Microsoft’s crown’, Times of London, 29 May 2010.
2. www.jbhifi.com.au
3. Morgan P et al. International Contact Lens Prescribing in 2009. Contact Lens Spectrum Feb 2010
4. U.S.A. Census Bureau, International Data Base.
5. The 2010 Intergenerational Report, Australian Government
6. Holden B, The principles and practice of correcting astigmatism with soft contact lenses. Aust J Optom 1975; 58; 279-299.