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Here and Now Evaluation

What is ‘Best-Practice’ for Prescribing Soft Toric and Multifocal Contact Lenses? We look at the first impressions from the Ciba Vision Here and Now Evaluation.

Both the toric and multifocal contact lens markets are under-represented in Australia and New Zealand.1,2 While some eye care practitioners question the profitability of contact lenses, many others use contact lenses as a strategy to boost their loyalty, revenue and profit.3 With the assistance of more than 170 practitioners, Ciba Vision conducted a survey, to identify the specific strategies likely to have a positive impact on toric and multifocal prescribing and on the success of an optometry practice.

Participants were surveyed about how the practice promotes, prescribes and supplies soft toric and multifocal contact lenses. Each practice then fits 10 patients with either Air Optix Aqua Multifocal, Air Optix for Astigmatism or Focus Dailies Toric All Day Comfort. In theory, practices with a clear contact lens proposition, motivated staff and a convenient contact lens service, should perform better than those without. The survey results (n=67) are described below.

‘Clear and Simple’ Contact Lens Proposition

Practices are asked to answer questions describing the clarity of their contact lens offer (Figure 1). A ‘clear and simple’ contact lens offer is proposed. This involves a simplified range of brands, a discussion of fees before starting the contact lens fitting, the inclusion of contact lenses in advertising and direct mail and high in-store visibility of contact lenses.

Increased internet competition has motivated many practices to make their contact lens service more convenient, but how well has this translated for toric and multifocal designs

Most practices (84 per cent) limit their initial product discussion to only one or two lens types, which may reduce patient confusion and definitely helps control product mix. Allowing the patient to choose from a list of options often makes price the point of comparison, which usually moves the mix away from products like torics and multifocals. Tracking the product mix (e.g. measuring toric and multifocal unit sales against spherical units, over a 90-day period) can help move the mix towards higher performance lenses, which in turn builds the practitioner’s reputation and profit.

Almost all practices (96 per cent) present professional fees and product pricing up-front. Some practices find it difficult to provide product pricing before completing the contact lens prescription. Communicating a preferred products list to staff, and presenting pricing for the most commonly prescribed toric or multifocal brand, will help in these cases. Giving some information is better than giving none.

Only 68 per cent of practices promote contact lenses in all their external advertising (e.g. websites, print, yellow pages). Fewer still (45 per cent) announce new products through direct mail, citing lack of time and energy. New toric and multifocal designs now make it easier to upgrade patients to higher performance contact lenses and using direct mail alerts patients sooner, rather than at their annual eye examination.

Motivated Staff

We have known for a long time that enthusiasm positively impacts compliance and success with contact lenses.4 The survey shows practitioners proactively discuss contact lenses, but staff are less likely to have the responsibility or incentive to do the same (Figure 2).

Most practices (82 per cent) have trained their team on the basics, but only 31 per cent have appointed a contact lens champion and fewer still (13 per cent) reward staff for contact lens growth. Formally appointing a staff person to contact lenses increases accountability, reduces administrative errors, and improves clinical efficiency. Lack of delegation and efficiency could explain why some practitioners (33 per cent) – despite the availability of higher performance products – only fit spheres to low astigmats and why others (33 per cent) don’t offer contact lenses to newly diagnosed presbyopes.

Convenient Contact Lens Service

Increased internet competition has motivated many practices to make their contact lens service more convenient, but how well has this translated for toric and multifocal designs (Figure 3)?

Seventy-nine per cent of practices ask lifestyle questions to help tailor the examination, product and advice to the patient’s needs and expectations. All practices pre-advise toric and multifocal patients that the fitting may take more than one appointment, but only 31 per cent of practices allow more time at the fitting visit. This suggests some toric and multifocal patients are asked to attend a second fitting appointment, and for the 30 per cent of practices who don’t fit at the first consultation, this would mean a third appointment.

Three-quarters of practices recommend a six or 12-month supply of lenses, with a discount. Selling larger quantities increases revenue, compliance and loyalty, and reduces transaction costs. Transaction costs are lower if a product is dispensed from inventory (with 16 per cent of practices holding a multifocal inventory) and lower still with direct-to-patient delivery. The lowest transaction cost, and possibly the most convenient method for patients, is reordering through the practice website combined with home delivery. Sixty-six percent of practices now offer home delivery and 36 per cent offer website reordering for torics and multifocals. Patients may not see any advantage in returning to the practice to collect contact lenses if the delivery method can be more convenient to them.

Twenty-nine per cent of practices follow up new contact lens fits by telephone to check vision, comfort and satisfaction. Fewer provide the same service for ‘tricky’ fits. Calling newly fitted patients, especially toric and multifocal wearers, can help you uncover concerns earlier, reduce drop-outs, and is an unexpected demonstration of your concern.

Helen Gleave is an optometrist, with a special interest in contact lenses and is the Professional Affairs Manager for Ciba Vision Australia and New Zealand.

  1. Morgan P, et al. International contact lens prescribing in 2009. Contact Lens Spectrum, February 2010.
  2. Australia and New Zealand population aged 40 years, from U.S.A. Census Bureau, International Data Base, www.census.gov, accessed 2/6/2010.
  3. Atkins NP, et al. Enhancing the approach to selecting eyewear (EASE): A multi-centre, practice-based study into the effect of applying contact lenses prior to spectacle dispensing. Contact Lens Anterior Eye 2009, doi:10.1016/j.clae.2009.02.004.
  4. Bennett ES, Schwartz CA. When words mean as much as Dk and base curve. Review of Optometry, January 2000.

The Here and Now Experience
Michael Michael, an optometrist and practice owner from Kensington, Sydney, has gone from prescribing monovision only, to trying and fitting 34 multifocal contact lenses in two weeks.

“I decided to bite the bullet and take Air Optix Aqua Multifocal to my patients. This covered a wide range of patients from the early insipient presbyopes, to others who have worn spectacle correction for the past 15 to 20 years. To summarise the response I have received, in one word, is ‘overwhelming’.”

Michael saw the Here&Now Evaluation as an opportunity to recall patients and to become a better practitioner.

“I am still working out which patients suit multifocal contact lenses best, but I am also trying to keep my process simple.”

After fitting the lenses, Michael sends the patient out for a same day trial, cutting out the initial need to insert and remove lenses. To refine the prescription he asks a single question, “How does the lens fit with your lifestyle?” While more questions might follow, it is the answer to this first question that guides his clinical decision.

What Can You Do Here&Now?
Let’s start to think about the opportunities for toric and multifocal contact lenses, to make these lenses more readily available. What part of your toric and multifocal service could be easier for staff and easier for patients? Here is a simple method to share with your team, to help you start making your contact lens offer clearer, simpler and more convenient:

1. Review your product mix to understand the available opportunities.
2. Select one area of focus.
3. Convene a process improvement staff meeting

  • Agree on a goal
  • Review the current process
  • Agree on the changes needed
  • Assign responsibilities
  • Decide on measures to track changes
  • Review monthly, for three months

4. Choose a second area of focus.