With rapid improvements to toric and multifocal contact lenses, the Here&Now survey of 146 Australian and New Zealand optometrists was conducted to define best-practice prescribing for these lens types.
The Here&Now survey was commissioned to understand why local toric and multifocal prescribing rates were lower than rates overseas and to identify which practice approaches work best.
“The combination of silicone hydrogel material with the latest advanced designs has made toric and multifocal lenses much easier to fit,” said Ciba Vision Marketing Manager Mark Halling, who commissioned the study.
“Vision is more predictable, patients are getting longer wearing times and with the numbers of astigmats and presbyopes in the population, there is now real potential for these lenses,” he said.
Best-practice’ optometrists sell (toric and multifocal) contact lenses to 81 per cent of patients fitted and have lower rates for unsuccessful fittings (8 per cent versus 21 per cent), undecided cases (7 per cent versus 24 per cent) and patients taking prescriptions elsewhere (3 per cent versus 5 per cent)
To work out the most effective methods of prescribing, participants fitted 10 patients with Air Optix Aqua Multifocal, Air Optix for Astigmatism or Focus Dailies Toric All Day Comfort and reported the commercial outcome of each (n=964). ‘Best-practice’ optometrists (n=52) are defined as those who performed above the group average of 67 per cent of patients buying in-practice.
What’s the true potential for toric and multifocal contact lenses?
“We expect ‘best-practice’ optometrists by definition to sell more contact lenses, but now we have the data to understand how to optimise toric and multifocal dispensing,’ says Helen Gleave, Professional Affairs Manager and coordinator of the evaluation.
She said ‘best-practice’ optometrists sell contact lenses to 81 per cent of patients fitted. But they also sell larger supplies to successful patients and have lower rates for unsuccessful fittings (8 per cent versus 21 per cent), undecided cases (7 per cent versus 24 per cent) and have fewer patients taking prescriptions elsewhere (3 per cent versus 5 per cent) (see Figure 1).
What do ‘best-practice’ optometrists do differently?
Ms. Gleave said ‘best-practice’ optometrists are taking full advantage of the new technology and actively recommending toric and multifocal contact lenses to all suitable patients. They are more likely to ask lifestyle questions (p<0.01) and focus on the patient’s goal, rather than obtain an exact acuity (p<0.05). There was also a trend to fit more torics as a first option for low cylinders and to offer multifocal contact lenses to all new presbyopes (see Figure 2).
“We can see the more successful optometrists are moving towards lifestyle dispensing, which creates the opportunities to fit astigmatic and presbyopic patients,” said Ms. Gleave. “As more patients in the practice become contact lens wearers, a dedicated contact lens assistant starts to make sense and it becomes self-perpetuating.”
Sydney optometrist, Narelle Hine, recognises the ongoing challenge of training staff, including training a contact lens champion. “The best education we ever gave staff was to fit them with contact lenses. Once they have the personal conviction, they start to see contact lenses can be for almost anyone and become more interested in learning about the specialty lenses. It’s also easier for them to encourage patients because they understand the challenges that new wearers face.”
Toric and multifocal contact lens fittings are practitioner driven, with 54 per cent of fittings initiated in the consulting room. Successful cases were more likely to be a recall of an existing contact lens wearer (21 per cent versus 12 per cent, p<0.01), whereas unsuccessful cases were more likely to be patient initiated (26 per cent versus 17 per cent, p<0.01).
Ms. Gleave said it is encouraging to see a shift towards professional fees, with 87 per cent of services charged.
Only 10 per cent were charged at a premium rate and mainly for multifocal fittings. Toric and multifocal fittings however use similar chair time (mean of 2 versus 2.2 visits) and the same number of trial lenses (both 1.6 per eye). Unsuccessful cases were more likely to have been fitted for free (19 per cent versus 10 per cent, p<0.001).
“The most standout result of the survey is how the price quoted influences the end purchase. Overall toric and astigmatic patients buy the volume of lenses quoted to them upfront. If a patient is quoted a three month supply, they purchase three months and if they are quoted six months, they purchase six months. People don’t openly admit it, but they inherently like to be given a recommendation about what they should buy,” said Ms. Gleave (see Figure 3).
Presbyopes purchased more six month supplies than astigmats (21 per cent versus 15 per cent, p<0.001) and astigmats were more likely to take a prescription elsewhere (5.8 per cent versus 1.3 per cent, p<0.001), but astigmats were more likely to be successful (4 per cent higher).
“Interestingly, three quarters of optometrists say their practice recommends six or 12 month supplies, but only a quarter of astigmats and presbyopes are actually quoted these amounts. It shows the opportunity for practitioners to check that what they think is happening at the front desk is actually happening,” says Ms. Gleave.
Ian Buchanan, Buchanan Optometrists, Christchurch, New Zealand who routinely recommends annual contact lens supplies, says, “If you recommend a year’s supply and give patients a bit of an incentive to bulk buy, the majority will go for it, and it builds in a reason for recalling for an annual contact lens assessment. With the Air Optix combi packs the patient gets the cleaning solutions at a discounted rate, thereby providing the customer with a good deal and ensuring they are using a suitable contact lens cleaning product. It is convenient for the customer and great for compliance.”
Although optometrists are acting more confidently with toric and multifocal contact lenses, 745 of 964 fitting services (77 per cent) were conducted without any delegation. Optometrists may be concerned that delegation will lessen the perceived quality of service, however, the data shows delegation has no influence on patient satisfaction or the commercial outcome.
Keeping toric and multifocal contact lenses simple
“Best-practice optometrists also keep things simple. Whether by following the fitting guide or drawing on conventional wisdom, they get the basics right,” says Ms. Gleave.
Successful patients were more likely to give a top box rating to vision, comfort and quality of life for all three lens types used (p<0.001) (see Figure 4).
‘Best-practice’ optometrists fit presbyopes earlier (mean 50 years +/- 8, versus 52+/-7, p<0.05), give patients more time to adapt to multifocal vision and fit lower amounts of cylinder (mean -1.2 DC versus -1.4 DC, p<0.01), but these differences alone do not explain the higher satisfaction.
Optometrist Michael Curtis, from Curtis Vision One, Christchurch, New Zealand, says, “With specialty lenses, I think it’s important the patient knows upfront that you’re working together. If you put a lens on and vision is 6/6, that’s wonderful, but it’s really about being practical. For multifocals, instead of reaching for the letter chart, I get patients looking at their mobile or something else just as relevant and then get some feedback. If you start looking for 0.25 changes you can make patients hypercritical and over complicate the process.”
Customer Service Difference
Is customer service different for toric and multifocal contact lenses?
Michael Curtis says, “Astigmats and presbyopes don’t usually see themselves as suitable for contact lens wear, so once you’ve sowed the seed, I really like the idea of getting a lens on the eye straight away. We offer same day fittings and can dispense either straight from inventory, or via home delivery if we don’t stock the parameters.”
“We’ve also set up an automatic lens re-ordering system and although you need to manage it a little, having it in place sends the right message to patients about compliance and long-term success. I think it’s probably one of the keys to dealing with the internet,” he said.
But only 15 per cent of practices hold a multifocal inventory and only 16 per cent offer automatic replenishment, suggesting there is still plenty of opportunity for practices to make toric and multifocal lenses more readily accessible. A surprising 65 per cent of practices offer home delivery, which offers delivery convenience but not immediacy (see Figure 5).
These Here&Now results provide a first view into a fast growing area of contact lenses and confirm the aspects of practice that are most important with modern toric and multifocal designs. Not unlike spherical contact lenses, confident practitioners who actively seek to understand patient lifestyles and ensure good contact lens vision, comfort and immediate service, do best.
Top 5 Practice Tips for Toric/Multifocal Success
1. Proactively ask lifestyle questions to understand the patient’s need
2. Recall and upgrade existing wearers
3. Charge fees and quote prices per year (not per box)
4. Always check patient satisfaction with vision and comfort
5. Make supply immediately available – inventory and direct to patient delivery
Jenny Saunders is an optometrist and medical writer who consults for the ophthalmic and medical device industries.