Patients’ Claim My Vision Comes First

The ground breaking Needs, Symptoms, Incidence, Global Eye Health Trends (NSIGHT) study, an online survey of thousands of vision-corrected patients worldwide, can supplement the clinician’s artistry through its rigorous quantitative assessment of patients’ selfreported vision and eye care experiences

Conducted by the independent research firm Market Probe Europe, NSIGHT surveyed 3,800 vision-corrected patients, 15 to 65 years of age, from seven different countries (the United Kingdom, the United States, China, France, Italy, Japan and Korea). Participants included spectacle and contact lens wearers.

NSIGHT gathered comprehensive baseline data on all respondents, including gender, age, social class, education, community type (city, villages, etc.), occupational status, work environment, and level of physical activity. Vision and eye care data included type of vision disorder and method of correction.

FIGURE 1: Hierarchy of features when choosing eye-related products

Utility Index Score

Study Methods

NSIGHT respondents reviewed a list of 40 potentially beneficial attributes of eye/ vision care products (eg, “provides vision that is as close to natural as possible”, “protects eyes in dry environments”, “makes eyes feel fresh”). The features were presented in multiple groupings of six. For each group of six features they were shown, respondents were asked to rank one feature as the most compelling of the group and one as least compelling when choosing products for their eyes. Each feature was viewed three times in differently combined groupings. The results allowed creation of a Hierarchy of Needs-a rank ordering from most to least compelling of the 40 individual features and the eight categories into which they can be grouped. (The eight categories are vision; health; environment; eye condition; convenience; comfort; personal performance; and personal appearance.) This sequence of repeated evaluations, or MaxDiff analysis, generated a data set from which a utility index (UI) score was calculated for each feature and category. According to study criteria, a score of 151 or higher signified “high importance”, 100 to 150 signified “medium importance”, and less than 100 signified “low importance”. A UI score of 200, for example, would signify a feature twice as compelling as one scoring 100.

Vision Comes Out on Top

What was probably the most striking response in terms of absolute numbers was an overarching importance placed by patients/consumers on ‘vision’. Figure 1 shows the hierarchical importance placed on various core needs categories. In fact, Vision was the only category with a UI score that ranked above 150 signifying high importance to patients.

Interestingly, when broken down by the 40 individual potential product features, six of the top eight features fell into the vision category (Figure 2). With the top three vision-related features as follows:

• provides the best possible all around vision (UI 192)
• renews lost vision (UI 188)
• provides vision that is as natural as possible (UI 182)

FIGURE 2:

The study also shows that vision is six times more important than ‘appearance’ and twice as important as ‘comfort’. This adds some perspective from the patient as it shows relative importance of vision to other categories as they were asked to make a choice of one most compelling and one least compelling feature from each group of six presented. When broken down by region, the same trend exists for the USA, Europe and Asia. Vision remains the most important feature. There are subtle regional differences though as visualised in Figure 3.

FIGURE 3: Needs Hierarchy Categories by Region

Vision is a global term and can be used in many contexts. For example one useful clinical concept is to explain to patients the difference between the concepts of Vision as far as resolution and quality are concerned.

Patients are the ultimate judge as to whether their vision is good, irrespective of the quantitative measure that acuity charts may provide. For example there are some patients who achieve 20/20 (6/6) on the Snellen chart post refractive surgery or with multifocal soft lenses yet when you ask them how they see, they say their vision is ‘lousy’. It may be ghosting or hazy or variable in nature and this equates to poor quality.

Cataracts, irregular corneas and epiretinal membranes are some other causes of poor quality vision. It is our skill in interpreting these findings that helps us to know what to look for as a cause, or indeed how to improve the visual quality. Many factors may contribute to reduction in vision. The skill comes in minimising impact of all factors that can reduce vision. For spectacle and contact lens wearers alike, a change in lens form or function may improve qualitative results. These are some of the things that skilled eye care professionals can embrace in the quest to provide excellent visual outcomes; the eye care feature most desired by our patients.

Health and Environment

As a category, ‘health’ ranked second out of the eight. With the top two healthrelated features as follows:

• Improves the health of your eyes (UI 182)
• Mimics the natural action of your eyes to preserve their long term health (UI 163)

One can see from Figures 1 and 2 what patients may go for if they had to trade off certain things to attain another. As I explain to my complex patients, some things are mutually exclusive and a in, say, a keratoconic patient, may not provide the best vision or the best health. However, it is critical that we keep our patients emotional, functional and health needs top of mind as we consider the best treatment options.

As we also saw in Figure 1, ‘environment’ rated third most important in the hierarchy. In this study, environment encapsulated issues such as comfort in dry, air conditioned environments and relief of asthenopia while working at a computer. Protection of the eyes from pollution, UV, dryness and allergy were other environmental considerations.

The correct form of spectacle lens is critical in specific environments, as are ideal contact lenses. The best vision correction option for night driving may not be the same as one needs for efficient visual function and comfort with computer use. Similarly an occupational lens would likely be better than an allpurpose progressive for computer use. This supports the provision of multiple modes of correction (whether it be spectacles or contact lenses), specialised for work, sport, fashion, fishing and a multitude of other occupational or recreational uses. Of course with contact lenses, management of dryness with prolonged computer use and air conditioning is critical. Modern moisture retaining disposable lenses have provided significant improvements. Contact lenses are, of course, highly desirable for sports and recreation and multi-focal lenses should be considered for asthenopic relief.

Needs Hierarchy by Demographic Groups

When one considers age it again seems obvious and the data confirm it: Vision ranks as the most important category for all age groups and vision and health become even more important with increasing age (Figure 4). Knowing this allows us to address these needs relative to lifestyle and ask appropriate vision questions related to age group.

FIGURE 4: Needs Hierarchy Categories by Age Group (Overall Global Data)

Additional analysis broken down by type of ametropia showed that while once again all refractive groups ranked vision as the most important category, presbyopes and hyperopes were slightly more concerned with vision and health compared with myopes and astigmats.

There did not seem to be major differences in the importance placed on different items as far as social class (upper, upper middle, lower middle, lower) was concerned. Respondents who reported lower social class status did however place a greater emphasis on appearance and performance.

That’s a look at the global hierarchy of needs data. Now let’s take a look at some specifics that relate to contact lenses and lens care.

Contact Lens Trends

Nearly half (45 per cent) of study respondents reported having worn contact lenses at some point, 30 per cent were currently wearing them at the time of the study, while 21 per cent used them ‘most often’. The data tell us that the most common contact lens modality reported by participants in the NSIGHT study was in the two-week replacement category (35 per cent) followed by monthly (30 per cent). However, with this study covering Europe, USA and Asia, some differences were borne out by the data. For example, Asian wearers had a higher incidence of rigid gas permeable lens (RGP) wear compared with Europe and the USA, albeit a distant second to soft lenses.

For soft contact lens care products, as expected, multipurpose disinfection solutions (MPS) have the lion’s share of the market. However, 14 per cent of patients reported using peroxide systems. Almost 30 per cent more Americans than Asians consider the brand of their MPS as important.

In Europe and the USA, three in four contact lens wearers were satisfied with their lenses, whereas in Asia only 56 per cent were satisfied. Sixteen percent of the vision-corrected population wore contact lenses in the past but stopped wearing them. In the NSIGHT Study, the main reason for discontinuing lens wear was the inconvenience to remove or to insert lenses (39 per cent).

Of those who discontinued contact lens wear, 21 per cent ceased wearing contact lenses within six months of fitting (34 per cent in Europe, only seven per cent in USA), and half stopped wearing them after two years or more.

Interestingly we hear a lot about comfort as a lea



ding reason for drop out with contact lens wear. We need to be mindful of other reasons as posed by those surveyed. It is important to recognise that inconvenience in handling and care of contact lenses is a major cause for drop out. Having a welltrained staff member who conducts the contact lens care and handling instruction sessions for patients is a key element of a successful contact lens practice. They are a key coach for successful contact lens fitting. It is also important to recognise that drop outs can occur early (within six months of fitting). It is also important to reach out to newly fit patients early and routinely to help them with any challenges they may have with adaptation.

Despite the fact that a portion of contact lens wearers discontinue lens wear for various reasons, nearly 90 per cent of contact lens wearers would be bothered



if they could no longer have contact lenses. Now that’s loyalty!

Summary

The NSIGHT Study, which was commissioned by Bausch + Lomb, provides the global eye care community with new, in some cases unexpected, insights that ECPs can take into account in discussing vision and eye care options with their patients. Most notably is to consider and not underestimate the importance of vision to our patients no matter their age, correction type or where they live. The findings provide an evidence-based framework that will enrich ECPs’ ability to meet their patients’ vision and eye care needs.

Whether you are an eye care professional that practises as a pure refractionist, in a mainly medical model or a combination of the two, there is plenty to learn from our patients through this study. ECPs should expect that achieving the best vision possible is of paramount importance to their patients-crucial information in evaluating product and treatment options.

It is important that we both address and as much as possible resolve our patients’ needs. Before we can do that we must effectively communicate with our patients. By taking note of this desire of patients to put vision first, maybe we can also start tweaking our practices to re-focus more on this area of practice. We can thus be more successful, and claw-back some of our traditional bread and butter. Refraction, spectacles and contact lenses are not dirty words: They are core services needed to ensure successful practice and provide the vision consumers so clearly state is their number one priority. The people have spoken.

Alan Saks is a third generation optometrist, served as President of the Contact Lens Societies of South Africa & New Zealand, presents at conferences, and acted as examiner in Contact Lenses & Clinical Optometry. He sat on the editorial boards of the journals; The South African Optometrist and International Contact Lens Clinic. Alan writes for journals, websites and industry, takes part in protocol studies, international panels, lectures and acts as a consultant. His monthly columns ‘In Contact’ and ‘Saks on Eyes’ are subscribed to the world over.