It’s Good to Talk About Contact Lenses

Unsurprisingly, Australian telcos have followed in BT’s footsteps with campaigns echoing the same sentiment.

In this article, British optometrist Neil Retallic explains what we can learn from BT’s powerful communications strategy to overcome common contact lens concerns and promote their wear.

Imagine what a difference it would make if your whole practice team – from the shop front to the consult room – could confidently and proactively discuss wearing contact lenses (CLs) with every suitable patient.

Right now, you probably notice that a typical conversation begins with the question, “Would you like contact lenses?”.

The answer is most likely, “No”. And the conversation comes to a halt.

By changing your approach – by subtly flipping the question – your team is more likely to spark interest in CLs, get an effective conversation flowing, and finish with a sale (and a happy, loyal customer).

Why Lack of Interest?

Polls often report sight as being our most valued sense,² which naturally may result in apprehension and a guarded approach to eye-related factors, including CLs.

The influence of other people in the patient’s life, a lack of understanding, or the simple fact that CLs have never previously been recommended, may also cloud judgements.

Some will be discouraged by a negative personal experience, even though the majority who do have issues with CLs are able to successfully return to lens wear.³

So, How Should We Introduce CLs?

A good starting point is to go back to basics to establish how CLs can support your patient’s individual lifestyle and visual needs. You can do this by asking open questions such as those listed in Figure 1. Finding a personal motivation and reason to believe is a powerful way to encourage even those averse to CLs to continue the discussions further.

To discover whether they currently wear CLs or have worn them in the past, and to gauge how they feel about them without engendering a binary yes/no response, ask “How often do you wear contact lenses?”.

This open-ended question may even stimulate their thinking about their current eyewear choices (Figure 2).

To provoke more thought and interaction, build on this question by asking them to imagine a day without needing to wear glasses while still being able to see clearly, and how this may make them feel. Paraphrasing back and linking to personal information already received can be a powerful way to influence attitudes.

13 Mythbusters

Unfortunately, there are many common misconceptions about CLs that may have put your patients off trying them.

Before you attempt to address any of these, it is important to carefully listen to their concerns. Then, after paraphrasing their point of view, offer a calm, customer-friendly, and reassuring explanation, supported by evidence.

Consider the following common 13 myths and how these can be handled.

Myth One: Contact Lenses May Not be Suitable for My Eyes
Suggested response: You’ll be pleased to know that most people can wear CLs and you’re more than likely to be one of them. In fact, there are an estimated 140 million CL wearers worldwide, including people of all ages and those with astigmatism.⁴

The evidence: Publications such as BCLA CLEAR remind us that mass-produced soft lenses will fit 75–90% of eyes and, for those with irregular eye shape profiles or high prescriptions, there are usually numerous custom-made options available in a range of different materials.⁵ Therefore, in reality there is only a slim chance of someone not being suitable from a fitting perspective and this would more likely be linked to other factors, for example, eye disease, health, or patient-related reasons.

Myth Two: I’m Too Old/Young for Contact Lenses
Suggested response: It doesn’t matter how old or young you are – almost everyone can wear CLs. You’ll be amazed at how quickly little ones adapt to them. And, with 30% of the world’s population aged 45+, there are more multifocal lens options than ever before.⁶

The evidence: The consensus is that a decision about CLs for children should be less dependent on age and more linked to the benefits, the ability to be fitted and care for lenses, maturity, motivation, and their relative safety in this age group, which appears to be on par with adults.⁷

The ACHIEVE study concluded that CLs significantly improve how children feel about their physical appearance, their acceptance among friends, their ability to play sports and their academic performance.⁸ This means offering lenses can provide more than just visual benefits to the whole family (Figure 3).

The good news is children tend to do extremely well with CLs and researchers have proven that those as young as eight can successfully wear and independently care for their own lenses.⁹ Studies investigating myopia management more frequently include younger children. For the very young, CLs are usually only considered for medical reasons, with the child under the care of a hospital eye service provider.

At the other extreme of age, given most adults with presbyopia lead active lifestyles, and have a desire to feel young at heart, there is no upper age limit for CLs. The advancements in optical designs, materials, and options available mean multifocal CL success rates can be high and are often the preferred option for those with presbyopia.¹⁰ After all, age is just a number – all age groups can gain quality of life benefits by wearing CLs.

Of course, there are many other conversations that can be had about different lens types and designs, and CLs prescribed for purposes beyond visual correction (such as myopia management or therapeutic use). However, these are beyond the scope of this article.

Myth Three: Contact Lenses can get Lost/Stuck Behind Your Eye
Suggested response: It’s physically impossible for a contact lens to get lost or stuck behind your eyes. That’s because there’s a thin membrane that covers the white part of your eye and connects to the inner eyelids. Think of it as a built-in safety net!

The evidence: The eye’s anatomical features (Figure 4) make it unlikely for lenses to move ‘behind’ the eye, and there have been no large-scale studies of ocular lens retention, although there have been case reports of lenses becoming trapped in the fornix.^11-13 Astonishingly for one lady, even when her handy eyelid barrier harboured several lenses, she experienced no symptoms so remained unaware. It wasn’t until she attended a routine cataract consultation that they were discovered.¹⁴ There are reports of conjunctivitis believed to have become manifest secondary to a retained contact lens.¹³

Myth Four: Contact Lenses are Uncomfortable
Suggested response: You’re about to be pleasantly surprised. Contact lenses are actually one of the most convenient and comfortable eye care solutions. You may even forget you’re wearing them. Think soft, supple, and satisfyingly hydrating.

The evidence: Apart from the testimony of large numbers of loyal happy contact lens wearers, a landmark study compared daily disposable contact lenses, spectacles, and non-wearing benchmarks, and found no statistically significant difference in terms of comfort or visual quality.¹⁵

Comfort in contact lenses is likely to be multifactorial with the contact lens, environmental, eye-ocular surface, and patient-related factors likely to be associated.¹⁶ Regular review will enable performance to be maximised, with any signs of sub-optimal performance identified early. This will also allow for comparisons to be made between comfortable wearing times, and actual and desired wearing schedules. Visual quality has also been linked to comfort.

For some, depending on how they define comfort, the potential mechanical restrictions of wearing glasses may deem them to favour contact lenses. In a recent survey, the third most popular benefit identified with regard to wearing contact lenses was the lack of pressure on the nose and ears (Figure 5).¹⁷

Myth Six: Contact Lenses are Difficult to Apply and Remove
Suggested response: Putting in and taking out contact lenses is like riding a bike – you never forget how to do it. You just need to learn the knack, which we can take you through until you’re a pro. Easy.

The evidence: A common reason for early dropout is handling related factors.¹⁸ As with any new skill, good education, a supportive approach from the teacher, and allocating dedicated time to learn and practice are likely to be key to success. Follow-up courtesy touch points (for example a call in the first week) for new wearers may be beneficial and will provide the opportunity for coaching on best techniques. Addressing the potential for non-compliance, and considering the most appropriate lens selection, may support better handling. A reminder of the personal benefits of contact lenses, linked to their lifestyle activities, can often help motivate them throughout the learning process. Explaining the typical process and reassuring that it may take time to learn the new techniques is also advantageous. Understanding the patient’s emotional journey can help when relating to a new wearer (Figure 6).²⁵

Myth Seven: Caring for Contact Lenses is a Hassle
Suggested response: As with all rituals, contact lens care will soon become second nature. Daily disposables are considered the most convenient option, but reusable lenses are simple to clean and store. You’ll soon get used to it.

The evidence: Instilling good habits from the outset is better than taking a reactive approach to non-compliance, so it’s worth being realistic about the requirements right from the beginning. Daily disposables are the easiest to care for, reportedly taking around half the steps required for reusable soft CLs.¹⁸ Lenses licensed for overnight wear have convenience advantages, however they do come with a higher risk of contact lens complications.¹⁹

Myth Eight: Contact Lenses Aren’t Good for Occasional Wear
Suggested response: They’re perfect for occasional wear. For all those moments when glasses get in the way, contact lenses can come to the rescue – whether you’re exercising, socialising or just going about your day. Some people will wear contact lenses every day – the flexibility is there, depending on personal choice.

The evidence: A lovely aspect of contact lenses is the ease to dip in and out of wear, often without the need to readapt. The concept that new wearers need to gradually build up wear time is deemed unnecessary for modern soft lenses, although still required for other rigid materials.⁵ Success is clear with part-time, flexible, and full-time wear, depending on what best suits the individual, and even following temporary breaks from lens wear.

Myth Nine: Contact Lenses are Expensive
Suggested response: When you consider the huge benefits of contact lenses, they actually offer fantastic value for money. In fact, per wear, they usually cost less than a coffee from your favourite cafe.

The evidence: ‘Best value for money’ has been defined as the most advantageous combination of cost, quality, and sustainability to meet customer requirements.20 So rather than focussing on the physical cost alone, consider contact lenses seem a real bargain.

The great advantage of so many contact lenses being commercially available is that there are now offerings to suit all budgets, with additional benefits justifying higher prices paid for premium offerings.

Interestingly, although most non-wearers appreciate the visual, practical, and emotional benefits (Figure 7), they don’t seem to perceive the psychological benefits to the same extent as those who wear contact lenses.²⁵

Myth 10: Contact Lenses are Bad for Your Eyes
Suggested response: Trust us, your eyes will love contact lenses – you just need to wear and care for them correctly. Let’s talk numbers: only around one in 10,000 wearers per year experience contact lens related infections with daily wear.

The evidence: The risks associated with contact lens wear are small, and often mild in relation to the benefits, and frequently resolve on removal of the lenses. Corneal infection incidences range from one to two per 10,000 wearers for daily compliant use, to 20 per 10,000 with overnight wear.19 Instilling good compliance principles, and a proactive approach, helps to minimise risks.

Myth 11: You Can Wash Contact Lenses in Water
Suggested response: Nope. Unless you want your lenses to be introduced to an organism called acanthamoeba, which can lead to eye infections, you should never, ever wash your contacts in water. Stick to the contact lens solution.
The evidence: Although Acanthamoeba keratitis is a relatively rare serious eye infection, with an estimated annual incidence of 1.4 per million per annum, most cases are associated with contact lens wear (71–91%).²¹ As acanthamoeba are free-living protozoans, which can be found in water, highlighting that contact lenses and water should not mix is important. It is equally important to reinforce the need for correct compliance with hand washing, drying, care systems, and any lens storage, lens replacement frequency, shorter wear times (switch to daily wear), and regular reviews to minimise risks. In terms of contact lens-related infections overall, around 80–95% are due to bacteria origins with the small remainder by pathogens including Acanthamoeba spp. and filamentary fungi.¹⁹

Myth 12: If I Wear Glasses, I Can’t Wear Contact Lenses
Suggested response: Far from being mutually exclusive, a mixture of glasses and contact lenses offers many customers the best of both worlds. You get the freedom to choose what to wear, depending on what the day’s got in store.

The evidence: Surveys have revealed that having multiple eyewear options increases satisfaction, quality of life, and loyalty to the practice. Very few contact lens wearers will solely wear contact lenses, and 81% of wearers say that wearing contact lenses and glasses gives them the best of both worlds.¹⁷ They also bring on average six times more revenue to the practice than non-wearers.²²

Introducing contact lenses to support the frame selection process (Figure 8) also positively impacts eyewear selection and purchase experience.^23,24 In fact, in practices that implemented this tactic, the rate of those who went on to purchase contact lenses increased by 2.5 times.²⁴

Myth 13: People who Drop Out from Wearing Contact Lenses Won’t Ever Wear Them Again
Suggested response: It seems you can’t have too much of a good thing, because refitting success is reported to be high (>70%), showing that the benefits of contact lenses are simply too good to miss.

The evidence: A review of contact lens dropout research found a pooled mean dropout frequency of 21.7%. On a positive note, most were ‘lapsed wearers’ rather than ‘permanent dropouts’ and around three quarters (74%) of dropouts could successfully resume contact lens wear.³ It is important to revisit what they enjoyed about contact lenses, establish a motivation, and remind them of what they loved about CL wear.

Different lenses and additional management advice may be recommended to help address their reasons for ceasing CL wear. Also, consider supplementary management for any co-existing ocular pathology that could impact contact lens performance, such as dry eye. Figure 9 has some example questions and revisits those provided in Figure 1, which may also be advantageous.

Explaining the Benefits of Contact Lenses

Still not feeling comfortable about talking contact lenses? Here are some simple, engaging ways to explain some of the many benefits contact lenses provide.

1. Confidence boost…
“Contact lenses offer a more ‘natural’ look, increasing confidence when you need it most, whether that’s out and about with friends, at work, or simply going about your day-to-day life.”

2. Looking good…
“With contact lenses you can change your look and are free to wear any non-prescription sunglasses, giving you more choices to create your own unique style.”

3. Clear vision…
“By imitating natural sight, contact lenses offer a wider field of view without the interruption of frames, giving you a more authentic vision experience. Plus, they don’t fog up in the rain (or when you open the oven).”

4. Get active…
“When it comes to getting active, contact lenses come into their own. Whether you’re a fitness enthusiast or simply lead a busy lifestyle, contacts give you the freedom to go about your day as you always have done.”

The Test of Time

Of course, as the wearer ages and their lifestyle changes, the most suitable contact lenses for their needs will also change. Regular reviews will ensure they’re always in the best lens for their sight and situation. Useful explorative questions are provided in Figure 10.

Interestingly, when given the chance to experience new recommendations, even wearers who say they’re happy with their current lenses are impressed with the improved performance of CLs (Figure 11). A useful benchmark to help identify a potential need for additional management/different lens options is a two hours or more difference between comfortable and total wearing time or/and visual reduction compared to their spectacles. Exploring patient reported outcomes during specific tasks and seeking rating scores (for example scores out of 10) for various performance-related aspects, can also be useful.

Summary

It’s safe to say that one of the main reasons why more people who are suitable to wear CLs do not is us!

A recent survey found only one in six recalls mentioned contact lenses during their visit to an optometrist practice. So, the solution is simple, it is time for us and our colleagues to talk about contact lenses at each opportunity along the patient-customer journey. This can start as early as the booking stage by asking “Shall we book an eye examination and contact lens suitability check?”, followed by reminders of how aspects of their lifestyle could work well with contact lens wear. Finding links to personal motivators and relating to emotional factors is important.²⁶

And remember, they may not respond “No” forever, so revisit the conversation at future opportunities and have awareness resources on hand that explain the benefits of contact lens wear (Figure 12).

Investing time in contact lens training for the team may be useful (Figure 13) as, after all, it’s good to talk contact – about lenses.

 

Neil Retallic is President of the British Contact Lens Association and Head of Professional Development at Specsavers. He is an optometrist and has worked in various clinical, professional services, academic, charity, and industry roles across the optical profession. His former role was Global Professional Services Manager for Menicon.

This article is based on an article first published in Optician, UK.

 

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