Tag: Contact Lenses

Satisfy More Astigmatic Patients with New Toric Daily Disposable Technologies

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How would you explain to your patient the synergistic performance of the two significant design innovations delivered by ACUVUE OASYS® Brand Contact Lenses 1-Day for ASTIGMATISM lenses? Like wine and cheese, that’s how! Often times when you take one great idea and pair it with another the sum is greater than the parts. It takes the more consistent visual performance of BLINK STABILIZED® Design and combines it with the reduced frictional energy profile of HydraLuxeTM Technology, and the result is a lens that is even more consistently clear and comfortable than anticipated.  With each blink, the world is brought back into sharp focus and because of the tighter crosslinking meshwork the lens slides back into optimal position more effortlessly than ever before. Voila! What a magnificent pairing and what a remarkable way to share performance and innovation with your patients.
–Kent Prete, OD, Calgary Alberta

ACUVUE OASYS® Brand Contact Lenses 1-Day for ASTIGMATISM combine two unique technologies to deliver excellent comfort and clear, stable vision, with the widest parameter range.

Astigmatic patients achieve their best vision when both sphere and cylinder are corrected. However, toric contact lenses have historically been underprescribed relative to the prevalence of astigmatism. Barriers to prescribing toric lenses include limited parameter availability and difficulty achieving stable vision and comfort.

Among those who have been fit in toric lenses, 58% report declining lens performance over the course of a day, with those who experience more activities or more environments during the day being the most prone to declining lens performance.¹

A new daily disposable toric lens, ACUVUE OASYS® Brand Contact Lenses 1-Day for ASTIGMATISM, has been specifically designed to provide exceptional comfort and performance in challenging environments. It combines BLINK STABILIZED® Design, which works with the natural movements of the eyelids to settle the lens quickly and maintain stable vision, with HydraLuxe™ Technology, comprising an enhanced moisture network of tear-like molecules and a highly breathable, hydrated silicone that integrates with the patient’s own tears to help maintain tear film stability.

A subject-masked, one-week dispensing study of 162 habitual toric soft lens wearers (324 eyes) was conducted in the U.S.² Within just 3 minutes of lens insertion, almost all lenses (97%) settled within 10° of nominal orientation (toric lens markings exactly vertical at 12 and 6 o’clock). At 15 minutes, all 324 eyes showed less than 5° movement on blink, which is a key factor in providing stable, predictable vision.

Clinical performance

In a busy practice, I’m looking for a lens that stabilizes quickly. But what is even more impressive to me than fit and stability in the office is how well the lens performs in the patient’s world, during everyday tasks that can challenge vision. In the study, 99% of eyes were successful at one week in the first lens fit, and visual acuity was excellent, with 97% seeing 20/20 or better monocularly.

My patients also loved the comfort of these lenses. They have busy lives and spend a lot of time on digital devices, which tend to reduce the blink rate and increase discomfort. Because it works with the tear film to stay lubricated, ACUVUE OASYS® 1 Day for ASTIGMATISM helped my patients stay comfortable throughout the day.

ACUVUE OASYS®  1-Day for ASTIGMATISM

  • First-fit success rate of 99%
  • Settles within 10˚ of nominal orientation in just 3 minutes
  • All patients achieved 20/25 or better monocularly, and 97% achieved 20/20 or better
  • Available in 2,260 parameters–40% more than any other daily disposable toric lens

Widest parameter range
The parameter range, the widest of any daily disposable toric contact lens, makes this lens very easy to fit. In the past, the lack of oblique axes or plus powers meant that some patients had to accept a level of visual compromise, or forgo the benefits of a daily disposable lens.

With ACUVUE OASYS® 1-Day for ASTIGMATISM, all three cylinder powers (-0.75DC, -1.25DC and -1.75DC) are available in axes around the clock for sphere powers plano to -6.00DS. For patients with higher astigmatism, an additional -2.25DC option is available in the most common meridians. This allows us to bring the benefits of daily disposable toric lens wear to more of our astigmatic patients.

References
1. Mathews, K., et al. AAO poster presentation, Nov 2016. Market research survey on performance throughout the day with toric soft lens wearers. US, n=208, 12% daily disposable toric, 88% reusable toric.
2. Straker B, et al. Global Specialty Lens Conference Poster presentation, January 2017

ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from Johnson & Johnson Vision Care division of Johnson & Johnson Inc., by calling 1-800-267-5098 or by visiting acuvueprofessional.ca.

ACUVUE®, ACUVUE OASYS®, HydraLuxe™, BLINK STABILIZED®, and EYE-INSPIRED™ are trademarks of Johnson & Johnson, Inc.
©Johnson & Johnson, Inc. 2017

 

This article is sponsored by J&J Vision Care Canada.

 

ROXANNE ACHONG-COAN, OD, FAAO, FIAO

Dr. Coan received compensation for her work on this article.

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Success Steps: How to Reduce Contact Lens Dropouts

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Contact lenses can be a lifestyle-enhancer for patients and a profitability-builder for practices. You can maximize patient satisfaction, and the potential to grow your profitability, if you find ways to help patients to succeed in contact lens wear and not drop out.

Studies show that contact lens patients return more frequently for office visits and contribute more revenue over time than do eyeglasses-only patients.

In addition to working part-time at We Are Eyes in Boca Raton, Fla., I teach at Nova Southeastern University College of Optometry. In most typical primary care practices, approximately 30-40 percent of patients will be contact lens wearers. At NSU, I work primarily in the contact lens clinic, so 90 percent of my patients are contact lens wearers. Recent studies reveal that the typical contact lens drop-out rate in the U.S. is approximately 10 percent, but it can range up to 60 percent.

How Much Are CL Dropouts Costing You?
It is challenging for the typical optometric office to determine the financial impact of contact lens drop out. Many doctors rarely calculate it. But if you do the math, there is significant money at stake when a patient drops out of contact lenses.

For example, contact lens examination fees for standard hydrogel, or silicone hydrogel, lenses typically range between $60-$100, and average revenue for an annual supply of contact lenses range from $100-$500 per year. That adds up to a revenue loss of $160-$600 per year per patient.

So, if you take into account the entire lifetime of a typical contact lens wearer, every time a patient drops out of contact lenses, a practice could be losing upwards of $20,000 -$30,000. If five patients drop out, this could add up to $100,000 for the practice. In addition to that, if a patient is dropping out of their contact lenses because they are unsatisfied with the doctor, or the lenses that the doctor prescribed, a practice could potentially loose their optical business and referrals from friends and family also.

Curb Discomfort: Ask the Right Questions
The most common reason for contact lens drop-outs is discomfort, mostly related to dryness. Patients also drop out because of blurred vision, the cost of the examination and supplies, the inconvenience, or fears of complication from wearing contacts. And many patients won’t tell the doctor exactly why they are dropping out.

Therefore, the first step in preventing dropouts is asking the right questions of every contact lens wear. The only way you can prevent contact lens drop-out is by identifying the problem to begin with.

Never ask: “How are you doing with your contacts?”

Never ask: “Are you doing OK with your contacts?”

Always ask: “How do your contacts feel at the end of the day compared to the beginning of the day?”

Always ask: “How can I make your contacts even better?”

Stay Ahead of Discomfort and Complications
Once you have asked the right questions, the next step in preventing drop-outs is by making improvements before complaints occur, or get worse. Even if a patient denies discomfort, I always try to prescribe something new to each patient. Contact lens technology is constantly evolving and improving. There is a strong likelihood that there is a better contact lens available today, compared to the last time the patient was examined. If a patient is already wearing the newest lens, then I re-educate them about the most appropriate artificial tears to use. I prescribe a specific re-wetting drop and a specific dosing, even if the product is available over the counter.

Prescribing daily disposable lenses is another way to reduce contact lens drop-outs. Many long-time contact lens patients are unaware that single-use lenses are the standard, not the exception, now. There are many daily disposables to choose from for spherical, toric and multifocal patients. Single-use lenses are ideal for the part time wearer, but for the full-time wearer, as they can provide superior comfort and convenience.

When offering daily disposables, focus on the benefits, rather than the technical features. Educate patients on the health benefits, minimized risk of infection and complications, and superior end-of-day comfort.

Most manufacturers will provide diagnostic lens sets at no charge. So, there is no initial cost to an OD to educating, and enabling patients to experience, new lenses! I can’t think of any other situation in optometric business where there is no initial financial investment needed. But ODs have to be willing to use the newest lenses and prescribe them to their patients with confidence. And ODs have to know that contact lens technology is constantly evolving. In a year, there may be yet another lens that they have to learn about and be willing to try.

Address Dry Eye
The majority of patients, who drop out of soft contact lenses because of lens discomfort, have dry eye. So, managing underlying dry eye is critical. Eyecare providers should recommend a specific brand-name artificial tear and a specific dosing, along with other vitamin supplements, as part of the treatment regiment.

There should also be a discussion regarding environmental factors that can lead to dry eye, such as ceiling fans and air conditioning vents blowing directly toward the eyes. And even if a patient does not need prescription-strength medications for dry eye, they should be monitored closely.

But continued monitoring is even more important if a contact lens wearer needs to be on a topical medication for dry eye such as Xiidra or Restasis. A re-evaluation and re education every 3-6 months can significantly prevent contact lens dropouts.

When it comes to dry eye from more chronic, severe ocular surface disease, scleral contact lenses can revolutionize a practice. I have many patients with severe Sjogren’s disease that cannot tolerate standard contact lenses. Patients with true keratitis sicca often see better with scleral lenses. Scleral contact lenses correct for a patient’s refractive error, but can act as a shield from the elements to protect the cornea from dehydration.

In addition, the sterile saline used to fill the scleral lens before it is inserted acts as therapeutic tear reservoir. This can heal a patient with significant corneal superficial punctate keratitis or filamentary keratitis.

Prescribe Multifocal Contact Lenses
Many presbyopic patients believe that if they have to wear glasses over their contacts to read and work on the computer, then they might as well just wear glasses full time. This is the reason many presbyopic patients drop out of contact lens wear. For that reason, multifocal technology can also help to reduce dropout rate.

Patients should be educated that multifocal contact lenses have improved dramatically recently. They provide a better range of vision compared to monovision, and now even single-use multifocal lenses are available. For part-time wearers, daily disposable multifocal lenses can provide comfort, better ocular health and vision, as well as convenience.

THUY-LAN NGUYEN, OD

Thuy-Lan Nguyen, OD, teaches at Nova Southeastern University College of Optometry and works part time as an associate at We Are Eyes in Boca Raton, Fla. To contact her: TLNGUYEN@nova.edu

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Create a Healthy Eyes Plan for Healthy Contact Lens Practice Growth

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by Beth Lennox, O.D. Cambridge Eye Care, Cambridge, Ontario.

I often hear, unfortunately, from many colleagues that their contact lens practice is in decline.

In our practice, contact lens revenue has shown good growth in the past five years and accounts for an increasing share of our total revenue. Our growth comes from more than simply upgrading patients from frequent replacement to higher priced daily disposable modality. We are generating new fits and increasing the total sales provided by the tremendous potential of the contact lens patient – not only in contact lenses, but in solutions and other products and services we provide.

The contact lenses conversation starts from the very first contact with our office. When booking an appointment, the first thing that our staff does is ask, “Are you a contact lens wearer?” It’s obviously important to know if they are wearing contacts, but it also opens the opportunity for the patient to indicate their interest in contacts lenses.

During the case history, even if there has been no indication of previous contact lens wear, I’ll ask the patient if they’re a contact lens wearer. It’s important to not to make any assumptions, even if I’ve seen the patient before and know they have not ordered contacts from our practice.

Maybe they’ve ordered lenses online or tried something that a friend or a sibling provided. It gives me the opportunity to say, “Okay, what happened in that situation, why didn’t you continue? Let’s refit you into better technology.”

The Full Potential of a Healthy Eyes Plan.  

If patient stays with you for lifetime, i.e.  about 20 years or so, they are worth about $20,000 in revenue because they tend to spend more every year. They are not only buying an annual supply of contact lenses, but also purchasing other products such as rewetting drops, solutions as well as prescription glasses and plano sunwear.

We’ve created a Healthy Eyes Plan, which bundles contact lenses of every modality into a package of benefits that offers patient convenience and “no-surprise” price transparency.  Patients can opt for a 6-month supply or, for a modest discount of around 5%, a full annual supply.

The HEALTHY EYES PLAN is the driving force for add-on sales to the contact lens patient.

Our Healthy Eyes Plan includes a bundle of contact lens services as well as special offers for other vision care products. It encourages loyalty and compliance using a simplified one-price approach. The Healthy Eyes Plan includes:

  • “20-20 Special Savings Plan” which includes $20 dollars off frames and $20 off ophthalmic lenses
  • $25 or $50 off designer non-prescription sunglasses
  • All contact lens office visits and progress checks
  • Complimentary replacements for torn or damaged lenses

Our professional fitting fees are separate from the Healthy Eyes Plan, but are also presented as a one-price bundle that also communicates the value of our services; including lens and solution selection, training, all sample lenses, and a solution starter kit.

The bundling approach encourages patients to purchase as much as possible with our practice to help with all their vision needs. We highlight UV protection with contact lenses on the Healthy Eyes Plan brochure to reinforce the health message and help patients understand the need for full protection from harmful UV rays. The UV message is also a tie-in with the discount benefit for designer sunglasses. Our goal is to discuss the importance of UV protection with every patient, and present UV protection as an option.

UV Blocking option is offered to every patient.

When a parent is given the choice of UV protection or no UV protection for their child, they will most often choose the protection, as they want them to have the best.

The Healthy Eyes Plan also includes 24/7 contact lens reordering from our website, which is also a great counter to shopping online. The one-stop convenience, and the benefit of bundling solutions for their full eyewear needs, is something that simply cannot be replicated online. The easier we make it for our patients, the greater success we’ll have.

Our approach works extremely well with family members and is often spread by word of mouth and through social media. Recently one daughter came in with the idea of getting contacts. We ended up fitting the sister and mom, all with annual supplies of 1-day modality lenses. Of course, we actively promote contact lenses through our social media sites. When we bring in a new product, like Acuvue Oasys 1-Day, we’ll put that onto our social media feed so that patients know. We find that patients are happy to share their contact lens success even without us encouraging them to do so.

Recently a teenager on the school volleyball team was hesitant and afraid to wear contact lenses. I said, “Let’s have some fun and put a trial lens on your eye to see how they will perform for you.” Now he is a successful 1-day modality contact lens wearer since I was able to remove his fear barrier.

My advice to colleagues who may not be having the same level of success with contact lenses as we have: keep fitting the latest technology, take charge, be the expert and show enthusiasm! Consider a bundled Healthy Eyes Plan like ours to tap into the full potential of the contact lens patient and their social network. It will score points for the patient and your practice.

Dr. Beth Lennox is a Professional Affairs Consultant with J&J Vision Care

BETH LENNOX, OD

Cambridge Eye Care, Cambridge Ontario

Dr. Beth Lennox is a co-owner of Cambridge Eye Care, in Cambridge Ontario, a successful high-growth single-location practice, with 4 doctors and 13 staff.  The office has three lanes running full-time. Cambridge Eye Care is moving to an expanded space in August 2017.

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Hurry Up and Fit Them While They’re Young

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With an aging population, the opportunity to fit both current contact lens wearers and emmetropic patients with multifocal contact lenses is enormous. The benefits of doing so range from delighting patients through to increasing your revenue from higher value contact lenses and add-on sales of reading glasses. So take a moment to consider your practice: do you talk about multifocal contact lenses with every emerging presbyope or do they take a back seat until you have tried and exhausted other options such as monovision?

There are, of course, a number of positives for fitting monovision: it is quick, easy and costs no more than ‘normal’ contact lenses. However, monovision does not do so well in the long run for many patients. As the required near addition increases over time, it becomes more difficult to use the same prescription for both reading and intermediate distances. In my experience, more than half of monovision wearers have difficulty once the near add is over 2.00D. It is then that an alternative solution, such as multifocal contact lenses needs to be explored. The difficulty of this approach is that the patient already requires mid to high adds, and these are harder to adapt to.

My preference is to be proactive and fit multifocals early. In much the same way we might recommend low add varifocal spectacles to ease adaptation, fitting low add multifocal contact lenses makes initial adaptation easier for patients. It also maintains their binocular vision and provides a contact lens solution that can adapt with them over time.

Starting the Conversation Early
While no multifocal contact lens can promise to deliver perfectly clear vision 100 per cent of the time, steps can be taken to promote successful outcomes. In my experience, the most crucial step is to get communication right. Conversations about presbyopia should happen early, before its onset. I routinely talk to pre-presbyopes about what will happen to their vision in the future. It means they are not surprised when reading becomes more difficult and that they are aware of their options.

Communication is also key when it comes to setting expectations. Defining success with multifocal contact lenses helps patients frame their experience more realistically. Explain that multifocal contact lenses will work for a majority of the time and that supplementary reading glasses may occasionally be necessary for fine detail. Setting realistic expectations enables more patients to feel their contact lenses are working as well as could be expected. Scoring the relative convenience of both their spectacles and contact lenses works well too. An 8 out of 10 may not be perfect, but it’s certainly ‘good enough’ for many patients, particularly if they also score their reading glasses or varifocals at the same level. Also bear in mind that multifocal contact lenses are not the best option in every case: patients with unrealistically high expectations or specific detailed visual demands may do better with other forms of vision correction.

I follow three tips when fitting multifocal contact lenses. (1) I always use the manufacturer’s fitting guide, which will have been produced after extensive research. If the guide quotes a particular rate of fit success, it will have been achieved by following specific steps, so no matter how tempting it is to stray, I cannot recommend strongly enough that sticking to the guide should lead to the greatest fitting success. (2) I assess vision with ‘real world’ targets. I try to understand my patient’s visual environment and use that to assess how well they can see. Use real life reading material, ask patients to view their smart phone, tablet or laptop and check their vision across the street. Optimise their vision for everyday tasks. (3) Know when to stop making adjustments. As a young practitioner trying to achieve perfect vision, I would tweak multifocal prescriptions a lot, a practice that is not realistic and leads to disappointment. Use the fitting guide to make one or maybe two adjustments. Have the confidence to face your patient and say ‘this is as good as we can get it’. It is amazing how often they will accept that statement and happily choose to continue with those contact lenses. It avoids the endless pursuit of perfection and puts a sensible limit on chair time.

Increasing Choice for the Practitioner and Patient
Good choice exists for frequently replaced soft multifocals with options available in daily disposable and monthly modalities. Adding to this selection, it is worth being aware of some more recently released designs too. Available in three adds, Johnson & Johnson’s 1-DAY ACUVUE® MOIST® Multifocal is a new hydrogel daily disposable. It combines the performance of etafilcon A with an optimised aspheric centre-near design that accounts for pupil size variance due to both refractive error and age across the power range. Bausch + Lomb’s Biotrue® ONEday for Presbyopia is another new hydrogel. It delivers a centre-near, three-zone progressive design with two add powers. Less recent, but an important alternative in this category is the Clariti® 1-Day Multifocal from CooperVision, currently the only multifocal daily disposable available in a silicone hydrogel material. With many patients choosing part-time contact lens wear, increased choice in the daily disposable portfolio is welcome. Perhaps the most recent addition in the frequent replacement sector is the PureVision®2 for Presbyopia from Bausch + Lomb. Offering an updated design with a wider intermediate area and predictable, efficient fitting, it is a welcome addition to the silicone hydrogel category, alongside other options such as Alcon’s AIR OPTIX® AQUA Multifocal which offers three add powers.

In summary, fitting presbyopes with multifocal contact lenses is best done early and with good clear communication to ensure your patient’s expectations are realistic. Have confidence to be proactive with this group of patients and you will experience the professional and business rewards that follow.

This article was published originally in OPTIK Magazine, February 2016.

KAREN WALSH, MCOPTOM

Karen Walsh, BSc(Hons) PGDip MCOptom FIACLE Medical Research Fellow Phone: (519) 888-4567 ext.37548 Email: karen.walsh@uwaterloo.ca Karen graduated in Optometry from Cardiff University, Wales in 1997. She subsequently worked in the UK across all forms of clinical practice, along with supervising undergraduate contact lens clinics at Aston University, Birmingham. Following seven years of working with Brian Tompkins in his independent practice that specialized in contact lenses she joined Johnson & Johnson Vision Care as a Professional Affairs Manager for the UK & Ireland in 2007. Karen has authored clinical articles and educational training programmes on both contact lenses and UV radiation; she has lectured internationally, and has taught at the VISION CARE INSTITUTE™ of Johnson & Johnson Vision Care in both Prague and the UK. She holds a post graduate diploma in Clinical Optometry from City University, London and is a Fellow of the International Association of Contact Lens Educators. She joined the CCLR in 2015 and currently holds the post of Medical Research Fellow.

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