How to establish value in the minds of contact lens wearers

Over the past couple of years, multiple colleagues have suggested I read a book called Differentiate or Die: Survival in Our Era of Killer Competition by Jack Trout. While the book is still on my reading list, the theme was brought to mind again as I pondered the current threats to our contact lens practice.

With 1-800 Contacts forging ahead with its acquisitions and privileges, what will keep patients returning to us? What are we doing to ensure their loyalty in the face of convenient online refractions and relaxed prescription laws? And from their perspective, where does the value lie?

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We would like to think that our contact lens exam is completely different from our glasses exam, but is it?

Even more so, we would like to think the patient understands and appreciates that difference. But in order for that to happen, we must draw attention to what sets it apart, and demonstrate its value as we go.

Talk through your exam

A thorough contact lens evaluation requires many layers of assessment. While we may already be doing many of these things, the key is to talk about it with patients. Tell them what you’re looking for, and whether it’s there or not.

As always, start with the lids. Lid disease can cause a significant threat to tear film stability and subsequently the comfort of wear. One obvious example is the exotoxins released into the tear film in a patient with blepharitis.

Use lissamine green to evaluate the upper and lower lid margin. Excessive staining of the upper lid margin indicates lid wiper epitheliopathy, which can contribute to contact lens discomfort. When the lower lid stains anteriorly, it represents keratinization.

Whether the treatment is lid hygiene, lubrication, or debridement, if left unattended, it can cause problems down the road for your contact lens wearer.

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Before moving on, flip the upper lid and look for papillae. Though silicone hydrogel materials have helped minimize GPC, it is not extinct. While the sodium fluorescein is still on the surface, watch for any demarcation line in the tears, indicating a partial blink.

Contact lenses divide the tear film in half, increasing the potential for quick evaporation. Furthermore, evidence shows that contact lens wearers are more prone to meibomian gland dysfunction.^1-4 This combination can drastically affect the lens-wearing experience and cause cascading detriment to the ocular surface health. When treated, it promotes wearing comfort.⁴

Next comes the tears, another critical element of the contact lens exam.

Check the dynamic of the tears, looking for excessive debris that can later build up on the lens and decrease wettability. Also, check the tear break-up time to confirm their sustainability. If available, perform osmolarity on all contact lens patients.

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If you have the capability of conducting tear film interferometry, don’t skip it! Viewing the lipid layer over the contact lenses gives us valuable information on the actual wearing environment and how it changes when the lens is placed on the eye.

When looking at the cornea, check for signs of hypoxia such as haziness or pannus. This is one of the main motivators I use to switch patients into silicone hydrogel daily disposable lenses. Look superiorly for any evidence of superior epithelial arcuate lesions (SEAL) or superior limbic keratoconjuntivitis (SLK). Evaluate the conjunctiva to ensure there is no limbal hyperemia or blanched vessels from a tight fit.

Assessing contact lenses

The typical contact lens work-up usually starts with topography. Next, we assess the refractive error and ocular surface to handpick the right lens. We all spend time looking at the actual lens, checking wettability, centration, and movement.

But edge design and material also certainly play a role when we are considering comfort. We all check vision with the contact lens on, but be sure to ask patients if the vision fluctuates with the blink. It’s better to find out now rather than having to retrial later.

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We have so many premium lenses available-boasting truly advanced technology. We can add value for patients by educating them on new designs and materials and fitting them with the latest contact lens technology.

Some doctors try to change the lens type yearly in order to inspire patient commitment. I do this only when it is a true upgrade for the patient. If it were to be a mere lateral move, perhaps the same goal can be achieved by describing the new lens and discussing how it compares to their current lens.

The point here is that even the discussion on new technology is something they may not receive elsewhere. You want to ensure your patients know that not only are you up to date, but you also have access to the newest lenses available.

Value is different than price. When patients “shop” contact lenses, they are typically centered on price alone. It is our job to create value around the lens we’ve chosen. Always speak with conviction and confidence. Keep the health of the lens as the primary focus in the discussion, with convenience being second, and price coming last.

Patient perception

As you can see, when done correctly, there truly is a difference between a contact lens exam and a glasses exam-a difference that certainly warrants the fitting fee year after year. But even if we do all this and more, there may be no perceived value to patients unless we educate them throughout the process.

This starts with the appointment phone call and check in. Have your staff plant the seed by “preparing” them for the extra testing. Your tech even has an opportunity to begin the education while performing topography before the exam.

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The initial education from the doctor is best done at the slit lamp. Patient have no idea what you see, but they assume the worst and therefore any discussion is more impactful at the slit lamp. But it cannot stop there if we truly want to differentiate our contact lens exam.

Using pictures and videos is one of the most powerful tools you have in your arsenal, and unfortunately, they are grossly underutilized in the routine contact lens exam. Even if there is not significant pathology to demonstrate, consider including a couple anterior segment photos to use as an educational tool.

Explaining what you are watching for reinforces your skill and their confidence in you, as well as their dedication to seeing you specifically. If you have additional equipment, such as Oculus Keratograph 5M or TearScience LipiView, you can take it a step further to demonstrate the integrity and dynamics of the tear film and the blink.

It’s a good idea to plant the value seed early on. Encourage your staff to talk you up on the phone every chance they get. Include a brochure with your welcome papers that explains the fitting options and process, as well as any advanced equipment and care patients will receive in your office.

This brochure should also address why patients should buy their annual supply from your office. It is important to reiterate this on your website. You will likely be surprised at the number of new and established patients who visit your site.

Combat the competition

There is more competition now than ever before by way of both commercial and online optometric care. For some patients, this will remain a non-issue because they already know the value in your services. But we have all faced the patient who is outraged at needing an annual exam in order to buy new contact lenses claiming, “This is a racket!”

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We also have those patients who would never consider buying contact lenses from us because they can save a dollar at a big box store.

Finally, we all have the patient who lets you waste time trialing her in something new but has no intention whatsoever to change her lens because she is “doing fine” in the cheapest lens available.

These are our most challenging patients and will be the first to seek online care and purchases. Some contact lens practitioners may say, “Good riddance!” But for others, this may represent a large percentage of your contact lens practice.

To these doctors specifically, I say differentiate or die. Dramatic, yes-but necessary.

References:

1. Arita R, Itoh K, Inoue K, Kuchiba A, Yamaguchi T, Amano S. Contact lens wear is associated with decrease of meibomian glands. Ophthalmology. 2009 Mar;116(3):379-84.

2. Ong BL. Relation between contact lens wear and Meibomian gland dysfunction. Optom Vis Sci. 1996 Mar;73(3):208-10.

3. Korb DR, Henriquez AS. Meibomian gland dysfunction and contact lens intolerance. J Am Optom Assoc. 1980 Mar; 51:243-251.

4. Paugh JR, Knapp LL, Martinson JR, Hom MM. Meibomian therapy in problematic contact lens wear. Optom Vis Sci. 1990 Nov;67(11):803-6.