You probably wouldn’t wear shorts and flip flops to a wedding, use a screwdriver to hammer in a nail or dig a hole with a hockey stick. While any of these scenarios would technically “work,” they all fall under the same heading of “not using the right tool for the job.”
As practitioners, we have all heard of “lifestyle dispensing” when it comes to eyeglasses. For example, we might recommend an elegant pair of glasses for a wedding, safety glasses for work or Rx sport goggles for hockey, depending on the patient’s individual lifestyle choice. While we often talk about the right tool for the job with spectacles, rarely do we do we have this conversation when it comes to contact lenses
Admittedly, there aren’t as many applicable, discrete and definable contact lens lifestyle categories as with eyeglasses. However, such categories do still exist. The difference: These categories are more global and inclusive in nature. For example, instead of “sport goggles for hockey,” most athletes would fare better with just about any contact lens modality. And short of colored cosmetic lenses, there are no designated lenses for special occasions. Whether your patient is attending a wedding or making a big presentation at a business meeting, in these cases, you could recommend almost any contact lens with a beneficial result.
With this in mind, let’s take a look at lifestyle dispensing of contact lenses and how this might help to increase patient compliance.
As a consultant, I have found firsthand that European practitioners
have more readily embraced the concept of lifestyle dispensing with
eyeglasses. Because of this, they have had a much easier time
transitioning that view to contact lenses. It is more the rule than the
exception for these European practitioners to routinely discuss
multiple eyewear configurations, based on lifestyles, with their
patients. As those discussions became ingrained in everyday patient
discussions, it was only natural for our European counterparts to
continue the discussion with contact lens patients. Through my experience, I have found that European practitioners do not
recommend two-week lenses as a lifestyle alternative due in part to
compliance issues. In fact, European practitioners rarely prescribe
two-week lenses, and they have told me that these lenses are typically
purchased only by transplanted American patients. On the other hand, daily and monthly disposable lenses have a much
larger market share in Europe. The reason, practitioners say, is that
these two modalities alone (with continuous wear included in the
monthly category) are acceptable to the majority of their patients.
They further state that with these two main categories, compliance is
excellent. They believe this to be true because of the reported trend
of greater compliance with daily and monthly lenses vs. two-week
lenses, and also because patients’ lifestyles have been properly
aligned with their wearing schedules—just as it has always been in
Europe with eyeglasses.
What NOT to Do
A Global Look at Lifestyle Dispensing
Let’s start by reviewing a hopefully obvious example of a poor contact lens modality recommendation.
As a consultant, I have found firsthand that European practitioners have more readily embraced the concept of lifestyle dispensing with eyeglasses. Because of this, they have had a much easier time transitioning that view to contact lenses. It is more the rule than the exception for these European practitioners to routinely discuss multiple eyewear configurations, based on lifestyles, with their patients. As those discussions became ingrained in everyday patient discussions, it was only natural for our European counterparts to continue the discussion with contact lens patients.
Through my experience, I have found that European practitioners do not recommend two-week lenses as a lifestyle alternative due in part to compliance issues. In fact, European practitioners rarely prescribe two-week lenses, and they have told me that these lenses are typically purchased only by transplanted American patients.
On the other hand, daily and monthly disposable lenses have a much larger market share in Europe. The reason, practitioners say, is that these two modalities alone (with continuous wear included in the monthly category) are acceptable to the majority of their patients. They further state that with these two main categories, compliance is excellent. They believe this to be true because of the reported trend of greater compliance with daily and monthly lenses vs. two-week lenses, and also because patients’ lifestyles have been properly aligned with their wearing schedules—just as it has always been in Europe with eyeglasses.
Patient: “Dr. Lenz, I wear glasses most of the time, and I’m happy doing so. I know we’ve discussed wearing contact lenses before, but I’m really quite content with glasses. They seem so much easier than contacts. But, I’m going on a fantasy baseball trip in two months, and the trip will last four days. For that purpose alone, I think it would be helpful if I could wear contact lenses and not be bogged down by my glasses.”
(Remember: What follows is a poor recommendation…) Doctor Lenz: “Well, George. What I suggest we do is fit you with an inexpensive contact lens option that we refer to as PMMA. They are old-fashioned hard lenses, and they are very cheap. Because you’re only going to wear them for a few days, that alternative would keep the cost down. But, since you’re leaving in two months, we need to start the fitting process soon; you’ll have to increase your wearing time each day to get your cornea used to being oxygen deprived. So, between now and fantasy camp, you’ll be wearing them quite a bit. After camp is over, you can taper off your schedule and stop wearing them.”
That Could Have Gone Better…
Hopefully, none of us would offer PMMA lenses to a part-time wearer like George. Still, let’s review what is inherently wrong with this recommendation (besides corneal physiology considerations).
First, the patient is a committed, devoted and presumably happy eyeglass wearer. He stated he wears glasses and has previously rejected contact lenses because he believes wearing glasses is easier. Since ease of use is a key reason for his staying in glasses, if you recommend a lens such as PMMA that involves slowly scaled-up and carefully monitored wearing times and a slow comfort adaptation, this is a poor decision. Instead, a daily disposable lens would be a better choice since they require little if any adaptation, likely fewer office visits and no lens care.
Now, let’s look at how the choice of the “wrong tool” will affect compliance. After trying on the PMMA lenses, George will undoubtedly start to wonder if the rigors of staying with the wearing schedule you’ve prescribed are worth the effort. If so, he’ll try to stay with it as best as he can. If not, he’ll probably discontinue lens wear—until, of course, he arrives at baseball camp and decides to wear the lenses all day, thinking, “How bad could it be to wear the lenses all day for just a few days?” Of course, after doing that, you’ll be seeing him upon his return from camp when he finds out how bad it can really be!
If you’d given George a chance to learn about the ease of use (which was important to him, remember) of daily disposable lenses, he would more likely be compliant.
What You SHOULD Do
Now, let’s look at some less obvious situations and try to pair the best modality with the patient’s reality—and see how doing so will help compliance.
Regarding lifestyle, the biggest differentiator between all lens modalities is the ability to wear lenses overnight. It’s important to keep that in mind when discovering patient lifestyles and offering your ensuing recommendations. For example, patients with erratic schedules, such as medical school residents, new mothers, shift workers and frequent travelers might benefit from the flexibility offered by a continuous wear lens. Similarly, they would probably also like the minimal maintenance these lenses require. If you fit patients with a lens approved for sleeping, this should give them an added margin of safety for the times when they do fall asleep with their lenses either mistakenly or intentionally.
To that point, be careful how you ask patients about their lens wearing and sleeping habits. If you ask patients if they sleep in their contact lenses, you’re likely to hear, “No,” since many patients won’t want to admit they are wearing their lenses inappropriately. Instead, ask patients, “How often do you sleep in your lenses?” With this information, you can have a more focused discussion about lifestyle and the possible need for a continuous wear lens.
Patients who appear to be compliant are usually fairly regimented in their work schedules and don’t object to taking care of their lenses. These patients include the comprehensive group known as “nine to fivers.” So, in this case, a daily wear, monthly replacement lens can be a great choice.
You can pare down the lifestyle decision of daily vs. overnight wear by simply asking the patient, “Do you desire or need to wake up and see right away?” Note this is very different than asking the patient, “Do you want to sleep with your contact lenses?” That question is, of course, illogical; there is no lifestyle benefit to sleeping with lenses per se—only the benefit of being able to wake up and see clearly.
For patients who have no lifestyle need for continuous wear lenses, daily disposables are the next suggestion. The lenses are usually a great choice for patients who work in environments that aren’t always pristinely clean or are dry (e.g., bartenders, hairdressers, pilots and flight attendants), since a fresh, clean lens is never more than one day away. Medical workers concerned about higher infection risk are also excellent candidates for daily disposable lenses. These patients will generally achieve excellent compliance because their concerns about continual exposure to their environments will be alleviated, and they will also receive constant affirmation by putting on clean lenses every day.
One key patient lifestyle question you should always ask: “If you currently wear glasses, are there times when you would rather not?” Most patients will answer, “Yes.” From there, you can determine the circumstances patients are referring to and prescribe the best modality for each patient and circumstance. This will give you the right “tool for the job” to market a particular lifestyle lens to a specific niche patient base.
Make the Perfect Match
If you want to market continuous wear lenses to those with irregular schedules, create a targeted marketing and outreach strategy to groups in your area that would benefit from this particular lifestyle lens. So, if you practice near a hospital, see if you can make a presentation to residents, and make the flexibility of continuous wear lenses the hallmark of your talk. If you practice near a fire station, make an appointment to speak to the firefighters. Or, if there is a hospital nearby that offers a “new mothers” course, see if you can either speak to this group or ask if you can leave your marketing materials with them.
No matter the group, make sure your message is on target for the audience you’re trying to reach. Talk to expectant moms about the ability to wake up at any hour of the night and not have to go searching for glasses. Let them know these lenses would allow them to quickly tend to their crying baby (whom they’ll hopefully get back to sleep). Likewise, talk to firefighters about the importance of speed and safety in their jobs, and that these lenses would allow them to not miss a beat when they are summoned to an emergency.
Next, choose marketing material that is appropriate for the audience. In the above cases, new moms have about as much free time as a firefighter rushing to battle a blaze. Weary readers won’t invest a lot of time ferreting through pages of information to find your key message, the benefits about continuous wear lenses. Keep it short. Make sure your text is very succinct, akin to a billboard sort of message. With this group of prospects, you must tell your story in a few seconds.
Of course, patients with more time and structured lives can be approached differently. While time is at a premium for everyone, at least this group should be able to devote a few minutes to something like a direct mail letter or brochure. But as mentioned above, the key points need to match their lifestyle, or no copy—long or short— will be effective. Train your staff to be on the alert for lifestyle dispensing implications during non-clinical routine patient discussions. For example, if a medical resident says he’s late for his appointment because he was on call for the last 24 hours, your staff should ask if he’s wearing a lifestyle-compatible contact lens. The same goes for “weekend warriors” who make small talk about their tennis or golf game. The discussion of contact lens lifestyle dispensing doesn’t have to start in the examination room.
In an effort to boost compliance—which invariably leads to happier patients, more patients and greater profitability—smart practitioners will start to think of contact lenses not only in terms of their base curve and materials, but in terms of choosing the proper modality for their patients’ lifestyles.
Dr. Gerber is the founder and president The Power Practice, a practice building and consulting company. He has authored hundreds of articles, and his seminars have been attended by thousands of optometrists worldwide. He can be contacted at drgerber@PowerPractice.com.