In today’s contact lens and solution environment, a majority of patients feel there is no observable difference in contact lens products. When patients leave your office for the pharmacy or grocery store, they’re often overwhelmed by the quantity of products claiming to do exactly the same thing. In addition, the lens solution you recommend is often in the same color box as many of the others—others that may appear to be significantly less expensive.

A savvy comparative shopper may read the product labels for similar ingredients, only to find out that many are identical. Moreover, each product claims to address dry eye problems, maintain lens moisture throughout a normal contact lens-wearing day, and enhance lens comfort.
A strong product recommendation from you weighs heavily in the patient’s selection, and could potentially eliminate this grueling process. However, more often than not, the recommended product is one of the more expensive products—if you don’t stress the importance of using that specific product, your patients will simply choose an alternative solution. After all, they are all the same, aren’t they?

Practicing What You Preach
The practitioner’s views lie at the heart of this issue: If you don’t believe there’s any difference in products, then why would your patients think otherwise? If you don’t spend some quality time with them explaining your recommendation, how are they supposed to make an intelligent and informed decision at the point of purchase? It’s your job—in fact, your obligation—to let your patients know why you’re recommending a specific product.

If your selection is best for the ultimate health of their eyes, tell them that. If you believe one product is superior at disinfecting or has a lower potential complication rate than another, share this with your patient. If you think one product will clean better than another or ultimately be more comfortable, giving the patient longer, more enjoyable wearing time, such information will only reinforce the patient’s confidence in your selection. If, however, you don’t care, then your patient will have to deal with the solution confusion at the store shelves.

The Generics Issue
Every time you go to a pharmacy or give your patients a drug prescription, you’re faced with the decision of whether to get that prescription filled in the legend or generic form. You know the generic will be cheaper, but are you certain the prescription is exactly the same?

Although the active ingredients are identical, the inactive ingredients, most times, are not. There are times when these inactive ingredients will not agree with the patient’s system and they will experience some form of hypersensitivity reaction, leading them to believe they’re allergic to the drug in general. While, in fact, this may be true, it may also be that the inactive ingredients could have triggered the unwanted reaction and all they need to do is use the legend form of the drug. The point is that, while generics are generally the same as the legend drugs, they don’t always work the same.

If you don’t recommend a specific solution, chances are patients will reach for lower-cost generics.
Private-label generic contact lens solutions operate slightly different than their drug counterparts. Most of these products use older disinfectants and preservatives than what the newer contact lens solutions offer. When the manufacturers of these “generics” bring them to market, they cannot make any false claims or new claims on the box or in the package inserts. Instead, what they do is market the color of the boxes to look similar to the newer “legend” marketed products. This only adds to the consumer’s confusion at the shelf since so many products look similar or, in some cases, identical.

Unless your patient is armed with knowledge about the difference between these products, they may buy the older products simply because of the cost differential. In fact, statistics show a significant penetration from private label generic products into the current branded solution market.
In a study of nearly 600 contact lens wearers, UCLA researchers found the highest rate of complications were among users of private label and store brand solutions.1 Complications can and often do lead to contact lens dropouts. In fact, studies suggest the most common reason for discontinuation is lens discomfort, which accounts for between 43% and 72% of contact lens wear dropout.2 A 2005 survey revealed that 52% of contact lens wearers were most likely to self-report dry eye symptoms.3

In a 2010 issue of Review of Optometry, John Rumpakis, O.D., reported survey results that found 50% of contact lens wear dropout is due to comfort/fit issues, which translates to about $275.00 loss in annual revenue from each contact lens patient.4 Furthermore, it suggested the average dropout rate is about 16% in the United States, which results in about $45,000 of lost annual revenue.

Opinions In Sync
Addressing contact lens compliance is an ongoing battle. In a 2011 Review of Optometry article, Gina Wesley, O.D., M.S., suggested that confusion may occur if doctors’ recommendations don’t match up with those of the manufacturers.5 She noted that patients are savvy researchers and, if your recommendations contradict prevailing opinion or the manufacturer, they have no incentive to follow the remainder of your instructions.
Be cognizant of what is written on labeling or in the package inserts of the products you prescribe. If your instruction to the patient differs from what’s generally recommended, you can explain the reasons why you’ve chosen it. Surveys have shown that a significant percentage of patients are not aware of the ingredients in contact lens products. This gives you an opportunity to tell the patient why it’s important to pay more attention and listen to your recommendations. You can reinforce this by citing personal experiences or clinical studies. Either way, it’s an opportunity to get your patients back on the right track.

Let your patients know that you care about the health and comfort of their eyes and express concern about non-compliant behavior. While you don’t want to offend anyone, it’s important to let your patients know how strongly you feel about compliance. Dr. Wesley doesn’t recommend asking patients if they’re using the solution you prescribed because it’s too easy for them to simply reply “yes.” She suggests that you either have a variety of solution bottles in the office or, at the very least, pictures of the various branded and non-branded solutions so they can point out which one they use. If your patient doesn’t even know which product they are currently using, then that lets you know where you need to start with the education process. Education is definitely the key to success in this arena.

Many studies have been conducted over the years on contact lens compliance, addressing lens wearing and replacement schedules, lens case hygiene and the use of fresh solution, and not topping off the contact lens case—habits that patients often pick up. Many of these studies have concluded that compliance is a multifactorial problem that requires a multifaceted solution. Urging the proper selection and use of contact lens solutions and related products is a good place to start.

Implementing a Plan
So, how does this relate to the issue of private-label generics or store-brand generics? After all, these products have been FDA approved for their main ingredients, haven’t they? Of course they have. But are they the best possible lens care alternatives for our contact lens patients today? If you feel that prior reported contact lens research makes a case for prescribing the newest and best available products for our patients, then it’s time to take a proactive role in educating your patients. It will not only ensure a greater percentage of successful contact lens wearers but will increase the bottom line in your practice as well.

What can you do in your office to implement a “good practices” approach? One solution is to not just recommend—but actually prescribe—a particular brand that you believe will be compatible with the contact lens you’re fitting. When you give the patient the prescription, let them know why you chose it.

Take advantage of industry resources. The three major manufacturers of contact lens solutions, Alcon, Bausch + Lomb and Abbott, have done extensive research in both manufacturing and marketing these products. Speak to their representatives, look over their literature and read their studies. Finally, to be absolutely certain about how these products will perform, try them with successful contact lens patients in your practice and get their feedback. All of this will help you formulate an educated opinion on the value of each of these products.
Learn as much as you can about today’s products so your patients will benefit and improve their chances of contact lens success. It is incumbent upon you to know what you’re recommending and the reasons why. Along with this, know why they are uniquely better than the store brand or private label generics.

Our goal is always to keep our patients healthy and happy, while at the same time keeping them coming to our practices. Our recommendations and prescriptions for our contact lens patients will help do just that. Let’s not forget the power of our influence over our patients. Don’t let lens care non-compliance be the exit ramp for contact lens patients who were once loyal and satisfied. Speak to them at each office visit about what they’re using, and reinforce your reasons for staying with a branded product that you recommend for the health of their eyes and, ultimately, for the success of their contact lens wearing experience.

As the prescribing doctor, you can contribute significantly to the success or failure of your contact lens patients. Compliance ultimately depends upon the patient following our instructions—so make sure you give your patients a reason to trust your advice. If not, we will see not only more contact lens dropouts, but also the loss of patient revenue at a time when we should all be more attentive to each and every patient we’re privileged to treat. 

Dr. Schachet is in private practice in Englewood, Colo., specializing in dry eye, contact lens care, allergy and corneal refractive therapy.

1. Forister JF, Forister EF, Yeung KK, et al. Prevalence of contact lens-related complications: UCLA contact lens study. Eye Contact Lens. 2009 Jul;35(4):176-80.
2. Young G. Why one million contact lens wearers dropped out. Cont Lens Anterior Eye. 2004 Jun;27(2):83-5. (BCLA Presidential Address originally presented Sept 2002 at Royal Society of Medicine, London.)
3. Nichols JJ, Ziegler C, Mitchell GL, Nichols KK. Self-reported dry eye disease across refractive modalities. Invest Ophthalmol Vis Sci. 2005 June;46(6):1911-4.
4. Rumpakis J. New data on contact lens dropouts: an international perspective. Rev Optom. 2010 Jan 15;147(1):37-42.
5. Wesley G. How to address CL compliance. Rev Optom. 2011 Aug 15;148(8):58-63.