CONTACT LENSES

Don't Sweat The Changes

There are still plenty of opportunities to grow this part of your practice. But are you taking advantage of them?

Jeffrey S. Eisenberg,
Senior Editor

Sidebar:

Patient Visits (Initial and Refit) Among M.D.s, O.D.s, Retailers and Chains for Contact Lenses (in thousands)
Benchmarks for Your Contact Lens Business

The O.D.s who attended the AOA's Joint Section Symposium in Phoenix braved 100° temperatures, but few seemed to be sweating the future of contact lens practice. Despite challenges from refractive surgery, chains, mail order and the Internet, there were no indications that contact lens practice is in danger. Quite the opposite. "Contact lens practice is in a really good place," says Alameda, Calif., optometrist Charlotte Tlachac, one of the lecturers.

Several studies support this. Jobson Optical Group Data Base put total contact lens retail sales volume at $2 billion in 1999, up 6% from $1.89 billion in 1998. Contact lenses make up 12.5% of U.S. optical retail sales.

According to a Health Products Research (HPR) survey, O.D.s reported a total of 2.5 million soft lens fits for the first half of 2000, up from 2.3 million for the same period a year earlier.

Also, O.D.s reported some 226,400 RGP initial fits and refits, an increase from 195,600 a year earlier; and 8,800 PMMA fits and refits, a 57% jump over last year's numbers (See the sidebar, Patient Visits (Initial and Refit) Among M.D.s, O.D.s, Retailers and Chains for Contact Lenses).

At Your Disposal
Not surprisingly, disposable soft contact lenses remain the most popular contact lens option among patients, representing nearly half of all fits, Jobson's research shows. The next most popular modalities: planned replacement at 30%, then conventional annual replacement lenses at a little over 20%.

Review of Optometry's own research mirrors this. The O.D.s responding to our annual Ophthalmic Product Research (OPR) surveys fit up to 100 patients in soft lenses each week, with the average being 26 (nine of them new fits). Here's the breakdown:

16 patients get 1- and 2-week disposable lenses, plus another four get daily disposables.
Seven get planned-replacement spherical soft contact lenses. Half the respondents recommend monthly replacement, about one-fifth recommend quarterly or 2-month replacement. A mere 2% recommend 6-month replacement.

Three get conventional, annual replacement spherical lenses.

Three get extended wear.

A similar pattern emerges with the average seven patients who get toric lenses each week in the typical practice: three in disposables, three in planned-replacements and just one in conventional annual replacement lenses.

Torics are where the growth lies. New disposable toric fits have more than doubled over the past year, as has the number of patients switching from other brands to disposable torics.

That's because of the fairly recent availability of these products, HPR reports. New fits are up 39% for monthly replacement lenses but only about 2% for quarterly. However, for lenses worn 6 months or longer, new fits are down 53% and brand switches are down 50%.

A Big Bi-Product
Nonetheless, several at the AOA meeting suggested that given the availability of disposable lenses through alternative outlets, the future of optometric contact lens practice may lie in specialty lenses.

The biggest growth opportunity comes from the presbyopic population. The U.S. Census bureau estimates that some 90.5 million Americans are age 45 and above. Optometrist Stanley Yamane, Vistakon's vice president, professional affairs, estimates that some 6 out of 10 patients in the average practice are presbyopic and are candidates for bifocal or multifocal lenses.

This is also the group able to afford contacts. Statistics from the Census Bureau and Bureau of Labor show that median household income was $45,756 for households headed by someone age 30-34. This continues to rise with age-to $48,876, ages 35-39; to $52,650, ages 40-44 ... you get the picture.

However, O.D.s may not be taking full advantage of this opportunity. Those responding to Review of Optometry's OPR survey on soft lenses fit an average of just two patients a week in bifocal or multifocal lenses.

One possible reason: Many of you remember past experiences in which bifocal contacts were time-consuming to fit, and didn't provide what many consider to be satisfactory vision. "The bad experience keeps many [O.D.s] from trying the newer modalities, which have a much better success rate," says Dr. Tlachac, who is past chair of the AOA Contact Lens and Cornea section.

More O.D.s are opting to fit monovision, instead. A 1999 Health Products Research survey of 662 contact lens wearers revealed that 5.6% wore multifocals, but 9.4% wore monovision. Of 202 respondents who were age 40 or older, 16% wore multifocal lenses and 28% used monovision.

The Next Boom
Not only do these baby boomers present an opportunity to grow your contact lens practice, but so do their children. CooperVision market research shows that 95% of all first-time contact lens wearers are younger than age 20.

This is also the group perhaps most interested in wearing contact lenses. About two of five 18-29-year-olds who need vision correction opt for contacts, a recent Gallup poll reports. The higher the age brackets, the fewer the lens wearers: About one in five of those 30-49 wear contacts, as do about one in 10 of those past age 50.

This population also keeps growing. The Census Bureau predicts that by the year 2007, there will be 2 million more children in high school than in 1997. "We believe that represents a significant opportunity for the contact lens industry," says Bill Shelly, senior marketing manager for CooperVision, which has launched its Preference Teen program promoting its Preference quarterly planned replacement lenses to teen-agers as well as its own line of costume lenses.

A Colorful Alternative
Besides appealing to teen-agers, cosmetic lenses have the potential to increase the number of contact lens fits in your practice. In fact, 40% of contact lens fits are plano, says CIBA Vision CEO Glen Bradley, whose company just acquired Wesley Jessen.

Meanwhile, Wesley Jessen surveyed 351 consumers who bought its FreshLook tinted lenses. More than two-thirds were first-time color lens wearers. Half had previously not worn contact lenses. More than 90% said they would buy colored lenses again.

For now, O.D.s fit an average 3 patients each week in cosmetic tinted lenses, according to the OPR survey. In an HPR survey in the first half this year, O.D.s reported 227,300 patient visits for initial fits and refits of color enhanced or opaque lenses, up from 222,300 for the same period last year.

Surgical Alternative
While many of you worry about refractive surgery taking away from your contact lens base, others believe it may help. Patients who inquire about LASIK may instead opt for contact lenses. Some patients do so for economic reasons. Others may be previous dropouts for reasons that no longer exist, such as complicated care systems and expensive lens replacement costs. Still, others are waiting until there's a more viable refractive procedure to correct presbyopia.

With 30-day wear on the horizon, contact lenses may also take a more prominent place. Some 57% of respondents to Review of Optometry's soft lens OPR survey say they would be willing to try 30-day extended wear lenses in appropriate patients if FDA-approved.

For now, almost two-thirds of those doctors say refractive surgery has not helped grow their contact lens practices; only 13% say it has.

No doubt, your contact lens practice faces challenges, but there are still opportunities ahead to address special needs of different patient demographics. You need not sweat the future, even if you do sweat the summer months. u

Patient Visits (Initial and Refit) Among M.D.s, O.D.s, Retailers and Chains for Contact Lenses (in thousands)
	1999 Q1	1999 Q2	1999 Q3	1999 Q4	1999 TOTAL	2000 Q1	2000 Q2	2000 TO DATE
M.D. Soft RGP PMMA	312.7 59.0 2.8	309.8 41.1 0.0	389.5 54.3 2.2	423.7 52.1 2.3	1435.6 206.5 7.3	489.2 92.6 1.1	654.0 87.5 0.4	1143.2 180.1 1.4
O.D. Soft RGP PMMA	1095.2 92.9 3.2	1201.1 102.7 2.4	1243.0 107.0 3.7	1159.8 103.0 5.0	4699.2 405.6 14.3	1251.0 114.7 4.2	1288.7 111.7 4.6	2539.7 226.4 8.8
Independent Soft RGP PMMA	545.6 55.6 2.4	562.1 58.4 0.3	595.5 45.9 0.3	518.7 49.7 0.4	2222.0 209.5 3.4	496.4 48.0 2.3	541.9 45.8 1.7	1038.3 93.8 3.9
Chain Soft RGP PMMA	897.6 57.8 0.6	853.8 43.5 0.5	1061.7 44.6 0.3	734.4 29.7 0.0	3547.4 175.6 1.4	864.5 46.9 0.0	840.8 35.9 0.0	1705.3 82.9 0.0
Source: Health Products Research

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Benchmarks for Your Contact Lens Business

Like many of you, optometrist Ric Munz of Wake Forest, N.C., had two goals for his contact lens practice: Live up to the practice's mission statement-to "preserve and enhance vision"-and receive appropriate compensation for doing so. To achieve these goals, however, he had to make certain changes to his practice. To decide if you need to do the same, consider these three benchmarks.

Inventory. Are these costs higher than necessary? Review of Optometry's research shows that while nearly 60% of O.D.s take advantage of direct delivery from contact lens manufacturers to patients, an average of just four patients a week have their lenses directly shipped to them.

Also, practice management consultant Annette Juneau of Lake Worth, Fla., surveyed 100 practices across the United States and found O.D.s wasting space-and money-on excess inventory. These O.D.s stocked an average of six brands of contact lenses for sale to patients and another 25 brands of trial lenses. Of these, they fit 10 brands every week, six brands once a month and nine brands up to four times a year. At least three brands never made it off the shelves.

The loss: Those brands that didn't budge took up 9 cubic feet of space. At an average monthly cost of $28 per square foot of space, that's $252 a month, or $3,024 a year, they're losing.

On the other hand, Ms. Juneau studied more carefully 16 of these 100 practices that generated an average $800,000 in gross revenue, with 28% net. These O.D.s, she says, limited inventories to those lenses they use weekly or monthly. Their inventories average three brands for sale and 16 brands of trial lenses.

Need more convincing? Then consider this: About 18 months ago, Dr. Munz kept some 2,000 disposable multi-packs in inventory. He has since reduced the amount to less than 50. "Assuming an average cost of $12.50/multi-pack and 1,950 multi-packs fewer, we have a savings of $24,375 in inventory costs," he says. "Clearly, the ideal situation is selling annual supplies directly shipped to the patient and gradually eliminating inventory."
Fees. Do these reflect your specialty, patient demographics and chair costs? Ms. Juneau's survey found these national average fees for contact lens patients:

– New patients: $79, comprehensive exam; a fitting fee of $55 for disposable lenses, $65, extended wear; or $85, specialty lenses; plus the cost of the lenses.

– Existing patients: $63, comprehensive exam; a fitting fee of $37 for disposable lenses $43, extended wear; or $55, specialty; plus the cost of the lenses.
Patient service and education. Contact lens manufacturer Biocompatibles surveyed some 506 contact lens wearers in 10 geographic areas. Some 72% said they believe that shopping around for the best price is usually worth the time and effort, and 30% said they felt comfortable buying lenses over the Internet. Slightly more than half these contact lens wearers bought their contact lenses at some time from a mass merchandiser, mail order or a doctor other than the original one who prescribed their lenses. Review of Optometry's OPR survey found that an average 14% of patients take their contact lens prescriptions to get filled elsewhere.

In her own survey of patients, Ms. Juneau found that 17% shop around for service, convenience and price, but only 2% buy lenses over the Internet. "So, that's 83% of patients you can control," she says.

Of course, that depends in part on patient education. More than seven out of 10 respondents to Biocompatibles' survey said they enjoy learning about new products and technologies, and almost as many said they would pay more if they would benefit from these improvements. Sounds like an ideal way to enhance your patients' vision and your practice's growth.-J.S.E.

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