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The State of OptometryOphthalmic Dispensing: Getting Ahead of the CurveIndependent O.D.s lead the pack when it comes to dispensing specialty lenses and add-ons-and they do it cheaper than other dispensers.Rich Kirkner, Editor-in-Chief Sidebars: Perhaps no other function in eye care promulgates more optometric angst than ophthalmic dispensing. Although this involves frames and all the glamour that high fashion pulses to, O.D.s today get their glamour in primary care and therapeutics. Your typical patient may indeed think this an upside-down kind of glamour. One word that may well summarize the state of the dispensing optometrist: schizophrenia.  Ah, but not necessarily the state of optometric dispensing. When it comes to helping patients focus clearly on objects, nobody does it more or better than the person with "O.D." behind his or her name. You might not make as much money on it as the chains do, but O.D.s-whether in private practice or employed in a chain, HMO, optical shop or ophthalmologist's office-do almost two of every three eye exams and three of four new patient exams, the AOA reports. "There was a song popular in the 1950s entitled 'Love and Marriage,'" says Irving Bennett, O.D., past chair of the AOA Committee on Information and Data. "That's how I feel about dispensing and optometry-it is an integral part of the primary care profession." One reason: Ophthalmic dispensing contributes more to the typical practice's gross than all other areas combined: 55 cents on the dollar. Who Wears Them Ophthalmic dispensing also comprises the largest slice of the ophthalmic market pie. Some 164.2 million people needed some vision correction in 1999, according to the Jobson Optical Group Data Base and the U.S. Department of Commerce. Yet, a little more than half actually got that vision correction in 1999. (See table, "Who Gets Vision Correction vs. Who Needs It.")  While private optometrists command more than a third of the overall ophthalmic market, as the AOA reports in its "Caring for the Eyes of America," that share fades when it comes to dollars spent on eyewear. Eyewear-frames, lenses, add-ons, sunwear and accessories- comprise the largest component of the ophthalmic market: $16 billion in 1999, Jobson Optical Group Date Base shows. The chains have about 38.5% of that market in terms of dollars vs. 29% for optometrists and less than 6% for ophthalmologists. The typical O.D. dispenses 1,840 pairs of eyewear a year, or a median of 35.4 pairs a week, our own Ophthalmic Product Research (OPR) shows (175 O.D.s responded to our frames survey). That comes out to about $5,000 in fees a week. Indeed, units of eyewear dispensed vs. dollar volume tell two different stories. O.D.s account for about 34% of the eyewear dispensed in the top 25 U.S. markets, Jobson's 20/20 magazine reports in its "Bestsellers Survey 2000," but only 29.4% of the dollar volume. Chains, on the other hand, actually dispense fewer units than O.D.s-around 28%-but account for 38.5% of the dollar volume. The average price of eyewear in the top 25 markets is around $220, 20/20 reports. The priciest: Minneapolis/St. Paul, at $282. The cheapest: Boston, around $200. Doctors who responded to our frames survey are way under that: a median price of $141. This could make the case for optometrists raising their materials fees. "Patients already perceive that the private O.D. has higher eyewear prices than the chains, so I don't believe that raising optical fees would cause patients to leave the practice," says Neil B. Gailmard, O.D., M.B.A., a private practitioner and consultant in Munster, Ind. "More importantly, the excellent eyewear services that O.D.s provide are worth more." Convenience, not necessarily price, may explain why 95% of the typical optometrist's patients get their eyewear from the doctor who examines them. "Patients do not generally want to go to two different places when it comes to getting their eyes examined and a pair of eyeglasses," Dr. Bennett says. What Makes 'Em See Optometrists have shown over the past couple years that they're no slouches when it comes to prescribing ophthalmic lenses. More than nine of 10 optometrists make progressive lenses their first choice for presbyopes, our OPR ophthalmic lens survey shows (247 responded to this survey). And, 65% routinely switch bifocal wearers into PALs. O.D.s have kept up with the new designs, too: 87% of those surveyed prescribe the short-corridor PALs made for smaller fashion frames. Technologically advanced lens materials have become part of your colleagues' armamentarium. Again, nine of 10 say polycarbonate is their first lens of choice for children, our OPR reports. However, O.D.s could do better with this material. It represents 21% of the lenses that labs ship, the Optical Laboratories Association (OLA) says, but only 18.4% of the orders O.D.s dispense. Chains, on the other hand, dispense polycarbonate about a third of the time, the Polycarbonate Lens Council (PLC) reports. "By featuring 'poly,' stores with in-office labs can stock one high index inventory and meet most customer needs," says Joe Bruneni, PLC consultant. "Poly's lower cost also increases [the chains'] profits from dispensing high index lenses." O.D.s are more likely to dispense other types of high index materials. One of every eight pairs of lenses that leave an optometrist's office is made of high index plastic, while fewer than one of 10 orders labs fill are thin and light plastic lenses. When it comes to add-ons such as anti-reflective coatings, O.D.s are ahead of the curve. (See table, "What the Labs Make, What the O.D.s Take"). Today, 24% of optometrists recommend AR to all patients, and almost 40% bundle hard coats into the base fee for lenses. Overall, 16% of the lenses O.D.s dispense have AR, and 63% have scratch coatings. Framing It You and your colleagues still care about the things that hold those lenses onto the face: frames. Two-thirds of optometrists participate in deciding what frames their dispensaries should carry. They either make the selections themselves (9% do), approve what the optical manager picks (18%) or a little of both (36%). Some 77% of all respondents to our OPR lens survey say they set policies for frame purchases, and 45% meet with frame representatives themselves. The five most important factors O.D.s consider when they pick frames: quality, refund policies, price, style and customer service, in that order. Most optometric dispensaries (57%) deal with 6-10 different frame vendors, but almost a quarter buy from 11-15 frame companies. There's turnover here: 56% say they've changed frame vendors in the past year. Most optometrists also dispense sunglasses. Some 56% say they or their staffs talk to every patient about the harmful effects of UV radiation on the eyes. And, almost nine of 10 say they dispense sunwear, about 25% of which are plano. Sunwear represents 10% of the total eyewear the typical O.D. dispenses. The median in our survey translates to about 102 pairs a year per doctor, with the typical inventory coming in at 50-100 pairs. Lens Trends Optometry and other eye-related disciplines have identified several key populations that could ensure eyeglasses remain the preferred modality of vision correction despite inroads by refractive surgery and contact lenses. Among them:
New opportunities in ophthalmic dispensing abound over the next decade or so, and you and your colleagues have positioned yourselves well to seize them. While your fancies may dally in therapeutic drugs and primary care, your livelihood may hinge on frames and lenses. Mr. Kirkner is a member of VCA's Computer Vision Task Force. top |
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