“We’re in a very lovely profession where what’s best for the patient tends to be what’s best for the practice”
“There’s a disconnect between practitioners who proactively sell premium, technically advanced, individualised and tailored spectacle lenses, but struggle to communicate effectively and do the same in the contact lens world.”
So thinks Arif Karim, an optometrist and owner of Eye Contact Opticians in London. It is a view supported by figures released at the MIDO 2017 eyeware show in Milan. According to GfK, a market research institute, growth in the optical industry is being led by the spectacle lenses and spectacle frames categories. “Spectacle lenses market growth is driven by premium products in which innovation is influencing the performance more and more positively,” notes Francesco Foffa, GfK’s senior global product manager for optics. Contact lens market growth, on the other hand, is more modest, and based around the daily segment.
“The industry has been busy over the last decade upskilling practitioners and changing perceptions – getting them to think about recommending premium spectacle lenses in a wholly more effective manner,” says Mr Karim. “Ten years ago, if you recommended and sold a pair of spectacle lenses for over £500, it was a special day.
“Today, the spectacle lens industry has done such an amazing job, that selling a £500 varifocal spectacle lens is an everyday occurrence. In contrast, on the contact lens side, practitioners’ thinking still tends to be based around selling commodity-type lenses. And they then complain that half their patients are buying their lenses online. Well they need to wake up to the fact that there’s an enormous disconnect.”
Brian Tompkins, a leading contact lens expert and proprietor of TK&S Optometrists in Northampton, thinks that the supply capabilities of some practices are restricted by their business models. “I don’t believe that any good contact lens practitioner won’t have thought of coming out of the realm of off-the-shelf, if you like, and going into some form of custom-made,” he says. “If you’re a contact lens practitioner worth your salt, you will know every option available to the world.
“What is very different is whether your practice, your business owner, your model of supply, allows that to happen. As an independent I have the capability to order from anyone, everyone and everywhere. But some practices say either you can order this, or you can order that. That’s their commercial decision, that’s their ethos within their business, whatever their reason might be. If you are a practitioner working in that sort of environment, you may not get a choice: instead, it’s a case of here’s what you can pick from.”
He urges practitioners to build professional relationships with as many laboratories as possible. “Explore fully the whole world of the capability of contact lens manufacture, and never be afraid to try something new, something you’ve never tried before. Go to a new manufacturer, get a new lens, look at it, and see if it’s going to work.
“David Samuel is the owner of Eyesite, an independent group with practices across southeast England. He agrees with the idea of giving practitioners greater autonomy. “We have a portfolio of lenses that we use by choice, from our favourite manufacturers, who seem to provide the best quality lenses to our practitioners. But we do allow our practitioners to fit pretty much any lens from anywhere, if they think that’s right for the patient. So there’s a preferred list, but we allow them to go off this.
“The preferred list that we have is driven by what our team of optoms and CLOs are finding that’s working. So they’ll feedback: they’ll try a custom lens, or try a few patients on various lenses, and then report back and say, this looks good. Other practitioners will pick up on that, and the proof is in the pudding, as they say: if it’s working, that lens will make its way onto our preferred list, so that if we’ve got locums or other people in, who don’t necessarily know the full portfolio, they’re picking the best lenses for the patient.”
Since custom lenses are generally available only through eyecare practices, not via the internet, many practitioners regard them as an important factor in terms of increasing patient retention. In addition, by creating more constant points of contact between practices and patients, they are seen as providing greater opportunity for practitioners to monitor the optical health of lens wearers.
How do practitioners go about recommending custom-made lenses to their patients? Arif Karim pitches three primary benefits: comfort, health and vision. “We’re appealing to those emotional levers in a patient where they’re looking for a lens that will be healthy, that they can see the very best that they can see with, and is very comfortable to wear. And we find that touching on those levers really helps us to pitch the lens well, and minimize any pushback from patients from wanting to try the lens, and then actually proceeding and buying the lens.
“Of course, it’s an expensive lens vis-à-vis other lenses in the marketplace, so there has to be a good story wrapped round the lens for the patient to understand where the value is. It’s only expensive if patients don’t see the value. So we talk about the benefits rather than the features. We don’t say this lens is available in umpteen million parameters; we talk about what it does for the eyes, and how it is better in terms of health, comfort and vision”
Mr Karim warns practitioners against approaching premium lenses by thinking about the benefits for the practice. “I want to be clear, we don’t decide that this is a really nice high-margin product, there’s a lot of cash profit in it, we want to try and push this lens, right, this is what we’re going to do. We go about it by saying to the patient, we feel this is the best product for you and this is why – how about it? And there is a difference between those two approaches. They arrive at maybe a similar end point, but you’re going about it in two very different mindsets.
“I come from a school of belief that if you pitch what is best for the patient, we’re in a very lovely profession where what’s best for the patient tends to be what’s best for the practice. So it’s all about trying to achieve the absolutely best patient outcome you can possibly search for.”
For Brian Tompkins, the most important point is that for some patients custom-made lenses are the only way to avoid failures with fittings. “Unless you have a custom build capability, anyone who’s not on the bell curve of average doesn’t get sorted. It’s as simple as that. You have to be able to manufacture to all types and not everybody falls within the standard distribution. No one is unsuitable for contact lenses. The old days of, no, we can’t do anything for you because nothing exists doesn’t happen any more. We can pretty much fit anyone walking through the door with virtually any problem.”
With these patients, Mr Tompkins adopts what he describes as an “inclusive” approach to prescribing lenses. “We don’t need to make a differentiation. I will say, yes, we have lenses that suit you. OK, they’re going to have to be made specially for you, they’re a bit more individual than some, but I absolutely don’t – what shall we say? – I don’t necessarily put a strong emphasis on them being custom-made. I try to treat everyone inclusively, and not make the patient feel as if they’re outside the ordinary. I’ll say, yes, I’ll make lenses for you.”
Studies suggest that a quarter of contact lens fits are compromised on corneal diameter (Caroline and André 2002; Woo 2015). When other variables are taken into account – such as base curve, level of astigmatism, presbyopia and astigmatic presbyopia – it is likely that many more patients are affected by ill-fitting contact lenses. Table 1 (below) lists some of the factors that influence a poor-fitting lens; table 2 highlights some ways that flexibility and customisation in lens design can achieve a truer lens fit.
Factors that influence a poor-fitting lens
Achieving a truer lens fit with custom-made lenses
Nevertheless, Arif Karim is keen to dispel the notion that custom-made lenses can only be used for patients with difficult prescriptions. “Yes, a custom lens is a really great lens – and often the only lens to use – if you’ve got a difficult prescription. But it’s a really good lens even if you haven’t got a difficult prescription, because you’re fitting a tailormade lens. Surely that’s good for the patient. You’ve got a choice of geometries, you’ve got a choice of materials, you’ve got the individualised ambience of the product.
“Why would you not want to differentiate your practice by using products that help you to differentiate and insulate you from the competition? That has to be a good practice builder. People think about building their practice well with spectacle lens products, but they just don’t think about it in the same way for contact lenses.”
- Caroline, P. J. and André, M. P., 2002. The effect of corneal diameter on soft lens fitting, part 1. Contact Lens Spectrum 17(4): 56.
- Woo, S. L., 2015. A lens for every eye: custom contact lenses. Review of Cornea and Contact Lenses, 15 September 2015.