Cosmetic lenses represent just one of the many opportunities for promoting premium product in the contact lens category. Photos by Wesley Jessen.

To many practitioners, the concept of "selling" patients on contact lens upgrades seems distasteful. Yet five highly successful eye care practitioners thrive, in part because of their emphasis on specialty, or upgrade, lenses. They've achieved their success because they see contact lens upgrades not as a result of salesmanship but as the route to patient satisfaction.

These practitioners, who got together this summer at Wesley Jessen's offices, emphasize that contact lens upgrades are quick in-and-out visits. But the extra minutes reap multiple rewards -- more confident, informed, and compliant patients who are therefore willing to pay for additional features of quality products and are more likely to refer others. Both factors contribute to practice success and profitability.

Show-and-Tell

The practitioners agree that the level of patient education they provide differentiates their practices from others -- and also differentiates the best contact lens fit from a simple contact lens sale.

Phyllis L. Rakow, FCSLA, educates patients with show-and-tell. "By using three dimensional models and posters and even reprints of articles, I'm able to explain the condition to the patients," she says. "When they understand what's happening, they're much more open to the possibilities for correction."

For example, with astigmats, she pulls out a racquetball and squeezes it into an oval shape matching the person's astigmatism. Then the person can comprehend why a regular spherical lens wouldn't work. "I explain how they make special lenses for astigmatism, how those lenses are designed, ground, and stabilized," she says. Those patients walk out with a very clear understanding that a toric lens fitting requires more work. It also allows her to explain the need for trial fitting toric lenses. By teaching these patients about their condition and the solution, she imparts value. Rakow works with five ophthalmologists and three optometrists.

"I don't view myself as someone who sells lenses," adds Michael A. Ward, FCLSA, director of the contact lens service at Emory University, Atlanta. Rather, he considers himself a professional who educates his patients about the features and benefits of contact lenses.

"We (as professionals) have to look at the patients' individual needs ad provide the products which are most appropriate for those needs," Ward says. "The better they understand what we're doing, the more compliant they are to our instructions, and the more appreciative of our efforts."

The Astigmat Solution

Other contact lens fitters spoke about soft toric lenses as the specialty fit they did routinely. "For many years patients have been told they couldn't wear contact lenses because they have astigmatism. That hasn't been true for quite a long time, but disturbingly, the comments are still being made," says Ward.

Old impressions die hard. Once know as "snowflake" lenses -- because no two were ever alike -- soft torics have come a long way. However, some practitioners haven't adapted their thinking.

In one regard, that's great for "specialty" contact lens practices. They receive the accolades of grateful patients. They bolster their reputations. But it's a shame for patients who have bounced to different practices, receiving less than perfect prescriptions. not all of them have the stick-to-itiveness to keep trying.

With the combination of diagnostic equipment and highly reliable and reproducible soft torics, the vast majority of astigmats can be fit successfully. "We do have computerized topographical measuring systems so we can appreciate the corneal topography better than with only a slit lamp picture. We look very closely at any induced astigmatism secondary to aging soft lenses," says Jean Ann Vickery, FCLSA, one of five contact lens fitters in the 36-M.D. Dean McGee Eye Institute, part of the University of Oklahoma City. When introducing patients to a soft toric lens, the healthiest choice is to opt for a frequent replacement or disposable modality," she says.

Disposability Trend

"As disposability has become more widespread, the lenses tend to be a little thinner and don't mask as much astigmatism," Rakow says. In other words, those borderline low astigmats who might have achieved adequate acuity with a conventional lens aren't seeing as well today. "Disposable torics come with .75 cylinder, so we can take these people with borderline astigmatism and give them sharper vision," she says. About 50 percent of the soft lens patients in that practice are in specialty lenses; in the satellite offices, which see fewer routine patients, the percentage jumps to about 75, she says.

But the best way -- indeed, many say the only way -- to convince patients that soft torics are a worthwhile upgrade is to demonstrate the difference. "I came here from a nearby practice that had 11,000 lenses in its inventory," says Rakow, who is building up the inventory at the three location Princeton Eye Group, Monroe Township, NJ.

"I like the fact that manufacturers are supplying us with large diagnostic sets of toric lenses because then we can show patients what they can see with a lens that comes close to their prescription," she says.

"It's also much more convenient for the patients who don't have the time or inclination to come in repeatedly to try different lenses," adds Rakow. "If we can show them how the lens will perform and how it will feel, it's easier for the patient to make the decision to upgrade."

So why aren't more practitioners fitting the lenses? Time is probably the biggest factor, says Rakow. "Some practitioners are letting the lens settle for only five minutes. Then the practitioner is surprised when the patient returns after a week complaining that they can't see well. It takes longer than five minutes for the lens to settle, so if the practice is rushed, it's hard to do it right," she said.

There's also a learning curve, Ward says, although it's not very long. "For those who haven't fit the lenses recently, I'd encourage them to try it again."

And if not, well, Rakow sums it up this way. "Their loss has been our gain. I'm happy we've developed this reputation."

Premium on Materials

While disposability is the preferred modality for many patients, it's not the only choice. Some patients, simply don't want disposable lenses. Perhaps they've had trouble handling them before. Perhaps they're afraid they'll tear them. That's when Rakow turn to the premium materials available in some annual replacement lenses.

"Teenage boys in particular, who have great large muscle strength but aren't as good with small muscle coordination, can learn to handle a lens like that much faster," she says. Rakow reaches for the highest quality annual replacement lenses with many of her younger patients, as well as anyone who has had difficulties handling disposable lenses.

Removing Obstacles

"Once patients have verbalized their problems, you can easily present the option," she says. That's not pushing an upgrade -- it's removing obstacles.

Ward suggests that premium products aren't just for problem fits. "If you're fitting annual replacement lenses, you should be going to the premium products. For those who want or require conventional lenses, we should provide the best quality available. The results yield fewer problems and happier patients," Ward says.

Plus unlike thin disposable lenses, these high quality conventional lenses often mask astigmatism. So for patients with low astigmatism who want better vision and don't want a soft toric lens, these lenses can fit the bill, says Monica G. Fincher, one of three contact lens technicians at Eye Health Northwest, Portland, OR. The practice has seven locations with 20 M.D.s and five O.D.s. In her location alone, there are six M.D.s and two O.D.s and only the technicians do the contact lens fittings.

Since premium products also offer the best warranties, they're the lenses she reaches for with any patient who is unsure about committing to contact lenses. These patients are typically so enamored with the comfort and acuity these lenses provide, they keep them. But they also appreciate knowing that the lenses can be returned, she said.

As it becomes more common in contact lenses, UV protection is seen less as an "upgrade" and more as a feature. All patients, whether they're the outdoors types or not, appreciate knowing the UV protection is there.

Cosmetic Lenses

With all this emphasis on what are perceived as clinically challenging fits, is there room in these practices for cosmetic lenses? Absolutely, say all of the practitioners featured in this article. In fact, the cosmetic lenses are about the easiest upgrade of all because they're patient driven.

There is a little more time involved in both the presentation and product selection process with cosmetic lenses because a patient has to make a choice between the available colors. And most of these practitioners say the volume of cosmetic lenses tends to be a little higher in their satellite offices than at the central medically-oriented office. But none dismisses the impact or appeal cosmetic lenses have on the practice.

In fact, William Winegar loves them. "For any patient who has a spherical Rx, I suggest, 'Would you like to see what a color lens looks like? I can place one on there right now to show you,'" he says. Most say yes, and those that are still hesitant after trying them are sent home with a plano pair. "Take it home and see what your family says," he tells them.

"More often than not, they order them later," explains Winegar. "That's a second sale; it's incremental business on top of what they're already purchasing," he notes. Many buy two or three different colors.

This isn't a mall, or a store next to the high school. Winegar is the sole contact lens fitter at one of the largest eye hospitals in the world -- Miami's Bascom Palmer Eye Institute. And yet, the cosmetic lenses flow out the door.

Winegar estimates that at least 10 percent of his soft contact lens patients have bought at least one color. A number of those have bought lenses in all colors. "I tell all the patients that new blends are available which look much more natural. That usually prompts them to at least try them," he says. "Then when I tell them there's a rebate, the response is almost always, 'Well, this might be fun. I'll take a box." If you don't offer, many won't know about the lenses. You'd be surprised how many people are willing to try them."

He's been converting about 15 percent of soft lens wearers to cosmetic lenses and expects that to increase as word catches on about new more natural looking lenses.

Our practitioners agree that it all boils down to education. If eyecare professionals aren't telling patients about the developments in contact lenses, how are they supposed to know?

These practitioners insist they're not "selling" patients on a particular upgrade, but helping each patient customize the contact lens fit to that individual's visual requirements, comfort, and style. That the effort results in greater profitability is icing on the cake. EB