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In the contact lens profession, it is widely accepted that the number of new contact lens patients is only slightly higher than the number of patients who are discontinuing lens wear. The low, single-digit growth rate of total contact lens patients attests to that fact. Although there have been significant improvements in contact lens materials and designs over the past 20 years, the wearer dropout rate has remained relatively constant.
Recently, John Rumpakis, OD, reviewed seven studies conducted between 1993 and 2013 that investigated the rate of contact lens dropouts and found that the average dropout rate in those studies was about 20%, with a range of 12 to 26%.1-7 There was no decrease between the 1993 study and the 2013 study; in fact, the 2013 study revealed a higher dropout rate than the one in 1993, despite the material and design advances that took place during that time period.
As the percentage of new contact lens wearers hovers around only 21%,8 it is imperative to prevent existing wearers from dropping out.
What is the impact of contact lens wearers on a practice? Key findings from a study by the London Business School9 include the following:
• Contact lens patients had exams twice as frequently as spectacle-only patients (15 months vs. 30 months).
• At least 60% of contact lens patients purchased glasses at the location at which the fitting was performed.
• Patients who wore both contacts and glasses provided up to 80% more profit and were more loyal than spectacle-only patients.
• The lifetime value of a contact lens patient far exceeded that of a spectacle-only patient.
Using information gathered from a web-based survey of 138 US optometrists regarding contact lens patients and fees, Rumpakis calculated the median financial loss over the lifetime of a single contact lens dropout in the United States to be $21,695.1 Multiply that figure by the number of patients who discontinue contact lens wear each year, and it is readily apparent that there is a huge financial impact from contact lens patients who drop out.
There are significant advantages to preventing contact lens dropout that go far beyond the lost per-box profit and contact lens fitting fees. As contact lens patients are seen more frequently, much closer relationships are built with those patients. That may lead to increased patient retention, which is a key factor in practice success, as it is much more costly to attract new patients than to retain existing ones. In addition, contact lens patients are probably more likely to refer friends, family members, and coworkers to your practice.
Many doctors have embraced the “medical model” practice of optometry and feel that it is not financially worth the time to prescribe contact lenses. There are significantly more patients who have dry eye and allergy issues than there are patients with glaucoma, corneal ulcers, macular degeneration, etc. To increase the success rate of the many contact lens wearers who experience dry eye and allergy problems, those issues must be properly diagnosed and treated. Therefore, an increase in the number of contact lens patients will actually create an increase in the medical model aspect of one’s practice.
In addition, effectively treating dry eye disease (DED) and allergy patients will frequently prevent them from dropping out of lens wear, which creates two positive results:
(1) The longer patients continue to wear contact lenses, the longer they will stay in the practice, as failed contact lens wearers are more likely to switch to another office. As these patients age and begin to develop conditions such as diabetes, glaucoma, and macular degeneration, the medical model of one’s practice will further increase.
(2) The increased success rate of those contact lens patients will create an increase in referrals.
WHY PATIENTS DISCONTINUE
In order to prevent contact lens dropout, it is necessary to determine why patients are discontinuing wear. There are numerous reasons, but the most prevalent is lack of comfort, which is most frequently associated with the sensation of dryness. The frequency of self-reported dry eye problems is especially high with contact lens wearers.6 In most studies that have attempted to determine the causative factors for contact lens dropout, discomfort or dryness accounts for about 50% of the stated reasons.1
In addition, the importance of handling difficulties cannot be overestimated. For new patients in particular, the inability to easily insert and remove contact lenses is a primary reason for contact lens dropout. In a recent study in England, 502 practitioners were asked why their new patients were dropping out of contact lens wear. The percentage of patients who discontinued lens wear due to handling issues was actually slightly higher than the percentage of those dropping out due to discomfort (58% vs. 55%; multiple reasons could be chosen).10
For new patients, handling is obviously a critical component of continuing to wear lenses. Unacceptable vision is another major reason for lens dropout.
WHAT TO DO
How can contact lens dropout be reduced and what can be done to get contact lens dropouts back into wearing lenses? Fortunately, with our understanding of dry eye and allergy and a wide variety of excellent lens materials, designs, and modalities available, there are good options for reducing dropouts:
• Address DED and allergies. Treating the underlying reasons forDED and/or ocular allergy should result in increased contact lens comfort and wearing success.
• Material does matter. In my opinion, there is a greater chance of contact lens success when practitioners utilize materials that:
– provide high levels of oxygen (eg, silicone hydrogels)
– do not easily dehydrate
– have low modulus
– are naturally wettable and deposit-resistant
– minimally increase tear osmolarity (eg, omafilcon vs. methafilcon11)
• Optimize wearing modality. Fitting patients in 1-day disposable lenses may give them a greater chance of successful wear. Fewer deposits on 1-day lenses means better wettability and a less dry ocular surface, resulting in a more comfortable wearing experience.
• Consider refitting dropouts with 1-day disposable lenses. In a study in which contact lens dropouts were fit with 1-day lenses, Young et al found that 56% were still wearing lenses 6 months after being refit.5
• Provide the best possible vision. Do not cut corners:
– Do not mask astigmatism. There are many toric lenses that have very good rotational stability and provide excellent vision.
– Do not settle for monovision. When given an opportunity to experience both multifocal contacts and monovision, the majority of patients prefer multifocals, which provide much better stereopsis and intermediate vision.12,13
– Extended range options, such as Biofinity XR contact lenses (CooperVision), have significantly increased the number of patients who can now be fit with the latest generation silicone materials while maintaining the advantages of monthly disposability.
Contact lens dropouts can have a significant negative impact on practice revenue. By diagnosing and treating the underlying causes of dry eye and ocular allergy, and by utilizing lens designs, materials, and modalities that provide the best possible comfort, vision, and handling, it is possible to reduce dropouts. Ultimately, the strategies discussed above will lead to better patient retention, referrals, and profitability. n
1. Rumpakis J. New data on contact lens dropouts: an international perspective. Review of Optometry. January 15, 2010.
2. Schlanger J. A study of contact lens failure. J Am Optom Assoc. 1993;64(3):220-224.
3. Weed K, Fonn D, Potvin R. Discontinuation of contact lens wear. Optom Vis Sci. 1993;70(12s):140.
4. Pritchard N, Fonn D, Brazeau D. Discontinuation of contact lens wear: A survey. Int Contact Lens Clin. 1999;26(6):157-162.
5. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. 2002;22(6):516-527.
6. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007;26(2):168-174.
7. Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. 2013;39(1):92-98.
8. GFK, data on file.
9. London Business School. Seeing things clearly: an economic model of the optical retail industry in Europe. London: Euromcontact; 2001.
10. Perceptions of CL wearer retention. Optician. December 2013. http://www.opticianonline.net/perceptions-of-cl-wearer-retention.
11. Montani G. Modification of tear film osmolarity with the use of contact lenses in omafilcon A and methtafilcon A materials. Poster presented at: British Contact Lens Association meeting: 2010; Birmingham, United Kingdom.
12. Benjamin W. Comparing multifocals and monovision. Contact Lens Spectrum. July 2007.
13. Richdale K, Mitchell GL, Zadnik K. Comparison of multifocal and monovision soft contact lens corrections in patients with low-astigmatic presbyopia. Optom Vis Sci. 2006;83(5):266-273.
Harvard J. Sylvan, OD
• Director of Professional Relations at CooperVision