Silicone Hydrogels - Managing Change. Did you miss the boat?

Jim Kerr, O.D. Graduated from the University of Waterloo School of Optometry in 1976. Served as President of the Saskatchewan Association of Optometrist and President of the Canadian Association of Optometrists. Practices in Saskatoon, Saskatchewan, Canada in a large group practice. Has served on many contact lens advisory boards including Ciba Vision, Johnson and Johnson Vision Care, Wesly Jessen and Bausch and Lomb. Currently involved in clinical research in Extended Wear. Serves on the Board of Directors of the Horizon Laser Vision Center. Has spoken extensively on Silicone Hydrogel lenses over the past 3 years.

It may have been premature of me to declare that “HEMA is History” in 1999 when Silicone Hydrogel lenses were new to the contact lens market. Silicone Hydrogels had limited parameters, were recommended primarily for overnight wear and subsequently took some time to gain traction in the market. There was no doubt in my mind however that the increased oxygen that may permeate through these lenses provided a significant advance in contact lens technology, and as such they would eventually replace HEMA as the material of choice for most, if not all contact lens applications.

The proliferation of Silicone Hydrogel products and modalities available today is now making this prediction come true and these lenses have now captured up to 45% of the market. With this success follows the inevitable “comodization” of the lenses and the erosion of profitability. A question I am often asked is “how can we compete” with internet sales and big box stores? In answering this I acknowledge that although it is not easy to compete we continue to have opportunities to provide the best contact lenses for our patients whilst maintaining profit at the same time.

Our practice in Canada has seen a significant increase in contact lens revenue over the past 5 years using primarily silicone hydrogel lenses. We have achieved this by following the strategies outlined below:

• Recommend the best
  By recommending the lens which you consider is the best for that patient (taking into account fit, tear-film and wear schedule etc) you reduce the potential for discomfort and discontinuation. Also by continuously updating your patients into new lenses when possible you maintain their trust in your ability to provide then with appropriate and up-to-date products. You are the expert – they come to you for your advice. Give them the latest lenses and the best solutions.
  
  
• Make sure that your patients comprehend the cleaning and wearing schedules recommended by you, and also the potential complications. Often it helps to either give them written information, or to get them to repeat the cleaning schedule back to you so that you are confident in their understanding.
  
  
• Charge a fitting fee
  All lenses are not the same, and recent findings show that some lenses and solution pairings are potentially incompatible. Time is required in order to fit, assess, and monitor lenses and any possible adverse reactions, especially in overnight wear.
  
  
• Bundling and Multiples
  Lens/solution interactions mentioned above and also poor patient compliance with care regimes can be managed by the packaging lenses with specific solutions (bundling) and providing multiples (ie a year’s supply rather than a 3 month or 6 month supply). This will help to encourage both patient compliance, and practice profits. The chart below shows how revenue is directly associated with “multiple” sales. We made a concentrated effort over 2001-2005 to provide annual supplies to patients, rather than only 3 or 6 months. The chart below shows a direct correlation between increase in multiple sales and increase in overall revenue. In our case increasing multiple sales resulted in an increase in contact lens revenue of over $200,000. Due to this and other efforts, contact lenses have returned to generating profit in our practice and are currently accounting for over 20% of gross revenue.
  
  
  
  
  
  
• Payment Plans
  Another important factor in multiple sales is payment options. The new world survives on monthly payments and we offer all patients who purchase an annual supply of contact lenses a monthly payment option. Each patient is given the option of direct debit from their account over a period of up to one year. This allows them to budget for their contact lens costs and significantly improves compliance. We have them pay 25% down and give them the option of adding their glasses payment to the plan.
  
  
• Limit the companies you deal with
  Maximize rebates, discounts and marketing dollars by partnering with fewer suppliers. You should never compromise your professional judgment, but if products are equal it makes sense to align yourself more with one company to increase the financial benefits for both you and your patients. This can be done directly or through your buying groups.
  

Silicone hydrogel lenses are no longer considered new to the market. It is not too late to profit by the use of these new products and clinically it is the “right” thing to do for your patient’s eye health. Now that they are more “main stream” you may have to kick your “business” sense into gear to compete and profit.

HEMA is History but contact lens practice survives and can be better than ever. Get on the boat before the ship sails.