This article is more than 5 years old. Information may no longer be current.
Daily disposables, extended wear: experts predict increased patient interest, market share
Click Here to Manage Email Alerts
Round Table Participants | |||
 | ---Michael D. DePaolis, OD, FAAO, Editor of Primary Care Optometry News, is in private practice in Rochester, N.Y. |  | --- Michael Pier, OD, is director of professional relations for Bausch & Lomb, Rochester, N.Y. |
 | ---Dwight H. Akerman, OD, FAAO, is director of professional services for Wesley Jessen, Des Plaines, Ill. |  | ---Howard B. Purcell, OD, FAAO, is director of professional affairs for Vistakon, Jacksonville, Fla. |
 | ---Garold L. Edwards, OD, FAAO, is vice president of technical affairs for Specialty Ultravision, Campbell, Calif. |  | ---Richard E. Weisbarth, OD, FAAO, is executive director of professional services, North America, for CIBA Vision, Duluth, Ga. |
Michael D. DePaolis, OD, FAAO: We all recognize the benefits disposability has brought to our patients and our practice in terms of eye health, patient satisfaction and convenience. Given the mantra that more frequent replacement is better, why aren’t the vast majority of our patients currently wearing a daily disposable lens?
Dwight H. Akerman, OD, FAAO: I believe that practitioners feel there is a diminished return to disposability. During the past 13 years that disposables have been available in the United States, practitioners have found that 1- to 2-week disposables work very well. There are very few physiological complications as long as the patient is compliant. So, because there has been such a high success rate, for most patients, a daily disposable probably isn’t necessary. This is one reason why practitioners have not completely embraced daily disposables as their primary mode of prescription.
International markets
Garold L. Edwards, OD, FAAO: At the same time, if you look at international markets, particularly some European markets, daily disposables are huge, up to 30% of the value and 90% of the volume of the market. In the United States, it’s a cost/value thing. Practitioners perhaps are still more concerned about the patient’s pocketbook.
Dr. DePaolis: That’s a good point. Overseas, where daily disposables have a much greater penetration, are the economics the same? Is the relative cost of a 2-week disposable lens compared with a daily disposable on an annual basis about the same as it is here in the United States? Or are daily disposables priced more competitively in most European nations?
Michael Pier, OD: We’re comparing apples and oranges. In the European theater right now, 2-week disposables are not big players. One-month disposables are big players. The overall price/value equation to a patient with an option of daily disposables vs. 1-month disposables makes the jump more equitable than it does from 2 weeks to 1 day. So, missing that interim 2-week disposability makes the value of a daily disposable, in a patient’s mind, much higher because the convenience is there. All patients and practitioners do not embrace the mantra that more frequent replacement is better.
Dr. DePaolis: Do our European colleagues have data that says the vast majority of their patients are currently replacing lenses on a monthly basis? If they make that leap to daily, are patients happier overall?
Howard B. Purcell, OD, FAAO: The data speak more to the health aspect of it. Japanese practitioners have bought into the health concept and are telling patients that this is truly the healthiest way to wear lenses. There is an obligation to tell patients about daily disposables. If I don’t present the option of daily disposability to my patient, I believe it’s bordering on malpractice.
Too few practitioners in the United States are proactive with presenting contact lenses. That’s one of the real differences.
Present daily disposables as option
Dr. DePaolis: How are practitioners presenting daily disposables at this point?
Richard E. Weisbarth, OD, FAAO: Most practitioners still have misperceptions about daily disposables. The fact that the United States was one of the first countries where they were introduced is part of the reason for that. Typically, practitioners mention weekly and monthly lenses. If they mention daily disposables, they say that they are really expensive. Practitioners must embrace a belief that it truly is the best option for their patients, and they have to find a presentation style with which they are comfortable.
Practitioners who have successfully embraced it are trialing patients to let them see what it’s all about. They are recommending it to their patients as the best option.
The final thing is to demonstrate to the patient that you literally put it in, take it out and throw it away. That demonstration is very powerful.
Develop equitable fee schedule
Dr. Purcell: We did a study in Manhattan where we had price shoppers call practices and ask about a daily disposable modality. More than 50% of the time, the person was told that he or she probably would not want to use daily disposables because of cost.
Dr. DePaolis: Any additional clinical pearls?
Dr. Akerman: Practitioners must develop a fee schedule that makes it equitable to prescribe daily disposables. Weekly and bi-weekly disposables have been available in the United States since 1987, and practitioners have developed fee schedules with which they are comfortable and can make a fair profit. Many practitioners have not developed that same type of fee schedule for daily disposables. So, many practitioners feel like they are not making a fair profit with them. Hence, the economics are guiding their decision not to present the option proactively.
Dr. Purcell: In addition to cost, I’ve seen practitioners present the convenience aspect. Even a 2-week wearer responds positively to the fact that he or she doesn’t have to bother with the care systems.
Direct-to-patient shipping
Dr. DePaolis: Let’s talk about direct-to-patient shipments. This transcends all lens categories, but it’s particularly germane to daily disposables. Is there an advantage for practitioners to embrace more frequent replacement technologies by assuring patients that the products will be shipped directly from the manufacturer to the patient? There is nothing more convenient, and there may be better retention.
Dr. Purcell: The data are clear on that. In 1995, we began the doctor-controlled patient delivery systems with the launch of 1-day Acuvue. Back then, we had to wear flack jackets in the field when just bringing that issue up. Today, with our Acuvue 2 product, nearly 80% of private eye care professionals’ orders go out through doctor-controlled patient delivery. Clearly, there’s been evolution there.
Dr. Edwards: In the United Kingdom, lenses are directly debited from a patient’s checking account on a monthly basis, and lenses go out to those patients on a regular schedule, every 3 or 6 months. In addition to the convenience of throwing the lenses away at the end of the day, these patients never have to write checks. The lenses just show up on the doorstep.
Dr. Pier: We started our lens center program in 1993. The resistance then was sharing the patient’s name and address with the manufacturer for fear that the manufacturer would “steal the patient.” This has not happened, nor will it happen. I think that particular initial fear is gone now.
In the United States, many practitioners want to be paid for a 6-month or 1-year supply, and then they will direct shipments to the patient. Patients resist that, especially when the ticket is rather high.
In Europe, they are charged as the shipments are sent.
Payment schedules
Dr. DePaolis: We’ve grown up in an industry where payment is due before lenses are dispensed. How would you recommend that practitioners set up an amortized payment schedule for a year’s supply of lenses?
Dr. Pier: Patients can use their debit cards. The credit card company will automatically take care of that with the proper authorization. You don’t have to hire an additional person to do this. If you’re going to practice optometry independently as a businessperson, you’ll have to look at alternative payment plans.
Dr. Weisbarth: Practitioners don’t like to change office systems that are already in place and are working. In our profession, compared with other health care professions, we are very involved in the system. Other health care professions use ancillary staff to discuss fees and financial arrangements.
Practitioners can fit patients in trial lenses and then have them talk with an ancillary staff member if they like the lenses. This way, the doctor has completely divorced himself or herself from that equation and has gotten a staff member involved.
Changing habits
Dr. DePaolis: It’s a matter of logistics. It’s a matter of changing procedures and habits, which need to be changed if you’re going to be competitive and moving forward.
Dr. Purcell: Clinicians today are far and away better than those who graduated years before them. However, we still fall short in terms of helping them to be better businesspeople.
Dr. DePaolis: It never ceases to amaze me that we have no problem writing a prescription for a drug that costs a dollar a day, but we labor over prescribing a contact lens for a dollar a day.
Dr. Pier: The difference is that we don’t know how much the drug costs the patient, but we definitely know how much the contact lens does. If a third party were selling the contact lenses, we’d be more than happy to write a 1-day prescription.
Dr. Akerman: Unfortunately, optometry has been a material-based profession for most of its existence. The majority of profits in an optometric practice historically have been from materials. For this reason, many practitioners think about the patient’s pocketbook rather than thinking about what’s really best for that particular patient. In other professions, income has been derived from professional services and not from materials whatsoever.
Future market penetration
Dr. DePaolis: We cannot be that different from our European colleagues. We all agree that daily disposables aren’t appropriate for 100% of the contact lens wearing population. But, certainly, it should be more than the current 2%.
Where do each of you think daily disposable lenses will be within the next 2 years in terms of market penetration?
Dr. Akerman: At the end of 1999, daily disposables accounted for approximately 5% of the manufacturer’s revenue of all soft contact lenses. This is up 18% over 1998. I believe, in the next 2 years, that will at least double as practitioners learn to use these direct shipment options and as they learn how to structure their fee schedules so they can be adequately compensated for the responsibility they are assuming with that patient.
Dr. Purcell: We haven’t talked about maximizing performance. In the future, with refractive surgery, 20/20 may not be enough. We may push the envelope and try to give our patients 20/15 or 20/10 vision. If contact lenses are going to be able to compete with that, we’re going to have to look to the modalities that not only maximize health opportunities, but also maximize patients’ performance in terms of their overall visual performance.
As competition continues to grow for those particular patients, we must select the lenses that will not only provide the best health for our patients but give them the best overall visual performance.
Dr. Weisbarth: Our numbers show that daily disposables are 2% to 3% of fits in the United States, and we expect that to grow. At least a doubling in the next 2 years is a very reasonable projection. But it’s very difficult to predict. However, we can gather some very valuable information by looking at trends overseas. Practitioners need to decide whether they want to be in on the front end or whether they want to wait until the United States catches up with everybody else and the competition increases.
Demand and cost will drive future use. As more and more patients are fit in daily disposables, they will be walking billboards. Additionally, the cost of the product will come down. Daily disposables are very much on an elasticity curve. At $2 a day, only a certain number of patients are interested. At $1.75, the number goes up a little bit. Right now, about $1 a day is the magic number. If we can get the price below $1, there will be tremendous interest.
Dr. Pier: My prediction is that we will continue this slow and steady penetration or growth in daily disposables until we hit a critical mass. And then, at that point, it will start to geometrically increase. Now, whether that particular critical mass has to do with a word-of-mouth referral by patients or having the lenses drop-shipped remains to be seen.
Extended-wear lenses
Dr. DePaolis: The ultimate in contact lens convenience, of course, is a lens that is worn for a predetermined period of time and then removed and thrown away. Consumer research has shown that if we can assure our patients that this is a reasonably safe modality, they will do it. Why then, in this day and age where patients are willing to accept the risk in undergoing a laser in situ keratomileusis procedure all in the name of convenience, are we not seeing more extended-wear fits?
Dr. Pier: We have optometrists who are trained in technologies and materials from 1975. We’re dealing with a completely different technology today.
Dr. DePaolis: Do you feel that this is a gradual process and that clinicians will embrace newer extended-wear modalities after they get their feet wet?
Dr. Pier: One of the reasons that refractive surgery is popular is because patients can wake up and see. There is a consumer demand. But, we have done a great job during the past 20 years of telling patients that if they sleep in a contact lens, they will harm their eyes. And they have believed that, as they should. Today, it’s hard for us to change our tune based on our experiences.
Dr. Weisbarth: Practitioners are experiencing a cautious optimism right now. They’ve been burned once with the first generation of extended wear. They were burned twice when disposables came out and they were told that is was a safer option. So, the third time around, they’re a little more cautious.
The products are going to prove themselves in the marketplace. Patients want convenience, comfort and clarity.
Dr. Edwards: There’s a bit of a price/value disconnect. If you tell a patient that he or she will get 12 pairs of 30-day continuous wear lenses for $500 a year compared with 350 pairs of daily disposable lenses for the same $500, they don’t get it. They don’t understand the reason for the unit price differential.
Dr. Pier: We should not be gearing our value to the number of lenses in the box. You have to look at what the patient is actually getting in terms of vision. The mantra now is 20/10 by 2010.
Dr. Purcell: Another piece that ties to it is diagnostic tests. We don’t have a diagnostic test to determine the amount of oxygen required for a particular patient.
Patient motivations
Dr. Edwards: Health and physiology are important, but it’s also important to understand the patient’s desires and motivations.
Dr. Weisbarth: It’s important that patients have options. They want to know more and control their own destinies. However, our recommendation to the patient still carries a tremendous weight.
Dr. DePaolis: Are 30-day lenses now or soon to be a safe, viable alternative?
Dr. Edwards: As long as a lens crosses the limbus, I’m going to have concerns about extended wear. And the longer the period of extended wear, the greater the concern I’m going to have. I don’t like extended wear, and I don’t promote extended wear. I know some patients like it and demand it. Seven days is not an unreasonable period of time, but I like to have the lens off the eye once a week just for the cornea to get some fresh tears flushed over it, if nothing else.
Dr. Purcell: Patient selection is an important process. I’ve got to take a look at that patient and feel good about the fact that I’m going to partner with him or her in this extended-wear process. Clearly, I am responsible for what happens to his or her eyes with those lenses.
Appropriate follow-up is important. I want to see that patient at the end of the wearing schedule. I want to see the patient at his or her worst so that I can make some decisions about whether or not this is appropriate for that patient.
Dr. Pier: If you’re a contact lens practitioner, by virtue of your desire, education or expertise, and that’s how you present yourself to patients, then be that — be that doctor for your patient. Administer to them, take care of them. Give them the options, and then manage the one they choose. Your job is to take care of your patients, not to refer them away to someone else because you’re afraid to take responsibility. That’s your job.
For Your Information:
- Dwight H. Akerman, OD, FAAO, can be reached at Wesley Jessen, 333 East Howard Ave., Des Plaines, IL 60018; (847) 294-3283; fax: (847) 294-3962; e-mail: dwight.akerman@w-j.com.
- Garold L. Edwards, OD, FAAO, can be reached at Specialty Ultravision, 307 Orchard City Dr., Suite 100, Campbell, CA 95008; (408) 341-0700; fax: (408) 341-0717; e-mail: gedwards@ultravision.com.
- Michael Pier, OD, can be reached at Bausch & Lomb, 1400 N. Goodman, Rochester, NY 14603; (716) 338-6106; fax: (716) 338-0825; e-mail: Michael_D_Pier@Bausch.com.
- Howard B. Purcell, OD, FAAO, can be reached at Vistakon, 7596 Centurion Pkwy., Jacksonville, FL 32256; (904) 443-1019; fax: (904) 443-1252; e-mail: hpurcell@visus.jnj.com.
- Richard E. Weisbarth, OD, FAAO, can be reached at CIBA Vision, 11460 Johns Creek Pkwy., Duluth, GA 30097-1556; (678) 415-3560; fax: (678) 415-3151; e-mail: rick.weisbarth@cibavision.novartis.com.