Explore Specialty Markets to Build Your Contact Lens Business

By Linda Conlin, ABOC, NCLEC

INTRODUCTION

Successful brick-and-mortar businesses grow by offering unique products and ser-vices, thereby differentiating themselves from their competitors. While many con-sumers pursue the lowest price for goods and services, we have seen time and again that price becomes secondary to the value of a premium product and especially great personalized service. This is particularly true when it comes to a consumer’s health. By adding a specialty in contact lens fitting for athletes and children, ECPs can build a loyal patient base and brand themselves as offering products and services not easily available elsewhere.

ATHLETES AS PATIENTS

Let’s consider the unique visual needs of athletes. While you may not be the ECP for a professional sports team, many of your patients or perhaps your employees or children participate competitively in sports, whether it is a club, community organization or school, and they take that competition seriously. They invest time and money into training and equipment, all to gain a competitive edge. Remember, they are not looking for bargains, they are looking for a competitive advantage. Vision correction, especially with contact lenses, is the fastest identifiable way to improve performance in sports.

The visual demands of athletes are greater than those of non-athletes, going beyond correction to 20/20, and ECPs must identify those demands and make them a consideration in the contact lens fit.

The Visual Skills required for sports and a competitive edge (from “Color Contact Lenses: Not Just Another Pretty Face,” NCLE presentation, Linda Conlin) are reaction time, focus/acuity, peripheral vision, depth perception, fixation/fusion/tracking, contrast sensitivity and eye-hand coordination.

CONTACT LENSES CAN ENHANCE VISUAL SKILLS

Certainly, reaction time improves with acuity. The more quickly and clearly the athlete can see the stimulus, the faster the reaction. In addition to maximizing acuity, the correction should neutralize astigmatism of at least 0.50 diopters and reduce anisometropia to within 0.50 diopters. Contact lenses then have the advantage over spectacles because they offer more accurate image size, as well as fewer aber-rations, less glare and no reflections. They also won’t slip down, fall off, fog up or become covered with dust, mud or sweat.

The peripheral vision field increases by 15 percent with contact lenses versus spectacles, a big benefit in most dynamic sports. Depth perception improves in anisometropia because contact lenses will bring the image sizes in both eyes closer in-line, helping the athlete with spatial self-awareness. More equal image size between the two eyes improves the ability to fuse the images and that in turn improves fixation. Because the contact lens moves with the eye keeping the optimal vision correction directly over the pupil, it is easier to track a moving target. According to researchers at University College, London and Cambridge University, athletes depend on their visual cues combined with body motion for spatial self-awareness. It’s a critical need for gymnasts, divers and even a basketball player’s long glide to a dunk.

Eye-hand coordination is exactly that. The eye sends an image to the brain, and the brain sends a message to the hand or limb to react. Therefore, it cannot be “hand-eye coordination” as we hear so often. Eye-hand coordination requires a combination of visual skills such as acuity, depth perception, fusion and tracking. It is the precise coordination of vision and motor skills.

Outdoor sports result in long periods of exposure to sunlight. Often, sunglasses are impractical for the same reasons as spectacles. Without protection, rhodopsin, the primary pigment in the rod photoreceptors of the retina, bleaches out. This results in a loss of acuity and contrast sensitivity plus the sensitivity of the rods for peripheral motion detection. UV attenuating contact lenses, especially with a tint, can provide some protection. Lenses that block blue light can enhance clarity and contrast. Blue light tends to focus in front of the retina, resulting in glare or blur. Blocking blue light focuses the remaining light in a tighter range, improving acuity and contrast sensitivity.

Tints in contact lenses also can be sport specific. For example, amber lenses enhance detail, and objects appear to “pop” off the background. They help athletes in fast moving sports such as baseball, field hockey, lacrosse, softball, soccer and tennis. Gray/green lenses enhance red and green to improve detail and contour recognition. Consider recommending them to patients who participate in sports such as football, golf, rugby, running and cross-training. My son used gray/green lenses for competitive rowing after his third pair of sunglasses went overboard and found the reduction of glare and better peripheral vision beneficial.

Contact lenses are available in custom tints so you can work with your patient’s specific needs. Remember that customizing a tint is a form of negotiation with the patient. A good place to start: Find out if your patient prefers a particular lens color for sunglasses and why. Ask if the patient has problems with lighting, whether from the glare of the sun or the white beams of stadium light. From there, identify the usual conditions under which the patient participates in the sport. Show the patient a set of lens tints for spectacles and test which color gives the desired result. Then order the tinted contact lenses in that color. Remember UV protection and a set of clear contact lenses to use if conditions change, or for off the field.

PSYCHOLOGICAL EDGE

The late MLB Hall of Fame Yankees catcher Yogi Berra is purported to have said, “Baseball is 90 percent mental; the other half is physical.” A large part of the “mental” is confidence. We all have noticed professional ath-letes who have certain rituals before or during games or carry a charm for luck. In the practical sense, such things have no bearing on the outcome of the game or competition, but they do boost the player’s confidence. Imagine what the real benefit of improved vision can do for an athlete’s confidence!

Some professional football players have tried to use contact lenses as a “reverse psy-chology” to intimidate opposing players. Buffalo Bills defensive end Mario Williams and Atlanta Falcons defender Kroy Biermann have been seen wearing theatrical style contact lenses to unnerve opponents.

CONSIDERATIONS FOR THE ATHLETE

How and where sports are played will have an impact on the type of contact lenses selected for an athlete. ECPs must consider indoor or outdoor conditions for the sport, the likelihood of impact and the requirement for extreme body positions.

Contact lenses can be worn safely for water sports, with the caveat that lens loss is frequent. Larger diameter lenses offer stability. Thicker lenses will not fold as easily if water gets in the eye. Lenses can tighten when exposed to water, so consider a slightly looser fit. Scleral lenses are an option because they are less likely to dislodge. After leaving the water, the patient should allow the lenses to equilibrate for 20 to 30 minutes, then remove them. Lenses should be cleaned and disinfected immediately, or better still, disposed of. Because of frequent lens loss, avoid rigid lenses. For low astigmatic correction, consider spherical lenses or daily disposable torics when astigmatic correction is needed.

For cold weather sports, remember that they usually involve higher altitudes where oxygen is lower. High Dk lenses allow the most oxygen to reach the cornea. Cold environments are also drier. Low water content lenses will not dehydrate as quickly as high water content lenses. And don’t forget the need for UV protection.

Dynamic sports, impact sports and sports requiring extreme body position require a precise fit. Lens-es must center exactly with minimal movement and no blur after blinking. The lenses must remain stable in extreme positions of body and gaze. Here, too, avoid rigid lenses.

Indoor sports such as skating, racquetball and squash can have a very dry environment and harsh lighting. Fitting considerations are similar to those for cold weather sports with the addition of the use of lens lubricants as needed. Amber tinted lenses can reduce glare while maintaining contrast.

When RGP lenses are the best option for vision correction, start with a larger diameter lens with a large optic zone. Fit the lenses slightly steep for stability and to avoid edge lift. And be sure to dispense a spare pair.

ATHLETES AS PATIENTS

Overall, athletes tend to be good patients. They are generally aware of their physical condition and have good hygiene. On the other hand, they may see a vision problem as a “defect” and try to hide it. Be sure to stress the need for follow-up care, care in handling the lenses and spare pairs. As much as possible, avoid lens or regimen changes mid-season.

Coaches and trainers should be educated about contact lens care and safety. Offer to meet with the coach or trainer to discuss how to handle ocular emergencies for contact lens wearers and lens insertion and removal. You can provide a contact lens “care kit” as part of the team’s medical supplies. Include cases, solutions, a pen light, tissues, printed information, irrigating solution, a mirror and your contact information. With little time and expense, you can have a coach or trainer who is a great source for referrals.

KIDS AND CONTACTS

Pediatric contact lens fitting is another area in which ECPs can offer unique products and services. A 2006 survey by Johnson & Johnson found that only 2 percent of practitioners fit contact lenses for children age 10 and younger, and only 38 percent had prescribed lenses for children between 10 and 12 years old. Among the most common reasons they gave for reluctance to fit younger children were increased risk of noncompliance, lack of communication of problems and increased chair time. But how much of that is perception and not reality?

Consider the following: By age 2, children’s eyes are the same size as adults’ eyes, reducing the need for pediatric specialty lenses. Children tend to be healthier than adults, and so have fewer systemic considerations for contact lens wear. Younger children tend to “follow the rules” and have closer adult supervision. According to a 2007 study of 84 children ages 8 to 12 and 85 children ages 13 to 17 newly fit with contact lenses, the younger group required only 15 minutes more chair time over three months.

The realities of fitting younger children with contact lenses made an impact because a subsequent study of optometrists found that 71 percent were currently prescribing lenses to children 10 to 12 years old, and 21 percent were more likely to fit that age group than they were the year before. Why the turnaround? The ODs cited children’s increased participation in athletics, increased interest in contact lenses at a younger age and increases in children’s confidence with con-tact lenses over spectacles.

WORK THE TREND

Manufacturers are targeting a younger market through social media. The Facebook pages for major contact lens companies provide information about contact lenses in language geared toward teens and preteens, photos, testimonials and motivational slogans. There are also offers for free trial lenses. In many cases, patients and their parents come to their ECPs with a specific lens in mind and considerable information about contact lenses. One manufacturer offers young visitors the ability to send an amusing “I want contacts” ecard to a parent. The card contains links to information about contact lenses, rebates and studies.

ECPs can do the same thing for their prac-tices. Include information on your Facebook page or website about contact lenses for sports, cosmetic appeal and confidence. A “Q&A” section answering questions patients ask most often is helpful. Keep it lively and casual rather than clinical. Include a section for parents.

IT CAN START EARLY

The first year of life is critical for visual development, yet congenital cataracts occur in 1.7 of every 10,000 births. The most common cause of treatable childhood blindness, it is associated with genetics, metabolic disorders, birth trauma and maternal infection. Because babies grow so quickly, use of intraocular lens implants is impractical. Keeping spectacles in place and clean on a wriggling infant is challenging. Contact lenses are an excellent alternative, providing better vision and more accurate image size.

Contact lenses are usually fit seven to 10 days after surgery, and it is important to keep open communication with the surgeon. The difficulties of instrumentation for infants can be sidestepped using an average corneal diameter of 9 to 11 millimeters, and an average keratometry reading of 50.00 diopters. SilSoft lenses are a popular choice because they have a smaller diameter, steeper base curves and an aphakic power range. Estimate the lens power using a direct ophthalmoscope, then add 2 to 3 diopters for close vision. Remember that most of a baby’s world is close up.

Work quickly and confidently inserting or removing the lenses. Once you have the lens in place and it has equilibrated for 30 minutes, evaluate the fit with a penlight and magnifier instead of a slit lamp. The push up test should show 1 to 2 millimeters of movement. Because the infant will spend a considerable amount of time sleeping while wearing the lenses, avoid a tight fit.

The first follow-up visit should be in 24 hours, then in one to two weeks, using the penlight and magnifier to evaluate the fit. Once any adjustments to the fit have been made, follow up every two weeks for overnight removal and cleaning and disinfecting the lenses. Advise parents to apply a lens lubricant every morning and night. After about four weeks, parents must be instructed about lens insertion and removal, and how to identify a decentered lens and recenter it. They must be alert to redness, discharge and the baby rubbing his eye. Because this is an emotional and stressful event for parents, it’s a good idea to provide written instructions.

Another area of opportunity for very young contact lens patients is amblyopia. While it is common to use a patch over the good eye to stimulate the amblyopic eye or eyeglasses with one lens frosted, another option is a completely opaque contact lens. The contact lens serves the same purpose, is more comfortable for the child, stays in place and is cosmetically better. It is certainly an option to discuss with the referring doctor.

NOT A BABY ANYMORE

Beyond infancy, fitting considerations change. Children have larger pupils than adults, so there is more aberration of light. Consider lenses with anterior aspheric optics to minimize the effect. Children are more susceptible to the effects of UV light and tend to spend more time outdoors than older children and adults, so UV attenuating lenses are important. Because of a child’s smaller aperture, smaller diameter lenses will be easier to insert and remove. Before trying the lenses on the child, let her hold and touch the lenses. Tell the child what you are going to do and be truthful. Once you trick or deceive a child, you have lost her trust permanently.

You may not need special instrumentation to fit younger children with contact lenses, just a little ingenuity. You may be able to use a standard keratometer and slit lamp while the child stands or sits on a parent’s lap. A Burton lamp with a cobalt filter can serve in place of a slit lamp, and handheld slit lamps and keratometers are available if you want to make the investment. Most children can use an autore-fractor, again standing or from a parent’s lap, but you can also obtain a handheld autore-fractor. For children who are too young to read, eye charts with tumbling Es or pictures or Allen cards will determine acuity.

THE RIGHT CANDIDATE

Interest and motivation are the top consider-ations for young contact lens wearers, followed by maturity level and ability to take care of the lenses without assistance. Children who are good candidates to wear con-tact lenses are full-time spectacle wearers who frequently break their glasses. While this may indicate carelessness, it may also indicate a child who doesn’t want to wear glasses. In the case of frequently lost or broken glasses, contact lenses are a more convenient and ultimately less costly alternative to replacing glasses. Children who are active and athletic, regularly brush their teeth and hair and have good overall hygiene, or who show a loss of confidence or withdrawal since having to wear glasses are all good candidates for con-tact lenses.

Children and teens tend to resist lists of dos and don’ts. A more productive conversation is one of benefits versus responsibilities. Benefits include better vision, convenience, flexibility with activities and cosmetic appeal. To reap the benefits, the child must understand the responsibilities: keeping the lenses clean and changing them at the appropriate time, awareness of possible problems and honest reporting of any issues, and asking to reorder lenses before the last pair. Be aware that chil-dren may be afraid that the lenses will be taken away if they have any problems.

It is also important to determine the parent’s attitude toward contact lens wear. Does the parent want the child to wear contact lenses more than the child does? Are contact lenses a bribe or bargaining chip? For exam-ple, “If you don’t get an A in math, I’ll take the lenses away.” If the parent wears lenses, does she have bad contact lens habits that the child will learn? Frequently, you will find the answers to those questions during insertion and removal instruction. A parent who push-es a child who is having difficulty handling the lenses and interrupts or contradicts the instructor sends up a red flag. In those cases, ask the parent to wait outside. Then have an honest conversation with the child about contact lens wear to be sure he is the one who wants the lenses.

Be sure the child can insert and remove the lenses himself before allowing him to take them home, even if the parent insists otherwise. Flexibility and creativity with insertion and removal instruction is helpful. Working over a table rather than a sink results in less upset over a dropped lens. Give basic instructions, then observe dexterity and how the child responds. If one method doesn’t work after 5 minutes, try something a little different. Coach rather than instruct, be patient, don’t harp on mistakes and be generous in praising success. Be alert to the child’s frustration level and end the session or take a break when needed.

Care regimens for children should be as simple as possible. Of course, daily disposable lenses are the easiest. When a fit with a different type of lens is warranted, one-step solutions and frequent replacement are a good option. Be generous with extra solution samples and cases, and be sure both the child and parent understand that solutions should never be topped off.

NEXT STEPS

This exploration of contact lens opportuni-ties suggests a close look at the contact lens business in your office. Identify select target populations like athletes and children by mining your practice management software. Then advertise your fitting skills and expertise for the athlete and child through traditional channels and social media. Growing a contact lens practice with specialty groups can grow an overall contact lens practice.