30-DAYContinuous Wear: PRACTICE IMPACT
Two surgeons discuss how offering these contact lenses has affected their bottom lines, LASIK case volumes and patient attitudes.
By Christopher Kent, Senior Associate Editor

Thanks to their breakthrough technology and promising safety record, the new 30-day continuous wear contact lenses have received a lot of attention. But as a relatively new offering at most ophthalmology practices, their impact on practice management hasn't been clearly established.

To help shed some light on this issue, we interviewed two surgeons who have offered these lenses since they became available: Bruce H. Koffler, M.D., president of the Contact Lens Association of Ophthalmologists, who practices at the Kentucky Center for Vision in Lexington, Ky., and Peter C. Donshik, MD., F.A.C.S., an internationally known expert in contact lenses practicing in Bloomfield, Conn.

Patient reaction

Both Drs. Koffler and Donshik report that patient and staff experience with the new 30-day lenses has been extremely positive -- once preconceptions have been surmounted.

"We were concerned at first, but as it turns out, patient satisfaction is extremely high," says Dr. Koffler. "From our perspective, it's been a nice learning experience to see how white the eyes are in patients wearing these lenses, how little ischemia we find, and how comfortable the patients seem to be. This has caused a change in how our staff thinks about continuous wear. We were hesitant to offer something like this in the past. Now we're getting excited, seeing very positive results.

"Actually," he adds, "I wasn't convinced that patients would really care about being able to wear the lenses more than 1 week. But they really like the 30-day regimen."

Dr. Donshik concurs. "Some patients are hesitant to try them; their first reaction is, 'I've been told they're not safe.' So we have to re-educate them.

"Nevertheless, our patients like the lenses; they like being able to sleep in them. Some patients have initial awareness of them, but that wears off quickly. Then they're quite comfortable."

Effect on revenue

Both doctors said that their practices have benefited financially from offering the new lenses. "A significant number of our patients are interested in them," says Dr. Donshik. "These patients don't want the hassle of daily care. As a result, we're definitely getting more word of mouth. The number of contact lens patients we're seeing has increased."

Dr. Koffler reports a similar experience. "Until recently," he says, "we used 'extended wear' lenses sparingly. Now we have close to 40 patients wearing continuous wear lenses, and of course this affects practice revenue. Some patients who weren't contact lens candidates before are wearing them. Some patients had trouble manipulating lenses, putting them in and taking them out. With these lenses that's not an issue.

"I'd say that continuous wear lenses now comprise 10% of our contact lens business, and we think that will increase exponentially. We're seeing a lot of word of mouth."

Neither practice has spent a lot of money promoting the new contact lenses, but Dr. Donshik reports that his practice has "more than recouped" the amount they've spent.

Monitoring patient health

Both doctors follow patients wearing these lenses a little more closely than other contact lens patients, at least at the outset. "We see these patients once or twice a year more often than daily wear patients," says Dr. Donshik. "That, plus the increase in number of patients, means more office visits."

Dr. Koffler concurs. "We see these patients the first week, at 1 month, 3 months, 6 months, then every 6 months."

Both doctors said they check for the same things they'd look for in any contact lens wearer, and neither doctor uses any special tests when fitting or monitoring these patients.

Issues yet to be resolved

As you might expect with any new product, some issues remain to be resolved:

Patient age. Dr. Koffler says he's not sure if there's an age cutoff for this modality. "We're currently fitting a few 17- to 18- year-old patients, but we're not sure how young we dare to go. Fitting younger patients, such as teenagers, could increase mouth to mouth referrals, but it raises issues of compliance, cleanliness, maturity and more active lifestyles, including sports. This is a different patient group. We don't yet know whether this will be a positive answer for them."

Safety. Dr. Donshik cautions against becoming too cocky about the safety of the new modality. "The initial data shows the increase in oxygen has significant benefits for the cornea, and these lenses have probably solved the problem of increased risk of infection with extended wear. The complication rate is less than with extended wear -- maybe even less than with daily wear lenses -- but you have to remain aware of the potential for complications."

Limited available parameters. Both doctors agree that the limited parameters currently available are a drawback. "I'm waiting with baited breath for increased plus and torics," says Dr. Donshik. "And I see many patients with significant astigmatism, including LASIK patients who would opt for these lenses if the lenses could correct their astigmatism."

An option worth offering

Dr. Donshik and Dr. Koffler are both enthusiastic about the new modality. "These lenses are easy to fit, very durable, and they give patients good vision," says Dr. Koffler. "They center well and maintain white eyes. We've had a high degree of patient satisfaction.

"I think these lenses have a place in everyone's practice," he says in summary. "Doctors who've been hesitant in the past should give them a try."

Dr. Donshik agrees. "Doctors should get into offering these lenses and shed their previous negative opinions and concerns about this. This is not just a repackaging of old lenses. It's a truly new lens; it's the first major breakthrough in materials since the previous extended wear lenses.

"I embrace them. They're an important addition to our practice, and an important opportunity to offer patients something new and relatively safe. Plus," he adds, "patients like them. This modality is a good practice builder."