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Growing Your Practice Using Silicon Hydrogels
Silicon Hydrogel materials represent a major paradigm shift for contact lens fitting. Like many of us I have been conservative in fitting this lens category on an extended wear basis purely on the disappointing experience I had in the 80's with high water content polymers.

What has been obvious since then is that contact lens wearers love not having to take out their lenses every night. Convenience is probably the most important motivator in contact lens wear.

With the oxygen battle finally won, our practice has gradually moved a significant percentage of our contact lens patients from two weekly daily wear disposables to some form of continuous wear. All new fits are either offered silicon hydrogels on a continuous wear basis (starting with monthly) or daily wear if the patients feel that they will only be a part-time wearer. The conversion to silicon hydrogels has been fairly simple. We offer:

  • A healthier alternative
  • A more convenient alternative
  • Lenses that are more comfortable in most cases
  • Eyes that a whiter (an incredibly powerful point)

It has been obvious for many years that two weekly or monthly daily wear lenses were becoming less and less profitable. This occurred because the modality was promoted as a commodity and not a medical device by our suppliers. The profession also was responsible for the erosion of profits by haphazardly supplying free trial lenses and solutions. Patients consequently placed less value on the service of the prescribing optometrist and sought cheaper prices and more convenient purchasing sources once the fitting process was complete. Combined with this, two weekly lenses were often worn for four to eight weeks and monthly lenses for up to three months. Unfortunately both the profession and suppliers have suffered.

Even though our practice is known for specialty contact lens fittings such as keratoconus, post corneal graft and orthokeratology, today more than 50% of our contact lens product income is derived from disposable lenses. Believe it or not four years ago when silicon hydrogels were only just released, disposable lenses represented only 15% of our contact lens product income and slowly but surely declining. This incredible growth is directly attributable to continuous wear silicon hydrogels. Along with this our consultation income has increased by over 30% due to the extra chair time silicon hydrogels demand. Patients for the time-being are not searching for cheaper prices and they are unquestionably more compliant with disposal. Another growth strategy that we have implemented has been the sale of yearly supplies, which coincides with the consultation. If all is well, pre-appointment in another year occurs with strict instruction on immediate consultation if redness, vision decrease or discomfort occurs.

One of the disadvantages with continuous wear silicon hydrogels is the extra chair time and the increased number of incidents that occur. Incidents such as peripheral corneal infiltrates, superficial epithelial arcuate lesions and giant papillary conjunctivitis are not infrequent. Ironically it is this extra chair time that embeds in the contact lens wearers mind the importance of the contact lens practitioner and adds to the overall growth potential of this product.

These incidents will often require therapeutic intervention. In the state of NSW we are still not permitted to write prescriptions. This necessitates a referral to either a local GP or to an ophthalmologist. A practice builder for us has been the referral to the GP with an appropriate referral letter. This will include the diagnosis and a therapeutic plan. Peripheral corneal infiltrates require a topical steroid with antibiotic cover, GPC requires a topical steroid with an antihistamine - mast cell stabiliser combo (Patanol) and SEAL require refitting with a different peripheral curvature to stop the mechanical interaction. GP's in many cases on our advice will start the treatment and are delighted with the results. Many referrals have resulted once the GP perceives that we are competent in managing these red eye cases. From this further referrals have occurred once confidence in our eye-care ability has been established in the GP's mind.

Even though this increased frequency of complications might suggest that continuous wear silicon hydrogels are more dangerous than conventional daily wear lenses, anecdotal evidence seems to suggest that they are at least as safe. Microbial keratitis in my practice is definitely not more prevalent. Studies soon to be published, I think will put this misconception to rest, later this year.

In the last year or so we have noticed that laser enquiries have decreased, as have our referrals for this procedure. Once our patients experience success with continuous wear silicon hydrogels there is little reason to seek a more invasive option. Patients in general are interested and keen to try new options and technology. Silicon hydrogels represent a non-surgical totally reversible visual correction option. The combination of these benefits open up a unique opportunity to grow ones contact lens practice and for the first time in many years revitalise our professional interest in contact lenses.

One cannot underestimate the importance of recommending new technology products to your patients. As the years have past, low Dk hydrogel disposable lenses had stagnated and consequently we were just re-prescribing the same product, time and time again. It did not take long for our patients to realise that we were not delivering anything special. Deals were being done; advertising was demystifying the contact lens fitting process. Consequently our patients started to look elsewhere for cheaper sources. Now with silicon hydrogels, it seems that every time we consult we are in a position to offer better, healthier options. This has created a renewed interest in attending every year to find out what is new and what can we deliver to make life in contact lenses healthier and more comfortable.

Because our patients' perception is no longer stagnant, I believe that they value our service more. This in turn allows us to have more frequent contact with them and consequently we are recommending and refitting better options. We have progressed from Ciba Night & Day to Bausch & Lomb Purevision and then the release of Ciba Night and Day 8.4 base curve. Early next year I am eagerly awaiting the release of the Ciba O2 Optix. This new material promises to revolutionize contact lens fitting again. With a Dk of 138 and two weekly replacement, it is likely to frog leap all other products. Its high Dk and low modulus will initially be released as a daily wear lens. There is no doubt in my mind that it will be suited to continuous wear. Logic seems to suggest that this material will reduce the number of complications we currently see. Time will tell.

Continuous wear silicon hydrogels are now the option of choice for most of our contact lens wearers. I believe it is imperative that we all market our databases effectively to regain control of the contact lens market again. Silicon Hydrogels are now readily available to allow us to achieve this.



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