This Month’s Moderator: Janelle L. Davison, OD
Despite the volume of information available to us optometrists these days, it remains challenging to successfully merge clinical expertise with business acumen. Because these two skillsets inseparably support each practice, we must optimize both as they relate to the category of contact lenses. As contact lens technologies have changed dramatically over the past few years to offer improved features and visual benefits, we have had to match these advancements by creating a new experience around fitting them. We have learned to cultivate long-term relationships with patients that emphasize a premium level of care in order to compete with discounters. Similarly, issues of affordability and insurance reimbursements pose challenges to creating a strong revenue stream, and we don’t want to feel forced to choose between what’s best for our patients and what’s affordable for our practices.
This inaugural edition of Business Matters is focused on the recent technological strides made in toric contact lenses and the opportunities these advanced lenses present for astigmats. With improved performance, comfort, stabilization, and greatly expanded treatment ranges, today’s toric contact lenses can treat many more patients and be a win-win for our patients and for us as practitioners.
— Janelle L. Davison, OD
ABOUT MY PRACTICE
Name: Founder and owner, Brilliant Eyes Vision Center and the Visionary Dry Eye Institute
Locations: Smyrna, Georgia and Marietta, Georgia
Type: Private practice in a suburban area with own optical.
Demographics: Approximately 70% of my patients are Black; the rest is mixed between mostly Hispanic and White. My patients are predominantly female. Age range is 60% Millennial and Gen X; the majority of the remaining percentage is Gen Z and Baby Boomers. Pediatrics make up less than 10% of my patient population.
Contact lens volume: All contact lenses and services represent approximately 31% of business sales. Contact lens annual supply sales are around 40% of total sales. Specialty scleral lenses are about 5% of sales.
As the owner of Brilliant Eyes Vision Center in Smyrna, Georgia, I provide full-scope primary eye care to my patients. With the help of my staff, I perform comprehensive eye exams, treat glaucoma, comanage cataract and LASIK patients, and treat dry eye disease at a secondary satellite location (the Visionary Dry Eye Institute) I opened earlier this year. I also provide vision correction services fitting patients with eyeglasses, soft contact lenses, and specialty lenses, depending on their desires and lifestyle needs.
Over the years, vision care plan insurance reimbursements for contact lens evaluations, fittings, and materials have steadily declined and affected our practice’s revenue and profitability. However, we don’t offer contact lenses to make a lot of money; we do it to improve our patients’ quality of vision and life. We have been able to do that more recently for our patients with astigmatism thanks to advances in technology. All that said, I do put serious thought into my contact lens pricing, which I’ll discuss in this article.
CONTACT LENS BUSINESS
Contact lens examinations (including disposables, reusables, scleral lenses, and hybrid lenses) represent approximately 31% of our clinic sales. Contact lens annual supply sales are around 40% of the total sales in our optical. Our patients who have irregular astigmatism secondary to keratoconus fall under our specialty scleral practice, and they represent around 5% of our patients. Most of our toric contact lens patients opt for daily disposable contact lenses; however, approximately 3% prefer the sharp, clear vision of a rigid gas permeable or hybrid lens.
Pricing
Regardless of type, the revenue margin on contact lenses is slim. We do not price our toric contact lenses any differently than our other contact lenses, and I aim to price our contact lenses on par with local competitors as best I can for a small, independent clinic. Toric contact lenses are usually more expensive than standard lenses. When patients ask why, I explain that they contain more technology, but they also offer more flexibility in terms of freedom from glasses and better visual acuity than spherical lenses.
Our biggest competitors are 1-800 Contacts and Costco, so my staff and I check their pricing regularly. I don’t price below the big-box stores, but I make sure we’re able to offer rebates and other incentives that our competitors may not have access to, so our prices are in the ballpark. Sometimes our pricing is much lower than our competitors’ with insurance and rebates, and sometimes we can’t compete on price. Many patients don’t realize that the big box stores do not always have the cheapest price for contact lenses. The price the big chains advertise is not necessarily the price the patient qualifies for.
We use a proprietary software system that helps us calculate charges for both glasses and contact lenses (this same software also generates a price comparison between us and our local competitors). It accounts for any allowance the patient’s insurance provides and any rebates offered by the manufacturers, and it produces the final price for a 6-month supply of contact lenses versus a 1-year supply. Usually, the 1-year supply maximizes their insurance benefit and gives them the best price. We prefer to sell only annual or 6-month supplies of contact lenses so we can ensure patients are being compliant with their use, whether the lenses are astigmatic or spherical. We offer payment installment plans and buy-now-pay-later plans to keep those sales in house.
Education
My staff and I take the time to educate all our astigmatic patients about new toric contact lens technology and ask if they are interested in trying them. If we find that a new patient has astigmatism and is not using toric contact lenses, it is usually one of two reasons: either they were told they weren’t a candidate for them, or they had a poor experience with these lenses in the past. I address their concerns and I explain how these new, advanced lenses will benefit them.
Because I treat a lot of dry eye disease, there are certain contact lens materials that I think help ease those symptoms and that I recommend routinely for those patients, such as lenses with high water content.
Fitting
My minimum fit for a toric contact lens is 0.75 D of astigmatism. Research has shown that toric correction for even low amounts of astigmatism gives patients better visual performance,1 especially when using computer screens.2 Toric contact lenses have come such a long way that they don’t take me any extra time to fit versus spherical lenses. The manufacturers have figured out how to make toric contact lenses stabilize quickly, and most settle within 90 seconds. Also, the fitting guides of new-technology toric contact lenses have made it very easy to fit these patients.
My team helps with the lens fittings. Typically, after I do the examination and have the conversation with the patient about the need for a toric contact lens, one of my staff members fits the patient in a diagnostic lens. The team member shows the patient a video about the correct way to insert and remove the lenses (and clean them, if it’s a reusable lens). This technician also answers any questions the patient may have at that time. Another staff member counsels the patient on pricing and insurance and schedules the follow-up visit.
Follow-Up
I like my toric contact lens patients to return for their follow-up within 1 week (at most, 2 weeks, if it’s a 30-day reusable lens). One week is usually enough time for the patient to adjust to the material and the prescription, and if it’s working for them, I want them to get their supply ordered so they don’t have to worry about it anymore. Or, if they’re having some hiccups, I don’t want them to go too long without troubleshooting the issue. These follow-ups can be in-office visits or teleconsults, depending on whether they are new to contact lenses or not.
Ordering
I order the bulk of our contact lenses directly from the manufacturers or through ABB Optical Group. I order soft, disposable toric contact lenses from Alcon though its MARLO system, which acts as an ordering and tracking portal for both my practice and our patients. Our patients can order the lenses we recommend and have them shipped to their homes, and the system reminds them to re-order when they start to run low. It also sends us a reminder to check in with patients to schedule their annual examination as they get close to finishing their supply. Most of our patients see the value of this system and choose to opt in. They love having their lenses shipped directly to them, and I love not having to store boxes of lenses in the office. Several manufacturers now offer direct delivery of contact lenses to patients, as does ABB Optical Group.
Final Takeaways
The conversation about astigmatism and toric contact lenses is getting easier for optometrists. Public awareness about astigmatism is growing, and we now have high-performance toric lenses to offer these patients—we just need to educate them that this option exists. We should encourage former toric lens dropouts to give new-technology lenses a chance, because the optics and comfort are far superior. Similarly, patients who have never tried contact lenses need to know that there’s an alternative to glasses that will give them the same high-quality vision.
For any of my colleagues not already doing it: Put your patients in the new toric contact lenses. They will notice the difference, and they will appreciate you for it.
1. Zhang G-Y, Ye L, Wang W-J, et al. Effectiveness of toric soft contact lenses for vision correction in patients with different degrees of astigmatism: a real-world study. Int J Ophthalmol. 2023;16(11):1845–1853.
2. Chao C, Skidmore K, Tomiyama ES, et al. Soft toric contact lens wear improves digital performance and vision-A randomised clinical trial. Ophthalmic Physiol Opt. 2023;43(1):25-34.
