Continuing Education

Author: Craig Butler

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In the final part in our series looking at all matters relating to silicone hydrogel lenses in practice, Craig Butler describes thebest way to communicate the health benefits to patients and improve compliance (C5092, one contact lens point)

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Having read the previous five articles in this series, you will have a good understanding of the technical features of silicone hydrogel contact lenses (SHCLs), expectations of their clinical performance and tips for successfully managing SHCL wearers.

This article is intended to provide those practitioners who are motivated to recommend and fit SHCLs with information on communicating the benefits of this form of vision correction to patients and helping them become successful SHCL wearers.

SHCLs were first launched in Europe in 1999 and in the US in 2001. Currently, up to six silicone hydrogel materials are available in sphere, toric and multifocal designs to suit most refractive conditions and wear schedule modalities, so the range of patients from which to select wearers is increasing with each new SHCL released.

WHAT WE ARE COMMUNICATING TO PATIENTS: THE BENEFITS OF WEARING SHCLS

SHCL materials have several features which enable patients to have flexible wearing schedules, ranging from partial and all waking hours, to occasional overnight wear or continuous wear for up to 30 nights. These flexible wear schedules could appeal to the 25 per cent of existing contact lens wearers who admit to sleeping in their lenses, contrary to their practitioner's recommendation.5,6

The benefits of allowing more oxygen to reach the eye - which include reduced corneal hypoxia and limbal redness1, 2 - influences many contact lens wearers to consider SHCLs to be a healthy form of vision correction.3 A 2005 survey of 215 European contact lens practitioners, most of whom had at least 12 months' experience fitting SHCLs, found that 57 per cent agreed that patients wearing SHCLs achieved improved comfort, healthier eyes and longer wearing times than conventional hydrogel contact lens wearers.4 Based on a combination of these benefits, 78 per cent of practitioners would consider converting existing hydrogel contact lens wearers to SHCLs.4 The challenge for the practitioner is to identify lapsed, current and non-contact lens wearers interested in these benefits, and then communicate with them and motivate them to become SHCL wearers.

The patient can learn progressively more about the vision correction options that may be suitable for them throughout their interaction with your practice - from making the appointment, through to visiting the practice, having a consultation and becoming a successful SHCL wearer.

General information designed to generate interest can be communicated before the new patient attends the practice for their first consultation. Patients making an appointment by phone provide the reception staff with an opportunity to clarify patient expectations of the outcome of their visit. Simply asking the patient if they are a contact lens wearer makes the patient aware of this option, regardless of their experience or knowledge of the modality. Practices may consider using a recorded phone message for patients on hold, informing them of vision care services and vision correction options, and inviting them to ask the practitioner about these at their next visit.

EXTERNAL COMMUNICATION ORIGINATING FROM WITHIN THE PRACTICE

Prior to visiting the practice for the consultation the patient may be aware of SHCL brands via television or magazine advertising, visiting contact lens manufacturers' websites or from speaking to colleagues, family and friends. Product awareness may increase patients' receptiveness to discuss contact lens options, but it does not mean they will ask to try them when they attend for a consultation.7 Practitioners can find out how knowledgeable, interested, opinionated and experienced the patient is about vision care options including SHCLs, by sending out a pre-examination questionnaire, which can be completed and returned by the patient prior to the practice visit.

With 57 per cent of UK households having internet access,8 obtaining the patient's agreement when the appointment is made, to receive and return the survey via email9 or downloading and completing a printed version to either post or present at the practice visit, is a convenient communication tool. Survey questions should make patients contemplate their current vision experience and raise their awareness about alternative vision correction options.

The communications should use language which informs potential wearers about the benefit they will experience wearing 'contact lenses you can sleep in' rather than the technical feature of 'high Dk silicone hydrogel'.

The patient can be provided with a link to the practice website to find out more information about vision care products and services, including SHCLs, offered by the practice. Practitioners should be mindful that asking questions about eye health and vision-related experiences may raise both expectations and concerns for the new patient. The patient should be informed that these questions will be answered by the practitioner during the consultation.

KNOW YOUR PATIENTS

Creating a database of all existing patients, using information collected during previous visits - for example age, health status, ocular refraction, occupation, hobbies, purchase history, type of vision correction, drop-out contact lens wearers - makes it possible to select a group of current patients who may benefit from, and be interested in, SHCLs. The practitioner should review the list of patients before sending a concise personalised communication by email, mail or SMS, highlighting the specific benefits the patient is likely to experience from wearing the SHCLs and this should include a link to a 'FAQ about SHCLs' page on the practice website along with an invitation to contact the practice for more information.

IN-PRACTICE COMMUNICATION

There are several opportunities for a patient to search for information, such as reading contact lens-related articles online or asking friends and family. However, most people, if they follow a typical buying behaviour process, assume they will receive the information about vision correction options appropriate for them during the practice visit. Practitioners should not assume that patients will ask about contact lenses if they are interested in them.

Once the patient has arrived for the consultation, the in-practice communication to stimulate patient interest in considering SHCL options can begin. Half of wearers of a highly-marketed contact lens learnt about the brand from either in-practice point-of-sale material or a staff member.10,11 This implies that if a practitioner wants to discover all the potential wearers for a particular contact lens modality, it will be necessary to create an informative practice environment where patients can learn about a range of vision correction options that will satisfy their vision-related lifestyle needs. The practice must align all visual, written, spoken and intangible communications to create this perception in the patient's mind.

The intention is to create an environment that feels relaxing, interesting, and increases the patient's openness to learn about something new. In the first instance, providing a comfortable private waiting area, interesting décor and reading materials covering a wide range of topics (not just the practitioner's hobbies) will assure the patient that the practitioner is open to new ideas and aware of current social, political and personal issues affecting people's lives.

Well designed frame display areas tell patients that spectacles are a significant option for vision correction. A display of contact lenses in their boxes may not have the same impact, however SHCL point-of-sale material can create awareness of needs in the group of patients the lens will most benefit.

The material is usually aligned with externally viewed advertising, designed to prepare the patient for a discussion on the possibility of successfully wearing SHCLs.

SHCL manufacturers have information about the characteristics, attitudes and preferences of the patients for whom their marketing programs are targeted.

Knowing this, the practitioner can select the SHCL point-of-sale material which aligns with the patient profiles for who the practice intends to recommend SHCLs.

SHCL point-of-sale materials can be positioned to influence the patient from arrival through to the completion of the consultation.

In the first instance, an external or internal window display creates patient awareness as they enter the practice, that SHCLs are available. A SHCL-branded poster in the patient waiting area can prompt a person to contemplate the possibility of wearing SHCLs while they wait for their eye examination. At the end of the consultation, a generic in-practice or brand-specific manufacturer's brochure about SHCLs can be given to the patient, with the invitation to read it at home. The brochure should include information and answers to FAQs that support the practitioner's recommendations, confirm the benefits mutually agreed upon by the practitioner and patient during the consultation, and reassure the patient about their decision.

THE BENEFIT OF A COORDINATED APPROACH: SUPPORT STAFF AND PRACTITIONERS

Having staff knowledgeable about SHCL benefits contributes to patients experiencing consistent communication from the practice. The staff should be confident in answering any specific SHCL product questions by referring to patient brochures prepared by the practitioner, with FAQs about the modality. Existing wearers should be reminded of the practitioner's recommendations. Staff need to know enough about the process of fitting, teaching and managing SHCL wearers to be able to recognise an unusual wearer experience.12

Fitting staff that would benefit from wearing SHCLs increases their understanding of the modality and empathy for the patient. This strategy increases the staff confidence in SHCLs and can be useful when introducing new vision care technology for patients who require testimonials and endorsement from others.

A well-rehearsed handover system from the support staff to the practitioner using a completed pre-examination questionnaire or patient record card - which includes space for support staff to write highlight specific questions, responses and comments from the patient prior to the examination - gives the practitioner a relevant starting point to commence the discussion about the patient's specific vision requirements.

This reduces the time spent taking the history and establishing the vision-related lifestyle needs. It also means more time can be spent answering specific questions during the evaluation of the vision correction recommendations at the end of the consultation.

COMMUNICATION IN THE CONSULTING ROOM

The consulting room provides a unique opportunity for uninterrupted, face to face communication conducted in present time, about a specific topic with all the attention on producing a patient who trusts the practitioner enough to agree to accept their recommendations. Recommendations about SHCLs should be made by the practitioner only after the patient's vision and eye health have been assessed and lifestyle requirements evaluated.

The well-researched proactive approach to increasing the number of contact lens wearers is to discuss the modality with every patient, being mindful that for a patient to feel motivated to take a practitioner's recommendation requires them to feel a rapport with the practitioner, trusting that the advice is appropriate for their vision condition, and that the contact lens will satisfy or exceed their expectations to resolve a problem or enhance their vision experience.13

Studies conducted prior to the advent of SHCLs found that when a practitioner used this type of proactive approach, it resulted in five-fold and six-fold increases in the number of contact lens wearers.14, 15 Hutchison reports that many practitioners are reluctant to use the proactive approach because they believe that if the patient is interested to try contact lenses, then they will initiate the enquiry. This means practitioners are likely to miss nearly 50 per cent of patients who would try contact lenses because these patients are waiting for the practitioner to recommend them, or they don't know enough about contact lenses.7

The discussion initiated by the practitioner while taking the patient's vision history, at the start of the examination, provides the patient with an opportunity to reflect on their personal situation. The questions asked should be relevant in establishing the patient's unique lifestyle and vision correction requirements. A practitioner can create favourable conditions for a discussion about SHCLs, by first finding out if there are any situations where the patient experiences limitations or inconvenience wearing their current vision correction. Explorative questions based on the patient's refraction are an effective technique to discover specific situations in which the patient feels restricted or inconvenienced by the current vision correction device. Using these patient responses to initiate more specific questions will make the patient feel that the practitioner is listening and is aware of the patient's own experience of needing to wear vision correction.

Using modern equipment and explaining the purpose of topography and keratometry measurements, auto refraction and slit-lamp observations and fundus photography will raise the patient's confidence that the practitioner has concern for the patient's eye health.

During the procedures the practitioner can share observations and ask questions related to the patient's vision experience to help the practitioner and the patient gain insights into the final recommendations. By communicating throughout the consultation, the patient can participate in the consultation and will feel included in the decision making process. At the conclusion of the consultation the practitioner should summarise the discussion to ensure they have understood the situations the patient would like to experience differently and the patient should be invited to ask questions to confirm the benefits they are interested in will be provided by the recommended SHCLs. The practitioner can then explain, through use of brochures and graphics, the benefits the patient will experience wearing SHCLs16(see Figure 1). Any lingering concerns about SHCLs suitability should be addressed at this time. The practitioner may now consider whether to offer to demonstrate what a SHCL feels like, firstly giving the patient a lens to touch or with the patient's agreement, placing it on the eye.

COMMUNICATION: AFTER THE CONSULTATION

As experienced practitioners and support staff know, useful information is frequently revealed by the patient to the staff before and after the consultation. It is important to share this information with the practitioner to evaluate the patient's level of acceptance of the decisions that were made in the consulting room. At the conclusion of the consultation support staff should be empowered with a personal handover from the practitioner. Once the practitioner is engaged with the next patient, the staff should ask the patient general questions to confirm they are happy with the recommendations. Although it may feel threatening for the practitioner to be evaluated in this way, it is similar to conducting a post-purchase survey but done while there is time to modify the outcome. It gives the practitioner and the staff an opportunity to clarify any miscommunication that may cause dissatisfaction, inconvenience and unnecessary financial costs for both the practice and the patient. It is also an opportunity for patients to praise their in-practice experience.

To show the patient that the practice intends to develop a long-term relationship with them, the person should be informed that the practice will communicate regularly via telephone, email, postal service or SMS to ensure the they are successfully wearing the SCHL.

References

1 Morgan PB, Efron N. Comparative clinical performance of two SHCLs for continuous wear. Clin Exp Optom, 2002 May85(3):183-92.

2 Papas EB, Vajdic CM, Austen R, Holden BA. High oxygen transmissibility soft contact lenses do not cause limbal hyperaemia. 1997 Curr Eye Res, 19, 942-948.

3 Riley C, Chambers RL. Survey of contact lens-wearing habits and attitudes toward methods of refractive correction: 2002 versus 2004. Optom Vis Sci, 2005 Jun82(6):555-61.

4 Global Contact Lens Education Program, Europe, May 2005-Data on file. Conducted by the Vision CRC and the Center for Cornea and Contact Lens Research on behalf of Ciba Vision EU.

5 Weisbath R. Ciba Vision USA - data on file.

6 Jalbert I. Personal communication - data on file 1999. Cooperative Research Centre for Eye Research and Technology, Australia.

7 Hutchison G. Consumer and Practitioner Attitudes towards contact lenses. Insight Marketing Ltd, for the Association of Contact Lens Manufacturers, 2001.

8 National Statistics Online. Internet Access, 23 Aug 2006. www.statistics.gov.uk

9 Moss G, Shaw-McMinn. Eyecare Business Marketing and Strategy. Butterworth-Heinemann 2001, p.259.

10 Growing the Australian Contact Lens Market. Data on file. 2002-2003. Vision CRC, Sydney, Australia.

11 Spiller B. CIBA Vision Australia - personal communication. Data on file.

12 Morgan S. How to train staff in CL procedures. Optician, 2002 224:5875 22-25.

13 Thompson B, Collins MJ, Hearn G. Clinician interpersonal communication skills and contact lens wearers' motivation, satisfaction, and compliance. Optom Vis Sci, 1990 Sep 67(9): 673-8.

14 Hanks AJ. Proactive versus reactive contact lens discussion. CL Spectrum,1991December, 25-27.

15 Jones L, Jones D, Langley C and Houldford M. Reactive or proactive approach to contact lens fitting. J BCLA, 1996 19:2 41-43.

16 Figure 1 for references.

◆ Craig Butler is director of professional education, International Centre for Eyecare Education, Sydney, Australia

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