As consumers, we have embraced the notion that one size does not fit all and in some cases have come to expect specialisation of products for our individual needs. One example is athletic footwear. The primary purpose is to support and protect the feet, but the savvy shopper often looks for specific attributes best suited for their individual use; running or cross-training, grass turf or indoor court use, and even simple fashion choices are considered.
We see this same kind of segmentation in the marketing of many products across health care, including toothpaste, skin care as well as many products within optical practices. Consider progressive spectacle lenses. They all provide vision correction to presbyopes across multiple focal distances without unsightly lines. Beyond that, however, are a world of choices, depending on whether the wearer is mostly using the glasses indoors for computer and near tasks, wants something that functions well in a small frame, or prioritises the digital surfacing and distortion-free reading zones of a premium progressive lens.
So why do we cluster our contact lens patients into a few groups of modality categories and cost points? That risks making contact lenses increasingly commoditised and the prescribing transactional. What if, instead, we could put the patient’s unique needs and the practitioner-patient relationship at the centre of the contact lens recommendation? This new way to approach prescribing contact lenses has the potential to not only reverse trends toward commoditisation, but more importantly improve long-term outcomes for patients.
Data-driven insights
Over the past five years, Johnson & Johnson has undertaken global research initiatives involving more than 15,000 people in seven countries. In the largest of these studies, conducted in 2011 and 2012, contact lens wearers and those considering contact lens were surveyed allowing identification of at least four large segments based on commonalities in lifestyle needs and ocular physiology.
Subsequent studies have brought even greater clarity. In 2014, for example, researchers demonstrated that 80% of the time it was possible to correctly identify patients’ predominant needs and assign them to one of these four segments.1 In 2015, more than 3,000 subjects were asked to rank the importance of various statements to further validate the segmentation. So, while ‘protecting eyes from dust or dirt’ was important to many people, 37% ranked it among their top 10 attributes while 53% ranked reducing eyestrain while looking at computers for a long time among their top 10 attributes (figure 1).
Figure 1: Percentage of consumers for whom need was scored as top 10 for importance
Additionally, this research also revealed how contact lens wearers might respond if certain needs are not completely met. It was not surprising that more than half the contact lens wearers surveyed whose predominant need was not completely met said they would probably reduce their wearing time and more than 25% would take that so far as to reduce the number of days they would be likely to wear lenses (figure 2).2 Other researchers have also concluded contact lens wearers who persistently experience discomfort will initially reduce wearing time followed by wearing lenses less frequently and ultimately can discontinue lens wear altogether.3,4
Figure 2: Compensating behaviours if predominant needs not met
This partly explains the ‘leaky bucket’ phenomenon in the contact lens market, in which the percentage of contact lens wearers generally remains flat despite large numbers of new fits every year. Patients may be reducing wear time and eventually dropping out because their needs aren’t recognised or met. By identifying a better starting point for each patient, eye care professionals could increase patient satisfaction, help prevent some of that dropout and become more competitive, profitable and efficient in the process.
Figure 3: Segmentation of patient needs
Predominant need categories
It is well accepted that comfort, vision and health are common expectations in all these categories. But in addition to these overarching needs, patients can be differentiated by the importance they place on the following additional predominant needs as shown in figure 3.
- Eyes with sensitivities – Patients who feel their eyes are prone to sensitivity, irritation, or allergies and who want to be able to comfortably enjoy everyday activities. These are the patients who ranked ‘protecting eyes from dust or dirt’ and ‘protecting eyes from pollution’ among their top concerns. They are more likely to need a very low modulus lens which locks in a wetting agent and keeps key tear components in their natural state providing extra support for their sensitive feeling eyes.
- Challenging environments – Patients who have a lot to accomplish every day across a variety of environments and activities that challenge their eyes and may compromise their tear film. Their needs would be met most by a lens that can better integrate and support the tear film and offer superior performance in these more challenging activities and environments. This category represents the largest group of patients; among their top concerns are ‘reducing feeling of dryness when looking at a computer or other digital screen for a long time’ and ‘reducing eye strain from looking at screens for a long time.’
- Maximised wear – Patients who want to get the most out of their lenses, with minimal lens awareness. For these patients, the ‘ability to wear vision correction comfortably from the minute I wake up to the minute I go to bed’ and ‘having clear vision at the end of the day or throughout the month,’ were attributes that ranked very highly. They require a lens that mimics or integrates key tear components resulting in a near no-lens experience and reliable sustained comfort throughout the replacement cycle of the lens.
- Eye enhancement – Patients who want to enhance their eye appearance in a natural-looking way, while still providing exceptional comfort and supporting healthy contact lens wear. Putting a high priority on ‘enhancing how large my eyes look’ and ‘enhancing how noticeable my eyes are,’ these patients want contact lenses that provide depth, dimension, and definition to help them have more beautiful, radiant eyes.
Patients do not always fit neatly into one of these four categories. A patient with allergies may also spend lots of time at her computer and wish she had more radiant eyes. However, insights tell us that patients do prioritise some needs over others.
With some simple questions and observations (table 1) it is relatively easy to figure out which segment is the best fit for a given patient, and choose a lens designed to better address the more specific needs of the patient.
Table 1: Contact lens wearer attributes by need group
You may also identify a second category that can be considered if the patient does not succeed with the first lens prescribed, or if that lens choice stops working as the patient’s ocular physiology or lifestyle needs change. Perhaps more importantly, regardless of which lens brand you end up selecting, it is critical that the conversation about options and recommendations be geared toward creating a meaningful personal connection with the patient – a form of personal prescribing. An example of a simple patient questionnaire to help identify specific patient needs is shown in figure 4.
Figure 4: Example of simple patient questionnaire to help identify patient needs
Matching the right lens to the right patient
Once the patient’s predominant needs have been determined, then modality and price will need to be discussed. Within each of the segments described above, there may be both reusable (two-weekly or monthly) and daily disposable replacement options, or lower and higher cost options.
Personalising the recommendation shows your patient that you are thinking about their needs and means they are more likely to be successful and remain wearing contact lenses.
Let us consider how that might work in practice. A 29-year-old contact lens wearer comes in for an annual eye examination. He wears his lenses all day, seven days a week. He is a teacher and football coach, and is getting married soon. When asked to compare the first day with a new lens to the last day of the previous lens, he says that his current lenses can be a little annoying towards the end of the month because he has to take them out or use wetting drops occasionally and he really wants them to just be hassle free. Otherwise, he has healthy looking eyes, no history of allergies, and no corneal or tear film findings of concern.
The Acuvue Vita monthly lens was the initial choice because of its optimal density and distribution of beneficial lipid. This should help to maximise lens hydration to provide consistent comfort throughout the month’s wear.
But if he was struggling more with discomfort, especially in challenging environments, spent most of his day at the computer, and said he really can not afford contact lenses to limit his performance, an alternative might be Acuvue Oasys. With these brands, technologies allow tear-like molecules to be embedded throughout the lens and mimic tear mucin to help support a stable tear film for more comfortable wear, even when using digital devices.5,6
The choice of either a two-weekly replacement or a daily disposable option might be based on other patient characteristics – if he values convenience more or intends to wear the lenses more part-time, a one-day option would be a better recommendation. But for someone for whom comfortable wear in challenging environments is a priority for every day but cost may be a concern, the two-weekly replacement lens might be preferred.
The segmentation we have discussed here provides a framework for personalised prescribing, based on insights from thousands of patients about what their predominant needs are.
Ultimately, it is important to take this one step further, sharing with the patient why you are recommending a particular lens, and tying the specific benefits of that lens directly to the patient’s needs.
Each day we take into account our patients’ attitudes and lifestyle, ocular physiology and signs and symptoms to determine which available contact lens brand is best suited to the patient. That is the art and science of contact lens prescribing. But many of us miss the opportunity to transmit all that analysis in a simple, concise and meaningful way to the patient. Taking a few extra moments to convey this more personalised approach to prescribing can increase patient satisfaction and increase the value they place on our products and services. At the end of the day, no single contact lens – no matter how great – will fully meet the needs of every patient.
Key points
Role of eye care professional is more critical than ever in identifying predominant needs which:
1 Allows a more personalised conversation with patients.
2 Supports selecting the optimal contact lens to trial first.
3 Allows your patient to better understand why you are recommending a particular lens brand for them.
4 Can improve patient long-term outcomes and help reduce drop-outs.
No contact lens – no matter how great – will fully meet the needs of every patient.
John Meyler, senior director for global professional affairs at Johnson & Johnson Vision Care Companies where Brian Pall, senior principal research optometrist and Stuart Todd, senior manager for global strategic insights.
References
1 Roussopoulou E, Rose M. Contact lens wearers’ attitudes and needs: Similarities and differences. British Contact Lens Association, Liverpool, UK, May 2015.
2 JJVC Companies data on file, 2015. Global Consumer Survey, N = 3,232 consumers 16-45 years old USA, UK, Russia, China, Korea, & Japan. Base size varies: Data represents those CL wearers not completely satisfied with need. Understanding how wear time/dropout is affected by not meeting patient needs; Predominant needs refer to the top 10 self-selected needs.
3 Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. 2013;39:92-98
4 Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007;26:168-174.
5 Young G, Riley CM, Chalmers RL, Hunt C. Hydrogel lens comfort in challenging environments and the effect of refitting with SiHy hydrogel lenses. Optom Vis Sci 2007;84(4):302-308.
6 McParland M, Pall B, Schnider C. New Lens for Demanding Days. Optician 2016; 251; (6,555): 24-28