Marketing a high-tech product
Crossing the Chasm is a very popular book in business school curricula discussing marketing of high-tech products.1 The concept of a product adoption ‘chasm’ also applies to practitioners as we consider bringing new products into our practices (figure 1).
Geoffrey Moore, the author of the book, proposes that there is big gap between those who know how to create a competitive advantage by being first to adopt new technology, and the much larger group in the early majority who, while willing to embrace new technology, want and need the tips and tricks from the early adopters to help minimise their risk in trying.
Figure 1: Example of product adoption curve including the ‘chasm’ that limits product uptake in the early phases of marketing.
Adapted from Moore GA. Crossing the Chasm: Marketing and Selling Disruptive Products to Mainstream Customers. New York: Harper Collins; 2014
This applies very well to the uptake of multifocal contact lenses in markets around the world. This paper shares results from an ‘in-practice assessment’ (IPA) that employed a clinical expert from the multifocal contact lens manufacturer to help bridge that chasm for a large group of practitioners.
Does the presbyopia ‘chasm’ exist?
We know that there is a steady decline in the proportion of contact lens wearers after the age of 40 years; precisely at the time when near vision correction needs become almost universal due to presbyopia (figure 2).2
In 2017, Rueff looked at a group of 307 vision-corrected individuals between the ages of 18 and 76 years. In this group, 78% (237/304) reported spectacles as their primary form of correction and 22% (67/304) contact lenses. When looking at just the presbyopes, a significantly larger percentage (42.2% vs 23.9 %) were in the spectacles group, reflecting an under-penetration of multifocal contact lenses (p = 0.006, X = 7.4).
Figure 2: Steady decline of contact lens wear noted with increasing age in group of 1540 presbyopes surveyed (adapted from Naroo 2022)
However, roughly two-thirds of the spectacle wearers who had worn contact lenses previously said they would actually prefer contact lenses if good vision and comfort could be achieved, and the preference for contact lenses was not significantly different between the presbyopic and non-presbyopic group.3
Interestingly, ‘better vision’ was cited by former drop outs as the main reason for resuming contact lens wear, so reinforcing the fact that vision is so much more than just a visual acuity measure. Patients clearly also attribute some aspects of convenience (such as ability to see in active situations and inclement weather) to visual performance, since vision quality was also cited as a reason for discontinuing contact lenses.
Finally, Rueff noted that cost was infrequently cited as the reason for discontinuing contact lens wear in the presbyopic group, suggesting that focusing on overcoming comfort and vision issues can make the value equation worth it to these patients.3
In 2022, Naroo et al, published the results of an extensive online survey about perceptions of contact lenses for presbyopia, which augmented Rueff’s work. They presented results from 1,540 patients between the ages of 40 and 70 from several major contact lens markets (United Kingdom, United States, Netherlands, Germany, France, Spain and Italy) who were either wearing or interested in trying contact lenses.
Of the 50.8% (n=782) of presbyopes already wearing contact lenses at least part of the time, only 25% of these used multifocal contact lenses.2 But as shown in figure 3, contact lenses offered clear benefits to wearers in the survey by Naroo et al.2 Also telling, was the fact that practitioner recommendation was key to their decision to try contact lenses, though that conversation occurred fewer times than half the number of conversations for spectacle lens wearers.2 These results should serve as reminders and encouragement for us to offer multifocal options to more presbyopic patients.
Figure 3: Summary of the results from an extensive online survey about perceptions of contact lenses for presbyopia2
Should there be a chasm?
The availability of soft multifocal contact lenses has expanded significantly since the initial offering of the Acuvue Bifocal contact lens, the first disposable bifocal, back in 1998. In early 2022 in the United States, the contact lens website EyeDock listed more than 20 ‘branded’ disposable multifocals from the four major manufacturers, including daily disposable, two-week and monthly replacement options as well as monthly replacement designs for astigmatic patients.4
In addition, there were multiple private label brands and offerings from other manufacturers of gas permeable and soft lenses. In the UK, the 2023 ACLM Handbook lists 12 daily replacement, 26 up-to-one monthly replacement and 16 planned replacement (greater than one month) multifocal or bifocal contact lenses (see table 1).
Table 1: Contact lenses for presbyopia listed by modality in the 2023 ACLM Handbook, accessed May 2023. The ACLM Handbook may be accessed at aclm.org.uk and is free to BCLA members
We can also be sure it is not the lack of an age-appropriate population holding us back. According to 2021 estimates by the United Nations, the population aged 45-64 constitutes 24.9% of the population in North America (primarily the United States and Canada), 27.4% of the European population and 22.5% of the Asian population, with those 45-54 comprising approximately half or more of that group.5 And that 45-54 age group could be the ‘sweet spot’ for starting with multifocal contact lenses: they have low to medium adds and less chance of ocular media changes.6, 7 The patients are definitely out there.
If you are reading this article, however, chances are you are still not convinced about the reality of incorporating multifocal contact lenses into your practice. Could it be because you do not want to believe the ‘marketing’ claims of the manufacturers, thinking that the success rates sound too good to be true? Or maybe it still seems like fitting multifocal contact lenses is too hard, takes too long, or that patients will not like it or be willing to pay for it?
In this article, we have some answers for you. We will present data from real-world practitioners who tracked patients they fitted under no enforced protocol in what is called an in-practice assessment (IPA) versus a controlled clinical study. The patients they fitted were offered the opportunity to participate in a follow-up survey by an independent market research firm.
These results should address many of your questions, and we will also compare these responses to studies done under a strict manufacturer protocol. And finally, we will finish up with some specific tips on how to make multifocals a more significant and successful part of your practice.
In-Practice assessment*^
In all, 394 eye care professionals (ECPs) across the United States (US) and United Kingdom (UK) were enrolled in the IPA. They each agreed to track patients fitted with either Acuvue Oasys Multifocal, a silicone hydrogel multifocal lens for two-weekly replacement or 1-Day Acuvue Moist Multifocal, a daily disposable hydrogel option in the same design, during the study period (late 2021).
They attended a virtual training session on the Acuvue Brand Multifocal with Pupil Optimised Design delivered by Dr Kurt Moody, an optometrist and one of the developers of the proprietary design. The training reviewed the multifocal opportunity and best practise for fitting and patient selection.
Prior to the commencement of tracking, participating practices were provided a packet with information about the lenses and a card to give to patients they fit inviting them to register to complete a follow-up survey a few weeks after they left the office with their multifocal contact lenses.
The practitioners were asked to complete online experience logs/questionnaires after each fit visit, after all follow-up encounters, and at the conclusion of the IPA. Data collection and analysis was carried out by Ipsos Healthcare, an internationally recognised supplier of market research-related activities such as surveys and in-market/in-practice product assessments such as this one.
Participation rates
Of the 317 US ECPs and 77 UK ECPs enrolled in the assessment, there were 3,035 experience logs at the initial fit, 1,553 logs for follow-up visits, and 180 of them participated in the post-assessment survey. Of patients fitted with an Acuvue Multifocal, 213 individuals elected to participate in the online survey following wear outside the practice.
Figure 4 provides details on age groups for all patients who participated in the post-fit survey. Though there was no refractive data associated with the patient reported data, using decades as a rough proxy for expected add power (40s low add, 50s medium, 60s high), you expect that the largest group will be in the mid-add category, followed by low adds, and the smallest group projected to be in high adds; overall, a good distribution of ages and add powers.
Figure 4: Distribution of ages of patients fit in the study in total and broken down by lens design
What we learned
Let us look at some categories of common ‘myths’ or barriers we would like to dispel for those who have not made the leap into the mainstream multifocal contact lens market. We will do direct comparisons of some of the manufacturer claims from the controlled clinical studies with the results from the ECPs and patients who responded in this IPA.
MYTH #1 – ‘Manufacturer success rate claims seem too good to be true’
Most of us would be happy if we could tell our patients that our chances of success are around nine out of 10. Figure 5 shows that the success reported by the practitioners in this IPA was about that, and patient satisfaction was also high, even immediately after the first pair of lenses fitted.
MYTH #2 – ‘Contact lenses can’t deliver the vision my patients expect’
Focusing on Snellen visual acuity as a marker of success is not recommended. Instead, focus more on discussing the functional benefits of multifocal contact lenses and make sure you send your patients home with lenses to try in those specific situations before making a judgement about success (figure 6).
MYTH #3 – ‘Aging eyes have too many issues with comfort in contact lenses’
Yes, it is true that as we age, ocular surface issues tend to increase in frequency and severity. Do not be afraid to add other treatments such as lid hygiene or therapies to address lid and ocular surface problems identified. Figure 7 shows the outcomes relating to comfort.
MYTH #4 – ‘Multifocal contact lenses are not worth the higher cost to patients’
People pay extra for things that enrich their lives – things that make them look or feel better, things that save them time or money. Focus on the benefits contact lenses provide your patients. Framing cost by breaking a large cost down into a cost per use or cost per month can also make a higher price much less daunting. Figure 8 summarises the results regarding attitudes to cost.
A rewarding professional experience
While patient success is ultimately the goal, fitting multifocals can be very rewarding professionally, as well as a source of referrals and practice growth; 85% of patients said they would recommend Acuvue Oasys Multifocal to friends and family, 98% said they would recommend the practitioner who prescribed the lenses, and nine in 10 said they were more likely to purchase contact lenses from the same practitioner now that they’d been fitted with the lenses.
And as a result of this exercise, 95% of participating professionals said Acuvue Multifocal will be their first choice of multifocal contact lenses brands.*^
Acuvue range
Acuvue Multifocal with Pupil Optmised Design offers several features than can contribute to these high levels of success and confidence.
- They start with a unique optical profile8 designed to achieve an extended depth of focus.
- The optical design is then optimised for the expected variation in the range of pupil sizes across not only a limited number of add powers as most manufacturers do, but across all 183 prescription combinations of distance and near powers as well, accounting for pupil size changes resulting from both refractive errors. This Pupil Optimised Design is basically built-in personalisation for your patient – without you having to do any extra work.8
- A hybrid back curve design combines a central aspheric back curve to maintain the complex front surface optical design and a peripheral spherical back curve to achieve proper centration. Additionally, each lens contains a proprietary embedded wetting agent for a lens designed for performance and comfort.8
Get ready to leap that chasm
Have we convinced you it is time to ‘cross the chasm’? If so, start by getting a number of fits under your belt; 10 is a nice round number that helps you quickly get a handle on success rate.
The fit guide from the manufacturer should be your first step; follow it precisely for selecting the initial pair, but even more importantly, for problem solving, as there are major differences in approach depending on design principles. In this assessment, practitioners had the benefit of advice from an expert on ‘the other side’ of the chasm in the form of training by Dr Kurt Moody.
On the Johnson & Johnson Vision Professional website you will find an online fitting calculator to help you through the key steps in the process, just scan the QR code pictured to the right. If you still feel you would like a bit of coaching, reach out to your Acuvue account manager and ask what other resources are available.
Lastly, it is critical to remember that, while confidence in fitting multifocals generally is likely transferable across manufacturers and designs, every design is quite unique, employing some very complicated optical designs (see figure 11). It is important to follow the specifics of each manufacturer’s recommended approach. The good news is that the three simple steps to fitting Acuvue multifocal contact lenses (figure 10) are also good general guidelines that may help across lens designs.9
Figure 10: Steps to multifocal contact lens success
Figure 11: Contact lens options by presbyopia correction
- Dr Meredith Bishop is Senior Manager Global Professional Education, Dr Kurt Moody is Director North American Professional Education, Drew Hansen is Manager US Insights for Johnson & Johnson Vision Care, Inc. Natalie Ambrose is Manager EMEA Strategic Insights for Johnson & Johnson Medical Ltd.
- A review of a recent round-table of leading experts discussing contact lens correction of presbyopia will be published in the July and August Contact Lens Monthly issues of Optician.
References
- Moore GA. Crossing the Chasm: Marketing and Selling Disruptive Products to Mainstream Customers. New York: Harper Collins; 2014.
- Naroo SA, Nagra M, Retallic N. Exploring contact lens opportunities for patients above the age of 40 years. Contact Lens & Anterior Eye April 2022:101599.
- Rueff EM, Bailey MD. Presbyopic and non-presbyopic contact lens opinions and vision correction preferences. Contact Lens & Anterior Eye 2017;40:323–8.
- EyeDock - Contact Lens Clinical Reference.
- United Nations. World Population Prospects - Population Division - United Nations. United Nations Population Division 2021.
- DuToit R. How to prescribe spectacles for presbyopia. Community Eye Health 2006;19:12–3.
- Thompson J, Lakhani N. Cataracts. Primary Care: Clinics in Office Practice 2015;42:409–23.
- JJV Data on file 2022. CSM - Acuvue Pupil Optimized Design Technology: JJVC Contact Lenses, Design Features, and Associated Benefits.
- JJV Data on file 2022. Acuvue Multifocal 4 Page Fitting Guide.