Optician about growing the contact lens business, wine gums and four letter words
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‘If I eat out and the food is not great or it’s fine I wouldn’t go back, and I would tell my friends it was fine. If it’s rubbish you’ll complain, if it’s awesome you are going to vote with your feet and your wallet and go back.
‘If you ask your patients how their contact lenses are and they say fine you should probe because they may not be telling you how they really feel. Fine is a four letter word,’ he repeats.
Anecdotes come easily to the easy-going American who carved out his early career in J&J’s finance department back in the States. He later became chief financial officer of Vistakon USA before taking on a wider commercial role running the retail and distributor businesses, among other things, for the region.
His dislike of the word ‘fine’ epitomises his attitude towards recommending the best products first, practitioners proactively discussing all eye care options with patients and switched on practice staff educating and enthusing customers about products and services.
He comes to the UK with that breadth of experience to not only grow J&J’s contact lens business but also to play a role in leading the sector and growing the contact lens segment. ‘Even though we are a large multinational, we still expect to be a growth business so my remit is growth for both the category and our share as well.’
With market penetration of contact lenses in the US twice that of the UK there is clearly plenty of room for growth from many different areas. A year into the role he still has a bit of that US perspective but has ‘got most of the vernacular’ to steer him through the differences in the UK market.
‘One of the biggest opportunities in the UK is that the patient base continues to grow at the rate of the population. There are many more people considering wearing contact lenses than actually wear them so there are huge penetration opportunities,’ he says.
One observation he makes is the structure of the market. ‘A practitioner in Boots is a franchisee or employed while an optometrist in Walmart in the US is actually an independent practitioner. It’s their practice and their entire revenue stream is service fees. They don’t sell the materials; they don’t sell glasses, that’s left to the store. That’s a big difference. It’s not better or worse it’s just different and I believe it leads to more proactive recommendation and retail of contact lenses.’
A phrase repeated by Spandow sums up the issue. ‘It’s fascinating, and I’ve seen it in a number of markets. The practitioners wait to be asked and the patients wait to be offered.’
So with that experience what would he suggest UK practitioners do differently? He suggests taking the conversation right back to eye care and the visual needs of the patient through a proactive conversation that in the early stages puts economics to one side.
Historically there was a mindset in the market that it was glasses or contact lenses. ‘A lot of work has been done over many years and that has changed. That conversation doesn’t have to be just glasses or contact lenses but glasses and contact lenses.’
That value is well documented. ‘Glasses might be a bigger ticket item in the moment but there are all sorts of data around the frequency of exams and the frequency of purchase particularly in the UK. When you realise that a glasses only wearer doesn’t wear contact lenses but a contact lens wearer also wears glasses in most cases, then you can start to look at the patients and their profitability rather than how’s my contact lens business versus my spectacle business.’
For contact lenses that means going back to basics. ‘I would love to see fitting decisions on what the practitioner’s favoured lens is removed from the economics. If you believe Acuvue Oasys is the problem-solver then start there. If you have to change it later because of some price objection then that’s OK. Keep them in the category, but make sure you believe that the product you are putting them in will give them a great experience.
‘There is still a fairly high rate of drop-out particularly in the first 30 days and there are a number of factors. One is support for patients who are new to contact lenses. They go in they get a fitting and then they are a little bit on their own. At the BCLA we launched an app called LensPal that offers patients and practitioners online help and reminders. The idea is to provide that support with the tagline “my first 30” because those first 30 days are critical.’
Giving patients the best start
Spandow urges all practitioners to start with the lens they would consider to be most successful, regardless of price, and keep the patient in that for a month so they have the best start to their contact lens wearing experience so they stay in contact lenses. This leads on to one of the other areas of potential, retention. ‘Making sure that people have a great contact lens wearing experiences, that they have crisp vision, the ability to wear contact lenses for as long as they want all becomes an important piece of the conversation,’ he says.
‘Happy patients refer, they tell their friends and tell them that they have great eye care professionals (ECPs), you should go see them. Happy patients are loyal patients, they come back more often and they stay in the product you give them because they are relying on the expertise of the ECP.’
Practitioners are key. ‘It’s absolutely critical and patients want that expertise.’
A far trickier issue is how products are presented in the retail experience of the customer journey. He suggests the separation of consulting and retail can have an effect. Anecdotally, he says: ‘In the US, where the fit is separate from the transaction Acuvue Oasys does significantly better than where the material transaction and the fit take place in the same office. So you can see that the sale and profit is an import piece of the recommendation, which makes sense, but you have to be a healthcare provider and practitioner first to give the patient success.’
This will ultimately have a positive effect of retention and on practice profitability, he says.
Question of price
For cultural and economic reasons price has become part of the conversation quite early on, he says. ‘We as manufacturers need to help the practitioners have the conversation around features and benefits, about comfort, about handling, about being able to wear a lens long into the day, and about the importance of UV protection, so they understand why there may be price differences between lens 1 and lens 2. Until you have worn different contact lenses and compared them it is difficult as a patient. With spectacles and lenses you can pick them up and see the differences in weight, quality and colour.
‘In the US I heard practitioners talk about Acuvue Oasys as a problem-solver. When I asked what do you mean by that they say: “If I have a patient who is having a hard time I’ll put them into Acuvue Oasys and I know they will be successful”. I ask why wouldn’t you start there? Starting there means you avoid chair time and objections while the patient has the best experience of contact lenses,’ he says.
While some practitioners understand the greater value contact lens patients represent over their lifetime with a practice there is still a lot of education needed. ‘If you think about the journey for most contact lens wearers it might start with a phone call to the practice, so does the person answering the phone get it? When they walk in does the person at the front desk get it? Does the technician get it? Does the CLO get it? How are people incentivised? So it’s not just talking to the fitter but ensuring that everyone in that environment gets it.’
Wine gums may seem an odd example to choose but, Spandow explains how his own retail experience highlights a cultural difference.
‘In the US if I want to buy some candy I’ll put my money down, I get the candy and off I go.’ His retail experience in a motorway service station was somewhat different, recounting the story of wanting to buy some wine gums, a childhood treat, courtesy of his English mother. Having chosen a packet of his favourite £1.50 wine gums he was offered two packets of another type of sweet for £1.
‘In the UK people are looking out for each other, which is really thoughtful, and something you wouldn’t necessarily see in the US, but as a business owner I want you to delight your customers and grow your business by offering them the best products.’
Spandow took up the £1 offer, saving money, but being disappointed with the end result. ‘I didn’t want something else, I wanted wine gums. I don’t know why I did that.’
In practice that may translate into a consulting room chat about the benefits of the best lenses available being converted to a cheaper product in the dispensing area by another member of staff who thinks they are helping the customer save money.
‘I believe that patients should have options and an informed choice will win more often than not. I want them to know about all of the products out there.’ While J&J is working hard to provide that education, it is also educating practitioners about opportunities for growth with new types of wearers.
One of those is the market for younger wearers. ‘The average entry point for a contact lens wearer in the UK is 20 years old, in the US it’s 14. That’s six years of value within the category.’
Spandow says there is plenty of evidence about the benefits of contact lenses for kids and their effect on self esteem, how they feel about participating in sports and the fact that children can responsibly wear and care for contact lenses. ‘Some kids love glasses but there is a great opportunity to fit children in contact lenses,’ he adds.
The other big opportunity is at the other end of the age scale. ‘Multifocals is the highest growth sector of the category,’ he says and there is a growing demand. ‘We often get asked about a one-day multifocal. That’s what our customers are asking for, particularly the independents, because the age of their patient population is growing so they want multifocal designs in the materials that patients are happy wearing.’
Older patients are demanding, he says. ‘They feel strongly, particularly women, about staying in contact lenses.’
Practitioners also need to be more proactive in offering multifocal contact lenses to previously uncorrected wearers. Spandow, who didn’t need visual correction, recalls that he was never offered multifocal contact lenses as an option when he went to opticians with near vision issues. He was pointed in the direction of ready-readers.
The fitting behaviours for multifocal will change just as they started to for astigmatism 15 years ago. ‘It’s a curve’, once the issues around chair time and success rates are tackled and there is more proactive offering, penetration rates will grow. This will accelerate as technology delivers the products.
When asked where the biggest growth for contact lenses will come from, Spandow, surprisingly, selects neither teens nor presbyopes but existing groups of patients, particularly astigmats. He suggests that there are still large groups of people in their 30s and 40s who believe that they can’t wear lenses because of their astigmatism. ‘Research confirms that nearly half of all patients requiring vision correction have clinically significant levels of astigmatism in at least one eye. Additional studies show that toric soft lenses such as 1-Day Acuvue Moist for Astigmatism provide significantly better visual acuity compared to spherical lenses for astigmatic patients, and provide comparable visual acuity to spectacle wear,’ he adds.
Proactive management
He also notes that a big opportunity exists in keeping patients from dropping out of contact lenses. If they are managed more proactively and fitted with the best products, Spandow believes retention rates can be improved even among successful wearers.
The long-term sustainable healthy way is to drive people into the category and fit them with products that meet their vision and lifestyle needs
He is also keen to stress how he wants the Acuvue brand to be seen by patients and ECPs. ‘I want the patient to have a great experience, I want them to feel like they are informed and I want them to have great value.’
Research shows price is not the main driver for eyewear choice but patients need to feel they are getting value for money and that means practitioners getting across the features and benefits of superior contact lens products.
He wants ECPs to be successful, and says J&J Vision Care has their patients’ best interest at heart. ‘I call them shared patients. One of the anecdotes I like to use with practitioners is to ask them how long they spend with their patient and how long they see them for.’
That might be half an hour once a year but the manufacturer’s relationship is much closer. ‘The patient will be wearing the product they walk out with for perhaps 16 hours a day, 365 days a year. They spend a lot more time with the contact lens than they do with the ECP. They put the contact lens in their eye every day. Do they associate that more with the brand or with the ECP? I have that shared interest.’
The manufacturer to practice relationship is about openness and honesty. He points to a recent complaint and says he was happy that a disgruntled customer felt passionate enough to write to Optician about lens supply. ‘He still cares; I want to hear from him when he’s mad, if it goes to apathy we have lost him. We’ve got to fix it and we will. You can pick up the phone and call and if we are not delivering then tell us why and we’ll make an effort to deal with it. If I don’t know about something I’m certainly not going to be doing anything about it. Please tell me how we can be better.
‘We are a business full of integrity, and we care about the success of our customers and that is in our DNA. That encompasses business support and product technology. We are an honest upstanding company and we will walk a very straight line. It’s the right thing to do,’ he concludes.
Products are on their way, J&J is supporting practices with these and business information, it is running courses, roadshows, it’s the sum of many small things, he says.
‘Nothing in this industry moves quickly, it’s hard to turn an oil tanker but once you actually get to turn it maintains that trajectory.’ It is not a hard sell but wanting its customers to succeed. ‘I truly believe that if they are successful then we have a chance to be successful. If they’re not, we don’t and we are pushing water uphill.
‘I believe in our message and the people I work with and the portfolio of products and I do believe that we can help practitioners be more successful in their practices and create great outcomes for their patients. That is really all we want to do.’ ?
