Artificial intelligence, the internet, scientific breakthroughs in material science and a 22-year long career within Johnson & Johnson (J&J) has led to a stark truth for Giovanni Abruzzini: put the patients’ needs at the centre of everything you do and the rest will follow.
‘If we don’t build the world around customer-centricity we are never going to win. I believe this is going to be the game changer for the industry. That is my passion, finding out what it is that the consumer needs,’ says Abruzzini with a heart-felt, Italian/American zest. He explains that the passion for meeting the customers’ needs was borne from the fact that fifty per cent of the population needs some form of eyewear correction. ‘Vision is the most important sense that people have.’
He says that while the UK beats some of its European rivals, it remains far behind the US and Japan for contact lens penetration. ‘What keeps me awake at night is thinking about how we as an industry need to drive the category of contact lens user’.
He says as a company, J&J is committed to that and he has also made a personal pledge but, he says, while everyone has their own product offerings the industry, as a whole, has to think bigger. ‘We need to stop focussing on: “I want that piece of share, I want to sell more of this or that”, we need to focus collectively on how we solve the issues of the category. My biggest focus is to be consumer-centric,’ but, he says, studies show that if you want to get contact lenses you have to be a real diehard. ‘It takes multiple eye exams, it takes multiple visits, it takes on average four to six weeks to get fitted with contact lenses. I would ask you: who has the time to go on multiple trips to the optician and wait four to six weeks to get fitted?’
He says Japan and the US do best and show the way. Elsewhere it can be confusing for consumers to have to choose from an array of consultations from multiple eye care professionals (ECP) offering a multitude of services. He says consumers want to go to an ECP to have their vision assessed and to be advised on what their options are for correction and care. He likens it to opening up a closet of clothes and having the choice of what you would like to wear.
’Consumers want a range of options for their vision care, because they will have a range of needs over time, from finding the right fit and modality, to treating conditions like presbyopia. Today the consumer doesn’t have those options, they are confused about the type of consultation.’ He says this may be an eye exam, a contact lens consultation, a fitting, a follow up or a dry eye exam. ‘If you go [to the ECP] in the US you just have an eye exam. As a consumer you want to understand how your vision is doing and what are the options.’
‘The consumer journey here that starts with an eye exam is broken; we have data showing this fact compared to other markets where the penetration is very different.’ Where you are able to go in [ for an exam] and then have options to choose from. ‘For me this is the most important element that is driving the challenge –the journey.’
A seamless journey starts with patient awareness of the options around contact lenses, spectacles and refractive surgery. An eye examination takes places and all of the options are discussed with the ECP. ‘We call it pre-fit, during fit and after fit. It’s a comprehensive eye exam which is streamlined and giving all of the options at once. You can come out with spectacles and contact lenses and time is set aside for insertion and removal training.’
He says the importance of teaching can’t be overstated. One of the most successful markets from trial to wear is Japan where particular attention is paid to insertion and removal training. ‘That is one of the biggest barriers for new wearers, we don’t want to send them out to be home alone.’ If they are they are going to drop out. ‘You don’t need to have another appointment, you don’t need to see another doctor, you don’t need to wait to be shipped the product to try it. You have everything in there [at the first consultation]’.
Customer journey
To make that happen attitudes need to change. ‘Let’s first realise that the customer journey doesn’t work. It’s about how do you give the consumer the right choices and how do we make ECPs realise the massive opportunity that is out there to fill that gap.’ ECPs can be helped through programmes and through shared best practises, things that have been working in other markets. He also says J&J has been working with ECPs to join the dots between pre-, during and post eye exam.
Pre-exam includes consumer aids such as websites offering information on the benefits of lenses, the types of lenses available, free trials and an ECP locator. It might also include advertising and other marketing.
The during part is helping the ECPs drive the fit process to communicate that it should be about glasses or contact lenses. It’s not an eye exam versus fit, it’s about how you take care of the patient. That means finding out how J&J can help the ECP streamline their conversation from being an eye refraction to offer more time to take care of the patient by finding out more about their needs. An eye exam lasts for a finite time, he says, so why not spend more of that time discussing options rather than speeding up refraction. ‘We call it putting back the care into the eye exam, taking care of your patients rather than just doing an eye refraction.’
Abruzzini accepts that there are many different practice situations – owner practitioners, employees or locums – but he insists making the eye exam patient-centric will win out. ‘Just put the patient at the centre and all work together around what the patient wants,’ he says.
Sometime they will want glasses sometimes contact lenses sometimes refractive surgery or a bit of everything. ‘But guess what, they will be happier and they will be more loyal to you and they will use you as their eye care practitioner of preference. At the end of the day you win the patient and that’s what it is all about because then you don’t need to worry about the patient going elsewhere because of convenience, or because of price or because of promotions or because someone tells them there is a better coffee served around the corner.’
Post eye exam is about making the patient comfortable with their lenses. ‘The amount of time that we spend teaching people how to wear their contact lenses is completely underestimated.’ He says digital assets and the eco-system, both inside and outside the store, need to be used to aid this process of education.
Activity around the eye exam fits into the broader landscape of growing the market and that means bringing more people in, making sure wearers are happy and reducing drop outs.
Bringing people in goes not only back to awareness and communication but tackling issues such as pokaphobia and informing people about the products on offer. Another crucial element is age. ‘The age of entry is age 14 in the US, and 21 years old in the UK so you can already see why the penetration is much different.’
The second element is keeping people in contact lenses by making sure they are happy. He says how the ECP questions the patient is crucial. People just ask if the patient is ok, but that question needs to be more incisive and the patient made aware of the range of different products available.
Drop-outs
The third step is about drops outs which is a huge challenge. Abruzzini says J&J’s research points to three main channels for drop out: early drop out, natural drop out and presbyopic drop out. Early drop out centre around the ‘home alone’ idea and accounts for a third of failed wear. In the UK 31% of wearers drop out during the trial period after they are fitted, before they have even made a purchase.
‘This is all about the initial experience you give them. Not being left alone with insertion and removal and being able to give them a buddy that they can reach out to.’ He says the most successful ECPs in the world are the ones that will fit a patient and literally call back after one day just to say: “are you doing OK?” The point is how are you following up on that initial fit. ‘You are spending chair time, ECP time, consumer time, diagnostic lenses, a lot of money so are you following up? Usually the answer is no.’
The second group are described as natural drop outs who are dropping out because they don’t know the different options that are available for their lifestyle. He says J&J’s view has always been that shorter is better. Regardless of brand or type if you have a lens that has to be handled, cleaned and stored it invites more challenges to the wearer and more potential for drop out than a daily disposable lens. ‘We have to make people aware that they can avoid those elements of wear if they start to perceive issues of comfort, allergy or dry eye during their natural life cycle as a contact lens wearer. This natural pot of drop outs is probably the biggest pot because they are not being taken care of.’
‘The third bucket is extremely interesting and that is around presbyopia,’ says Abruzzini. ‘These are people already wearing lenses and they are dropping out because they become presbyopic and they can’t wear their lenses any more. I call it a tsunami that is coming.’ He bases this on the wearer demographic and the growth in soft lenses 20 years ago. ‘Guess what? The majority of those people are starting to be 40 plus.’
By bringing more people in, making sure they are happier and stopping them from dropping out the market can grow. ‘The whole point, and what continues to inspire me is taking the customer, the patient, and putting them at the centre. There are more people who would like to wear contact lenses than are actually wearing them. There is not a clear offer when you get into the eye exam.’
While product development plays its part in all three categories of drop out communication methods are changing too. This will shape the selection of patient, fitting, adaptation and communication to prevent existing contact lens wearer going down that road. He says the multifocal market has been a great success story for the category in the UK in recent years and is testament to the work carried out. ‘This has demonstrated that with the right approach, products and business model people can be kept in contact lenses’.
The difference between markets like the UK and Japan is not the patient or the product, but putting the patient in the centre. In the UK we do exams because we like doing exams, he says, but that is not what the consumer want, they want an answer to their eyecare needs.
Harking back to customer needs he says people wear contact lenses to see, to improve their performance or improve their appearance. The product must meet the needs of hyperopia, myopia, astigmatism, presbyopia. Innovations such as J&J’s stabilised toric design improve the way the eyelids interact with the lens on the eye. Similarly with its multifocal. ‘We understand that age has an effect on pupil size and pupil size has a huge impact on the way we see.’
These innovations have driven the design of product to optimise visual acuity, but it’s research has extended into visual comfort through its Transitions venture. ‘This is a massive conversation that is raising the bar.’ That brings new factors into play when you start to ask people about their vision.
‘Recently we discovered that 70% of people in the UK are bothered by light. They don’t want to wear contact lenses because they just don’t want the glare. That concept of putting the patient at the centre drove the 10 year development of the lens. That lens now not only provides comfortable vision but has the ability to raise awareness and drive the category. ‘It’s a very cool technology, having something on your eye that can adapt to light. It brings excitement and talks to new groups of people about contact lenses.’ He says wearers may or may not decide to stay with that product but they stay in the contact lens category.
Presbyopia Market
Abruzzini is understandably reticent to talk about up and coming products but hints where developments might arise. ‘What I can tell you is the presbyopia market is here to stay, big time, and we are committed to driving that through innovation.’ Of the tsunami and cliff? He says J&J isn’t going to let that happen. Presbyopia won’t be tackled using a single product, he says. ‘We will continue to strive to have better, innovative ways to address it.’
As a broad eyecare company J&J has innovations in intraocular lenses which also address the topic of presbyopia and Abruzzini stresses that looking at the customer needs will continue to drive the basis of innovation. ‘Presbyopia is a dynamic issue but the current solutions are static. Perhaps we need to start looking at more dynamic solutions for a dynamic problem? How do we build those solutions and bring about transforming technologies?’
He says businesses such as J&J have a responsibility to solve issues like presbyopia. But, he says, ‘We are not going to solve the issues of the world by ourselves, no way, so the focus is that we are inclusive and cooperative.’ That approach to growing the market has to be the way forward to benefit everybody. ‘It’s going to be a win, win, win. A win for the consumer, a win for the ECP and optical retailers and a win for the manufacturers.’ An open approach, to developing and investing in new technologies is the way forward. ‘It’s open, innovation cannot be closed.’
New technologies
Technology is likely to be a major factor in future change he says and describes data as: ‘the currency of the future across the whole chain from manufacturing through fitting and consumer support.’
Consumers don’t want technology for its own sake but for the problems it solves for them. ‘If I need to have three trips to an ECP in six weeks to wear a contact lens maybe there is a pain point and if someone figures out a way of fitting you and you get your lenses in 15 minutes maybe more of us will do that.’
The question is not what is technology bringing us but what can we do to deliver a solution to our ECPs and to our consumers. ‘We cannot be scared of what technology is bringing us, we should be scared of ourselves if we don’t understand why those technologies are gaining success.’ There are many things that technology can, or will shortly, be able to do. ‘If I spend my time doing something that a machine can do faster, better more efficiently maybe there’s an opportunity for me to spend that time doing something that a machine cannot do and I can add value.’
‘We shouldn’t try and find a solution against technology. Our role should be how do we embrace and collaborate together to create a different ecosystem. As leaders within eyecare we have a responsibility to shape that.’
This is an evolution but he doesn’t expect it to take forever. Change must include issues such as dry eye, which affects 80% of the UK population but for which only 20% seek help.
He says we should be talking about the evolution of the eye exam, talking about dry eye, different vision options, the surgical side, cataracts. ‘You want to be a primary eye care practitioner and to do that you have to demonstrate value, you need to be agile, you need to be open, you need to be fast, you are here to help and most importantly you are here to learn. The first place they [patients] go is for an eye exam. Are we carving time to have a conversation about dry eye or are we just talking about refraction?’
‘It’s very uncomfortable because people are going to lose control of some elements. Maybe some people will buy some more contact lenses online because they don’t want to be locked into a direct debit.’ Putting the patient first will win out he says. ‘Over half the population have less than perfect vision and together we want to meet their needs. ‘That’s what makes me so excited. How many industries do you have with that kind of opportunity? We have a responsibility to address it. We should stop working in silos and just looking at our corner and work more collaboratively.’