Alcon’s Academy in Surrey is the kind of corporate campus eye care professionals are regularly invited to attend for education and training and the firm is determined to see more pass through its doors over the coming months. Watchmoor Park plays home to seminar rooms, fitting suites, a wet lab and acts as the home for the Alcon Scholarship Programme. The latest round of education at the Academy focuses on presbyopia with a schedule of days throughout the summer and a roadshow touring optometry schools around the country for those unable to travel to Surrey.
It is only fitting then that Ray Pasko sees education and multifocal contact lenses as the big opportunities for Alcon. The ebullient American is an evangelist for education and, as a multifocal wearer, a proponent of the modality too.
Pasko, who joined the UK business in September 2016, has a 15 year pedigree with Alcon working in commercial roles but was given the chance to widen his scope with a posting to the UK. ‘The opportunity came to grow my experience and come to an international market and take on a different role. I was always a sales leader, now I am the business unit head which means I have responsibility for sales, marketing, and professional affairs training. It’s a smaller market but a bigger role,’ he says.
The move has meant a learning curve in attitudes and habits for Pasko. ‘I thought the two markets were the same and the people were the same and I was excited to be able to come to a market where people spoke the same language and, I thought, had the same cultures, but boy was I wrong.’
Pasko found many positives in the modalities worn in the UK but was surprised by other factors. ‘One of the biggest differences in the markets is how people buy product in the UK. This idea of buying on a direct debit and being billed once a month is extremely foreign in the United States. Patients there either buy contact lenses one time, on a cash pay basis, or they buy a whole year’s supply and don’t visit their eyecare practitioner for another year.’ He says he is amazed how much business is done on direct debit in all walks of life in the UK.
Although the penetration of contact lenses in the US and the UK markets are broadly similar at around 14%, the product mix came as a surprise. ‘The big difference from the US is that daily disposables are a much bigger piece of the market. In the US reusable lenses, monthlies and two-weekly lenses, are still a big portion of the business. While Pasko wears daily disposables himself, preferring to wear a new, fresh, clean lens every day, he thinks the company’s monthly lenses are a safe and comfortable alternative for those consumers who do not want to change and discard their lenses every day.
While the UK might have the edge when it comes to modalities he feels there are lessons UK practitioners could learn from their US counterparts. A big difference is the way practitioners approach the industry. ‘I feel that in the US more and more practitioners are comfortable with charging for their services, saying to their patients: “Look I’m providing a valuable service to you and it’s only reasonable that you should pay for it”. When I came to the UK and found people not charging sight testing fees or fitting fees for contact lenses it was a surprise to me.’
Not surprisingly this is down to the structure of the business, one big difference being the National Health Service. ‘That’s not a big piece of the business in the United States, people either have private insurance or they cash pay. The interesting thing about the insurance piece in the US is that predominantly when people have it they use the insurance to pay for spectacles. They get a nice discount off an expensive pair of spectacles and then they pay for their contact lenses with cash.’
Typically he says in the US the fee for a comprehensive eye exam is about $75 and an additional fee for the contact lens fitting. ‘More and more ECPs are building in added value to that service, such as retinal photography.’ But this does not mean that product is less expensive. ‘I’ve found that the cost is relatively the same,’ says Pasko.
Despite this difference in culture, patients’ attitudes are very similar. ‘I think, by and large, patients don’t understand the product that they are buying, the modality, the chemistry, or the material that the lens is made of.’ He suggests there are some manufacturers that take the same polymer and call it a one day lens or a one month lens. ‘One of the things that we have done in Alcon is try and develop the materials specifically for modalities. Take, for example, Dailies Aqua Comfort Plus – you cannot wear that lens for another day and experience the same wearing experience. Similarly, our monthly lens, Air Optix plus Hydraglyde is specially developed to last a month which is the way patients are supposed to wear the lens. I think they are becoming a little more aware in the US about what a modality means and why a particular product is one modality or another.’ That difference he says, is down to education.
He wants to use education in the UK to capitalise on key opportunities in contact lenses that will get patients into the right products and help ECPs grow their business.
Alcon’s Academy of Eyecare Excellence
The 2011 transformation of Ciba Vision into Alcon provided the opportunity for an education process in the US which continues to this day and is something Pasko wants to ramp up in the UK. In both countries it is the practitioners’ recommendation that carries the most weight with patients. Studies show patients would be keener to wear lenses if their ECP told them they could. ‘There’s still a low level of understanding.’ He uses the example of presbyopia: ‘That’s probably the number one low hanging fruit opportunity in contact lenses as the population ages.’ Ageing patients are not aware that there is a contact lens made specially to address this issue they are having with their vision. We do focus groups with patients and when we tell them that there is a contact lens out there that will let you see near and far they routinely say: “Oh, I didn’t know that”, we [in the profession] take that for granted.’
Another opportunity Pasko sees for Alcon is its dry eye products, such as the Systane family, coming closer together with its contact lenses. ‘We have a chart we call the slide of injustice which shows vision correction needs. Younger people don’t need much vision correction, but as you become presbyopic and as you grow much older you need to replace your crystalline lens, therefore, within their lifetime almost everyone will need some type of vision correction.’
Contact lens wear starts in the teen years, and peaks at nearly 50% of total vision correction in the 20 to 30-year-old range. But then as people age and they need more vision correction they drop out of contact lenses. ‘We always used to think it was because they became presbyopic and they couldn’t see near and far, but now we know there is as much a component of dry eye. Their eyes become dry and hence their contact lenses feel increasingly uncomfortable leading to contact lens drop-out, which is why we are really excited that we are bringing our dry eye portfolio with its Systane portfolio back from Novartis into Alcon.
‘We believe that presbyopia is the number one opportunity, we believe moving patients into daily disposables is a big opportunity from a health standpoint and a compliance standpoint and patient satisfaction. We believe we have the best contact lens in the market with Dailies Total1. It’s the only water gradient contact lens with a surface water content approaching 100% at the outermost surface, that’s just amazing and the science behind that excites me. So for us taking that material and turning it into a toric lens is another big opportunity for us.’
The third strand is children in contact lenses and that, he says, has to be down to individual practitioners to advise as they see fit. ‘We feel it will be the ECP who will be the driver of that. If they believe that contact lenses are right for the child and the child is responsible enough to wear them safely, then they can help us. I’ve been through many campaigns where we have tried to market to moms for kids but it’s always the ECP who is the gatekeeper who decides whether they feel it is appropriate for the child.’
In the longer term Pasko sees many more opportunities for contact lenses such as myopia management, something he describes as an exciting prospect. ‘I think it’s a very interesting marketplace and we are watching that closely,’ he says although he is not party to any plans for a lens from Alcon.
From his personal perspective rather than Alcon’s he says the eyes are the window for us to everything. ‘I think we can do a lot whether it be drug delivery or drug eluding technology, a contact lens would be a great delivery mechanism. I think there’s a lot of potential technologies for the future. Once contact lenses become powered or include autofocus technology who knows what else is possible?’
As he settles into his UK role Pasko is candid about his initial plans to bring best practises from the US to the UK and that there are no ‘magic bullets’. In the US a lot of work had been done phasing out two weekly lenses and he expected to repeat that. ‘When I came over here I thought, wow they are already so further advanced that I couldn’t really help much.’
But there is one area he is keen to explore. ‘One of the things I have tried to bring over here is a little more awareness of who Alcon is and what we do. We had a big push in the States after the integration of Ciba Vision and Alcon to educate our practitioners on who we are and what we stand for. I came over here and found that in the integration of 2011 that didn’t really happen.’
He says people were still using both names so in his first year he has been trying to personalise the company to explain who it is and what it does. ‘We have got a wonderful educational facility here and we do a lot of training; people didn’t know that. We have really ramped up the training that we do for our practitioners and said we are happy to help you understand our products and the philanthropy Alcon does and our relationship with Orbis [the flying eye hospital].’
He also returns to the attitudes of practitioners when it comes to charging professional fees. ‘I would really like to influence the industry to charge for their services. I think when you give your services away people value them for what they pay. It didn’t cost me anything so it’s not worth anything. We are also trying to help practitioners not diagnose patients’ wallets. By that I mean eye care practitioners who take it upon themselves to decide whether a patient can afford a particular contact lens or not. We suggest the ECP offer patients the best technology available and then let the patient choose. I’ve been in offices in the UK and Des Moines, Iowa [USA] where patients roll in driving a BMW 7 Series holding the latest iPhone and the doctor thinks: “They can’t afford Dailies Total1, it’s too expensive, I’m going to sell them a cheaper one.” I think that is an attitude we need to change.’
While that attitude has been fostered by a legacy of the NHS times are changing. ‘If you are used to that over time it’s hard to break that cycle but I have bumped into practitioners here in the UK who have a beautiful office [practice] and have high end spectacles and are willing to charge for their services and they are doing quite well. The opportunity for practices is huge.’
Patients need to be prompted by the practitioner and with market penetration at 14% there are 86% of the vision corrected population to go after. He hopes that through education with programmes such as ‘touch and be amazed’ and the EASE programme, where spectacle wearers are offered disposable lenses when choosing frames, patients can be encouraged to try and adopt contact lenses. Education at the Academy can supplement that by teaching ECPs about the latest products. ‘I think everyone could benefit from more education and I think some of the early generation of bifocals and multifocals didn’t perform well. If you are a practitioner that tried them 10 years ago or even five years ago you might be reluctant to try them again.’
He also takes a no nonsense US approach to how messages should be relayed. There will always be techies who want all the science, he says, but: ‘There are also the people who say: “I just want to try the darn thing and see if it works”. I think from an education standpoint we need to be able to flex in order to be able talk to both constituencies and sometimes that’s a struggle because you get so wrapped up in the science.’ It’s a question of seeing contact lenses as an “and” with spectacles and not an “or”’.
Essentially the attitude of ‘I’m a doctor not a commercial outlet’ is international. ‘It’s those that appreciate that one doesn’t cancel out the other that are successful.’