The Scary Rate of Dropouts in Contact Lens Practice

Chief Optometrist, Owner and CEO at Kontaktlinse Instituttet, Aarhus, Denmark

Introduction

Kontaktlinse Instituttet in Aarhus is Denmark’s largest specialized clinic for contact lenses and visual health. Generally, 80% of our patients are contact lens users, with some interesting demographics – especially when it comes to age. Here we describe our practice, its demographics, the lens fits, and the number of dropouts. We will try to explain the reasons for dropout and what we do to prevent dropout. In general, together with Buris Briller (spectacles specialist), and in close cooperation with ophthalmologists, our practice offers patients from all over Denmark holistic care and treatment options for their eyesight. At Kontaktlinse Instituttet, we have created a learning environment in which all staff is trained by educating each other. Our team consists of 9 optometrists, 7 assistants and 3 optometry students who continuously expand and update their knowledge and standards by training at national and international educational events, and they pride themselves in building strong professional relationships and cooperation throughout the health sector.

Patient Demographics

Our patients are predominantly women (~67%), and more than half of all our patients (55%) are older than 45 years. In this age group, generally all are presbyopic and thus suited for multifocal contact lenses. Approximately 34% of our patients have astigmatism 47% of these have astigmatism of ≥0.75DC in at least one eye. The percentages of silicone hydrogel versus conventional hydrogel lenses are equal (50% each). In the recent past in Denmark, most contact lens wearers were around 20 to 25 years of age. But today, the average age for a novice contact lens user is approximately 38 years. This development is suspected to have its cause in today’s increased possibilities for correcting hyperopia and myopia with contact lenses. Interestingly, we have observed that the number of contact lens wearers in our practice increases with age while the average percentage of over-55-year-olds wearing contact lenses is about 5% in Denmark, ours at Kontaktlinse Instituttet is above 25%.

New Lens Fits & Dropout Numbers

In 2021, we booked 543 new patient consultation appointments, of which 85% resulted in new customers (461 new customers) 15% of all potential new patients did not return (new customer dropout), 82 in total. And at the same time, we lost 7% of our loyal customers, resulting in 332 loyal customer dropouts. Hence, although the second category has a much smaller percentage, the net result is much larger. This usually doesn’t receive the attention it deserves.

Patient dropouts are a reality this is true in any contact lens practice. We started analysing the various reasons for patient dropouts in 2015, followed up again in 2017 and subsequently have analysed these data annually. In 2021, we found that one-third had suspended their prescriptions due to COVID-19 15% had returned to using spectacles, and 12% had simply not continued using contact lenses following the trial period of their prescription. The remaining third of all dropouts gave varying reasons that included relocation of the patient, eye surgery (IOL, laser, cataract, SMILE, LASIK), pricing and change of optometrist. Cases in which patients were not happy with our service, felt great discomfort using contact lenses, started buying their contact lenses online or who passed away were all very minimal: around 1% only.

Dropout Prevention

To prevent dropouts caused by start-up issues, we introduced new procedures. Following the initial consultation and fitting, we make sure patients are comfortable handling their contact lenses before they leave our clinic, and we book a 7-day-check appointment right away. An assistant explains all handling steps in an on-site introduction and provides the patient with digital educational material for later use at home. The very same assistant will call the patient 3 to 5 days after the first appointment to make sure that there are no issues. Should the patient have comfort problems or issues with handling the contact lenses, the assistant will ask them to return for an immediate check. In this way, by maintaining continuous, close contact and dialog with the patient, onboarding problems can be detected early and thus dropouts can be reduced – in our case by 50% within a year of implementing these procedures.

In polls we initiated in 2015, our patients’ priorities were clearly identified as all-day-long great vision, good comfort (also as the day ends), ease of handling, increased ocular health and, finally, reasonable cost. We find that most of our patients prefer one-day lenses (52%). Due to the perceived ease of handling, mainly our male patients prefer 30-day or 14-day lenses.

Lessons Learned

Dropouts happen - anyone active in the field of contact lenses should not bury their head in the sand about this. For a contact lens institute such as ours, that for the most part relies on contact lens wearers, this is of course a higher priority. By looking at the exact number of dropouts in the different groups (new and existing wearers), we have a better understanding of where problems arise and also to where to direct our attention, commitment, and energy. Typically, a lot of effort (and money) goes into attracting new wearers, and of course that is always a good plan. However, putting more emphasis on current lens wearers may deserve more attention.

By truly listening to our patients’ needs and individual situations, we can ensure that we offer them the best possible solution for their vision problems. What helped in our case was to specialize. We specialize in contact lenses – all types. Yes, we have a large proportion of daily disposable lens wearers, as we feel that this gives us loyal and long-term satisfied wearers in our practice. But at the same time, we offer all types of specialty lenses - including orthokeratology, corneal GP lenses and scleral lenses - and glasses if needed. But the message is clear: do you need contact lenses? Come to us. Especially for patients who have presbyopia: we can really make a difference as contact lens specialists for these patients and for our practice.

In general, we cannot prevent dropouts, not even in our specialized practice. But we’ll do everything we can to prevent them from happening – both in new and in existing lens wearers.

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