Coloured contact lenses - why they REALLY annoy me Of all the afflictions that have been placed upon the earth to test the patience of optometrists, none seems to annoy quite as much as the coloured contact lens. As well as being one of the least essential services that an optometrist provides, coloured contact lens fitting tends to be one of the most time consuming and unfulfilling tasks that falls within the ken of an otherwise respectable job description. Let me describe the whole grisly process to you in detail (using lots of sweeping generalities, of course). The story always starts when the prospective client or group of clients (usually all female) wander in asking whether we sell coloured contact lenses. --- Lesson 1 --- People don't expect to need to have coloured contact lenses fitted, especially if they haven't worn contact lenses before. After all, EVERYONE knows what to do with contacts, don't they? ---------------- After the inevitable ten minute spiel where we help them to realise their ignorance about contact lenses, we mention that there will be a fitting fee. --- Lesson 2 --- Many people don't expect to need to pay for the fitting or delivery of contact lenses, and all the expertise that goes along with these visits. They also don't consider that an optometrist's time is worth anything much at all, which is inherently degrading. Most people wanting coloured contact lenses will have this opinion, since they are inherently consumers and shoppers, not patients. This opinion is propagated by optometrists who advertise free eye testing, or try to package the cost of the consultations with the contact lenses. ---------------- Then they hear about the cost of the contact lenses. --- Lesson 3 --- Maybe surprisingly, people seem to mind less about the price of coloured contacts than they do about the fitting fee. Indeed, you will often find that they have an idea of the price to expect, because they have been through many other optometrists, trying to find the cheapest. However, if you're not the cheapest, most won't care that you do good optometry, even if you try to educate them. --------------- After the screening is passed, the client moves on to the consulting room. --- Lesson 4 --- Coloured contact lens wearers are fickle. If they don't get seen at once, you have a rather good chance of losing them, unless you've got a good incentive for them to come back. Not really a problem for slow practices, but a major problem for busy practices which lose money when patients in their appointment books fail to turn up. ---------------- The optometrist does a standard consultation for the client. --- Lesson 5 --- Patients don't expect to need a full standard consultation to get a pair of coloured contact lenses. Indeed, it is advisable not to take much more than 25 minutes to complete this initial consultation. After all, we live in a society where people want things NOW. So if you're going to do a full ocular health examination with dilation, or an extended binocular vision workup, be prepared for the consequences of not addressing the cosmetic issue first and foremost. ---------------- The optometrist then discusses the types of coloured contact lenses, long-term versus disposable, opaque tinted versus transparent tinted, blue versus green. --- Lesson 6 --- It always amazes me that clients will often want exactly the same thing that a friend has. After all, when a lady goes shopping for clothes, does she go and pick out the outfit that she saw a friend wear the day before? (Maybe she does.) ---------------- After the type of lens is narrowed down, the trial fitting process occurs. This involves the optometrist placing a trial coloured contact lens in an eye, and then letting the client evaluate the appearance in a mirror. If the client likes the lens, the optometrist assesses the fit. --- Lesson 7 --- How many lenses do clients need to try on before making a final decision? This all depends on the range of lenses available at the practice, the patience of the optometrist, the fussiness of the client, and the number of friends that the client has brought with them to `help' with the decision. If a client wants disposable lenses, I find that the decision process is normally rather quick, requiring only three or four trials. However, if the client is going for long-term lenses, especially blue or green, it may be necessary to use over ten trials, assuming that the practice offers a reasonable choice. Factor in the time required to insert each lens, especially for clients new to contact lens wear, and it is easy to imagine a half-hour session spent solely in colour selection and fit or comfort evaluation. ---------------- Finally, the optometrist takes a deposit for the lenses and tells the client that the contact lenses may take a few days to arrive from the supplier. --- Lesson 8 --- One lesson I learnt quickly is that some clients are strangely unlikely to come back and pick up their new coloured contact lenses unless you extract a sizeable deposit from them before ordering. Actually, the same philosophy seems to apply to prescription contact lenses or glasses, and I would guess that this fickle attitude is a widespread byproduct of competitive consumerism. Indeed, the effort and money put into the production of the (now useless) products goes unappreciated. Another lesson is related to keeping advance stock. If you buy stock in advance (which is only really viable with non-prescription coloured contact lenses), you can offer the client instant supply. However, there is a significant financial outlay associated. It can also be useful to have an enforced break between the initial visit and the delivery of the coloured contact lenses, one of which is the client's ever-growing fatigue, associated with a waning level of concentration. ---------------- The optometrist collects his consultation fees. --- Lesson 9 --- No, Medicare won't pay the fees for coloured contact lens fitting. Why should it? After all, the consultation is not created by some health-driven need. The one exception to this is for people who need coloured contact lenses to hide or alleviate some ocular abnormality affecting vision. ---------------- The optometrist then makes an appointment with the patient to deliver the lenses. This visit also includes instruction about insertion, removal and cleaning of the lenses. --- Lesson 10 --- Experienced contact lens wearers usually clean their lenses wrongly. They may also have picked up bad habits, such as rewetting contact lenses with saliva (which has a high bacterial load at most times), cleaning lenses just before insertion (resulting in minimal antibacterial action) or cleaning lenses once a week. ----------------- You may be able to see that it is unusual that a coloured contact lens wearer will take up less than 45 minutes of an optometrist's time on initial presentation. However, there is only so much mark-up that can be incorporated into the cost of the lenses or the consultation fees to recompense the optometrist. The competitive nature of the marketplace today means that a private practitioner will make a nominal amount of profit on the first sale. If the patient comes back and continues purchasing coloured contacts, this profit grows to a reasonable size. There are often arguments that contact lens provision helps to grow the practice as a whole, partly because the patient returns regularly to buy cleaning solutions or new contact lenses, and partly through referral. These may be fine in theory, but from my experience, the benefits may be rather easily outweighed by the lost time that could be spent seeing a number of other patients with real vision problems. These arguments only work for slow practices where the optometrist is able to spend an hour with a patient without too much difficulty. In conclusion, coloured contact lens fitting became one of the key reasons that I gave up optometry, if only temporarily. I got sick of spending my time in what I saw as a wasteful activity, when I could be helping those who had more important problems. I feel that I might still been in optometry if I had started in a practice where I was able to use my skills in a more productive and fulfilling way. Last edited 25 August 1999