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Managing the long-term wearer whose needs change

Published on Jun 5, 2018
15 Minutes Read

By Simon Donne and Shireen Bharuchi

Why initiate a contact lens conversation

Managing the dropout

Research suggests UK practices lose over half a million contact lens wearers every year.1

Are we as enthusiastic with the more established wearers as we are with the new ones? Are we happy to let them drift away, hoping there is somebody new to take their place?

While we strive to generate new contact lens wearers, are we paying sufficient attention to our current patients?

It is important that we identify visual and lifestyle changes in our long-term contact lens patients and offer alternative and more suitable options before losing them altogether.

As experts in the field, we need to ensure that we are giving up to date options and advice.2

Only 19% of contact lens drop outs have tried an alternative lens and 48% drop out without seeking any advice from their practitioner3

Reasons for dropout in the long-term wearer

  • Dryness and discomfort.4,5
  • Poor vision compared to glasses.6,7
  • Onset of presbyopia and other age-related issues.
  • Change in career, lifestyle or personal circumstances may mean current lenses are no longer suitable.8

All these factors are rectifiable and this is where our expertise and regular follow up with these patients is important.

Communicate prescription needs effectively

Avoid using medical jargon - speak to patients using everyday language.

Advise them it’s not a “health problem.” Astigmats have “a similar need to lots of other people” – “a more tailormade correction which they already have in their glasses.“

Advise presbyopes, “the lens in your eye naturally loses elasticity over time reducing your ability to focus closer. This happens to everyone and is why you now can’t see your watch clearly in your contact lenses”

While presbyopia is a significant factor in contact lens discontinuation, a majority of dropouts are under the age of 305

Generating patient loyalty

Be ‘in tune’ with your patients’ needs.

Don’t underestimate the impact of improving vision and comfort on your patients’ quality of life.

Advise patients on their ‘visual buffet’ when either spectacles, contact lenses or a combination of both may be the more suitable option.7

Remember - happy patients tell others!

What to look and listen for

Confront the assumptions

Talk to your patients using open questions and be alert to clues. They may be making assumptions about what is normal and be basing their decisions on incorrect beliefs:

  • ‘Now my arms are too short so I know I’ll need to wear my glasses more.’
  • ‘As you get older your eyes get drier, don’t they?’
  • ‘Vision isn’t as good as with glasses when you’ve got a stigma’

Warning signs

!  Patient attending early for an aftercare appointment.

!  Change in contact lens wearing habits.

!  Lenses not worn to the aftercare appointment.

!  Showing great interest in frames while waiting to see you.

!  Purchase of ready readers.

!  Frequent purchase of re-wetting drops.

!  Cancelled direct debit scheme due to backlog of unworn lenses.

Play detective

Listen for those patients who could be at a new stage of their lives and may need help, e.g:

  • First signs of presbyopia.
  • Patient proudly announcing their new job which might involve more hours in front of the computer.


Ask probing questions to determine exactly when and where any issues are experienced.

Utilise pre-screening either through an informal chat or questionnaires before their appointment.

Prepare your patients: be a ‘fortune teller’

Ensure your patients are aware that their needs will change and you’re there to help. Discuss with patients their impending presbyopia so they will be prepared rather than surprised and know that contact lenses can provide ‘vision for life’.

A patient prepared for change may be more willing to volunteer information when this happens.

Show them the difference

Holding cylindrical lenses over spherical contact lenses while observing a suitable visual aid immediately shows astigmats how being refitted will improve their vision.

Create opportunities

Provide information about the latest products with appointment reminders.

Try asking patients ‘ is your appointment purely for an eye examination or do you want to talk about contact lenses as well?’

Visual information on latest products can offer an opportunity for dialogue on our patients’ needs.

Wouldn’t it be great if I could fit you with a contact lens which means you won’t need your glasses 80% of the time?


Utilise the entire practice team

Ensure all staff are up to date with the latest developments to allow them to confidently discuss all options for maintaining excellent vision and comfort. Fit practice team members with contact lenses so that they can directly empathise and speak of their personal experiences.

Explain benefits

‘We’ve just starting fitting a new lens which helps you see far, near and all the bits in between’. ‘We can fit you with contact lenses that are tailored to your prescription to correct your astigmatism’.

Ask probing open questions

Ask for more detail to elicit potential concerns.
‘Do you ever use glasses with your contact lenses?’
‘Do you ever have to remove your lenses during the day for vision reasons?’
‘Are there occasions when your eyes feel dry?’
‘Are your lenses always as comfortable as you would like them to be?’
‘Are you thinking of using your contact lenses more…or less?

Download PDF


1. JJV Data on File 2019. Growth Levers Data.
3. Tranoudis I and Sulley A. Simple steps to grow your contact lens practice. Optician, 2010;6272:240 38-43
4. Young G. Why one million contact lens wearers dropped out. Cont Lens Anterior Eye 2004;27:83-85.
5. Nichols J et al. The TFOS International Workshop on Contact Lens Discomfort. Invest Ophthalmol Vis Sci 2013;54:TFOS1-TFOS203.
6. Naroo SA. Contact lens dropouts – ‘must try harder’ Cont Lens Anterior Eye 2013;35:5 195.
7. Young G, Veys J and Pritchard N. Lapsed Wearer Ophthalmol Vis Sci 2002
8. Chalmers R. Overview of factors that affect comfort with modern soft contact lenses. Cont Lens Anterior Eye 2014;37:2 65-76.

Full published article:

Donne S & Bharuchi S. Conversations in Practice: Managing the long-term wearer. Optician, 2014; 247 (6473):23-30

Important Safety Information:

: ACUVUE® Contact Lenses are indicated for vision correction. As with any contact lenses, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Contact lenses should not be used in case of eye infections or any other eye conditions, or in case of a systemic disease that may affect the eye. For detailed product information, including contraindications, precautions and adverse reactions, please consult the Instructions for Use or visit our Johnson & Johnson Vision website: