Meredith Bishop, OD, MS, FAAO, Kurt Moody OD, FAAO, Drew Hansen
Crossing the Chasm is a very popular book in business school curricula discussing marketing of high-tech products.1 The concept of a product adoption “chasm” also applies to practitioners as we consider bringing new products into our practices (Figure 1). Author Geoffrey Moore proposes that there is a big gap between those who know how to create a competitive advantage by being first to adopt new technology and the much larger group in the early majority who, while willing to embrace new technology, want and need the tips and tricks from the early adopters to help minimize their risk in trying.
This applies very well to the uptake of multifocal contact lenses in markets around the world. The following “in-practice assessment” (IPA) employed a clinical expert from Johnson & Johnson Vision to help bridge that chasm for a large group of practitioners.
Marketing a High-Tech Product
Figure 1. Example of product adoption curve including the "chasm" that limits product uptake in the early phases of marketing. Adapted from Moore GA. Crossing the Chasm: Marketing and Selling Disruptive Products to Mainstream Customers. New York: Harper Collins; 2014.
Does the Presbyopia ‘Chasm’ Exist?
We know that there is a steady decline in the proportion of contact lens wearers after the age of 40 – precisely at the time when near vision correction needs become almost universal due to presbyopia (Figure 2).2 In 2017, Rueff looked at a group of 307 vision-corrected individuals between the ages of 18 and 76 years. In this group, 78% (237/304) reported spectacles as their primary form of correction and 22% (67/304) contact lenses. When looking at just the presbyopes, a significantly larger percentage (42.2% vs. 23.9%) were in the spectacles group, reflecting an under-penetration of multifocal contact lenses (p = 0.006, = 7.4).
However, roughly 2/3 of the spectacle wearers who had worn contact lenses previously said they would actually prefer contact lenses if good vision and comfort could be achieved, and the preference for contact lenses was not significantly different between the presbyopic and non-presbyopic group.3
Interestingly, “better vision” was cited by former dropouts as the main reason for resuming contact lens wear – reinforcing the fact that vision is so much more than just a visual acuity measure! Patients clearly also attribute some aspects of convenience (such as ability to see in active situations and inclement weather) to visual performance, since vision quality was also cited as a reason for discontinuing contact lenses.
Finally, Rueff noted that cost was infrequently cited as the reason for discontinuing contact lens wear in the presbyopic group, suggesting that focusing on overcoming comfort and vision issues can make the value equation worth it to these patients.3
Figure 2. Steady decline of contact lens wear noted with increasing age in group of 1,540 presbyopes surveyed (adapted from Naroo 2022).
In 2022, Naroo et al., published the results of a very extensive online survey about perceptions of contact lenses for presbyopia, which augmented Rueff’s work. They presented results from 1,540 patients between the ages of 40 and 70 from several major contact lens markets (United Kingdom, United States, Netherlands, Germany, France, Spain, and Italy) who were either wearing or interested in trying contact lenses. Of the 50.8% (n=782) of presbyopes already wearing contact lenses at least part of the time, only 25% of these used multifocal contact lenses.2 But as shown below, contact lenses offered clear benefits to wearers in the survey by Naroo. Also telling was the fact that practitioner recommendation was key to the decision to try contact lenses, though that conversation occurred less than half the time for spectacle lens wearers.2 These results should serve as reminders and encouragement for us to offer multifocal options to more presbyopic patients.
Should There Be a Chasm?
The availability of soft multifocal contact lenses has expanded significantly since the initial offering of ACUVUE® Bifocal, the first disposable bifocal, back in 1998. In early 2022 in the United States, the contact lens website EyeDock listed more than 20 “branded” disposable multifocals from the four major manufacturers, including daily disposable, two-week and monthly replacement options as well as monthly replacement designs for astigmatic patients.4 In addition, there were multiple private label brands and offerings from other manufacturers of gas permeable and soft lenses.
We can also be sure it’s not the lack of an age-appropriate population holding us back. According to 2021 estimates by the United Nations, the population aged 45-64 constitutes 24.9% of the population in North America (primarily the United States and Canada), 27.4% of the European population, and 22.5% of the Asian population, with those 45-54 comprising approximately half or more of that group.5 And that 45-54 age group could be the “sweet spot” for starting with multifocal contact lenses: they have low to medium adds and less chance of ocular media changes.6,7 The patients are definitely out there!
However, chances are you might still not be convinced about the reality of incorporating multifocal contact lenses into your practice. Could it be because you don’t want to believe the “marketing” claims of the manufacturers, thinking that the success rates sound too good to be true? Or maybe it still seems like fitting multifocal contact lenses is too hard, takes too long, or that patients won’t like it or be willing to pay for it?
We have some answers for you. Here are data from real world practitioners just like you who tracked patients they fit under no enforced protocol in what is called an in-practice assessment (IPA) versus a controlled clinical study. The patients they fit were offered the opportunity to participate in a follow-up survey by an independent market research firm. These results should address many of your questions and will also compare these responses to studies done under a strict manufacturer protocol. Finally, you’ll find some specific tips about how to make multifocals a more significant and successful part of your practice.
In all, 317 eyecare professionals (ECPs) across the United States were enrolled in the IPA. They each agreed to track up to 20 patients fitted with either ACUVUE® OASYS MULTIFOCAL, a silicone hydrogel multifocal lens for two-weekly replacement, or 1-DAY ACUVUE® MOIST MULTIFOCAL, a daily disposable hydrogel option in the same design, during a three-month period (July to September 2021). They attended a virtual training session on the ACUVUE® Brand MULTIFOCAL with PUPIL OPTIMIZED DESIGN delivered by optometrist Dr. Kurt Moody, one of the developers of the proprietary design. The training reviewed the multifocal opportunity and best practices for fitting and patient selection.
Prior to the commencement of tracking, participating practices were provided a packet with information about the lenses and a card to give to patients they fit inviting them to register to complete a follow-up survey a few weeks after they left the office with their multifocal contact lenses. The practitioners were asked to complete online experience logs/questionnaires after each fit visit, after all follow-up encounters, and at the conclusion of the IPA.
Data collection and analysis were carried out by Ipsos Healthcare, an internationally recognized supplier of market-research-related activities such as surveys and in-market/in-practice product assessments such as this one.
Of the 317 practitioners enrolled in the assessment, 231 completed 2,736 experience logs at the initial fit, 1,496 logs for follow-up visits, and 143 of them participated in the post-assessment survey. Of patients fit with an ACUVUE® MULTIFOCAL, 184 individuals from 95 different practices elected to participate in the online survey following wear outside the practice. Figure 2 provides details about age groups for all patients who participated in the post-fit survey. Though there was no refractive data associated with the patient-reported data, using decades as a rough proxy for expected add power (40s low add, 50s medium, 60s high), you expect that the largest group will be in the mid-add category, followed by low adds, and the smallest group projected to be in high adds – overall, a good distribution of ages and add powers.
Figure 3. Distribution of ages of patients fit in the study in total and broken down by lens design
What We Learned
Direct comparison of manufacturer claims from controlled clinical studies with results from eye care practitioner (ECP) and patient surveys in the IPA can help to dispel some common "myths" and barriers for those who haven't made the leap into the mainstream multifocal contact lens market.
Graphic below: "Controlled Clinical Studies"
MYTH #1 – “Manufacturer Success Rate Claims Seem Too Good to Be True”
Most of us would be happy if we could tell our patients that our chances of success are around nine out of 10. The graphic below shows that the success reported by the practitioners in this IPA was about that, and patient satisfaction was also high, even immediately after the first pair of lenses in the office.
MYTH #2 – “Contact Lenses Can’t Deliver the Vision My Patients Expect”
Focusing on Snellen visual acuity as a marker of success is not recommended. Instead, focus more on discussing the functional benefits of multifocal contact lenses and make sure you send your patients home with lenses to try in those specific situations before making a judgment about success – you’ll probably both be pleasantly surprised!
MYTH #3 – “Aging Eyes Have Too Many Issues with Comfort in Contact Lenses”
MYTH #4 – “Multifocal Contact Lenses Are Not Worth the Higher Cost to Patients”
People pay extra for things that enrich their lives – things that make them look or feel better, things that save them time or money. Focus on the benefits contact lenses provide your patients. Framing cost by breaking a large cost down into a cost per use or cost per month can also make a higher price much less daunting.
A Rewarding Professional Experience
While patient success is ultimately the goal, fitting multifocals can be very rewarding professionally, as well as a source of referrals and practice growth – 85% of patients said they would recommend ACUVUE® OASYS MULTIFOCAL to friends and family, 97% said they would recommend the practitioner who prescribed the lenses, and nine in 10 said they were more likely to purchase contact lenses from the same practitioner now that they’d been fit with the lenses.§
As a result of this exercise, 92% of participating professionals felt they were now more confident to refit their spherical wearers in ACUVUE® MULTIFOCAL. The success also made them report being less likely to turn to monovision: 92% said ACUVUE® MULTIFOCAL lenses are a better long-term option compared to monovision.*
The ACUVUE® Advantage
ACUVUE® MULTIFOCAL with PUPIL OPTIMIZED DESIGN offers several features that can contribute to these high levels of success and confidence.8
- They start with a unique optical profile designed to achieve an extended depth of focus.
- The optical design is then optimized for the expected variation in the range of pupil sizes across not only a limited number of add powers as most manufacturers do, but across all 183 prescription combinations of distance and near powers as well, accounting for pupil size changes resulting from refractive error. This PUPIL OPTIMIZED DESIGN is basically built-in personalization for your patient – without you having to do any extra work.8
- A hybrid back curve helps ensure that the designs stay centered over the pupil, and each lens is infused with a proprietary wetting agent for exceptional all-day comfort.
As a result of participating in this IPA, 96% of eye care professionals agree ACUVUE® MULTIFOCAL Contact Lenses are their first choice of multifocal contact lens brands, 87% agreed they were the easiest multifocal to fit, and 97% agreed they would recommend them to colleagues.*
Get Ready to Leap that Chasm
Are you convinced it’s time to “cross the chasm”? If so, start by getting a number of fits under your belt – 10 is a nice round number that helps you quickly get a handle on success rate. The fit guide from the manufacturer should be your first step – follow it precisely for selecting the initial pair, but even more importantly, use the fit guide for problem solving, as there are major differences in approach depending on design principles. In this assessment, practitioners had the benefit of advice from an expert on “the other side” of the chasm – training by Dr. Kurt Moody. On the Johnson & Johnson Vision Professional website you’ll find helpful videos from Dr. Moody as well as an online fitting calculator that can help you quickly and easily find the right trial lens powers. If you still feel you’d like a bit of coaching, reach out to your account representative and ask what other resources are available.
Lastly, it is critical to remember that while confidence in fitting multifocals generally is likely transferable across manufacturers and designs, every design is quite unique, employing some very complicated optical designs. It’s important to follow the specifics of each manufacturer’s recommended approach. The good news is that the three simple steps to fitting ACUVUE® MULTIFOCAL contact lenses are also good general guidelines that may help across lens designs:9