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On Axis?
Although we now have a better than ever range of astigmatic disposables, it’s still a pain in the proverbial when one comes face to face with parameter limitations.
The companies all want us to increase the prescribing of toric CLs. This is evident from the number of lectures, road shows and CPD dinner options.
They also want us to convert more patients from older low Dk lenses to newer si-hy high-Dk versions. Irrespective of their desires, marketing and CE on offer, we should be proactively upgrading our patients to si-hy versions anyway as they are literally a breath of fresh air and so much better for the cornea.
Thus I get frustrated every time I want to upgrade a -2.75cyl patient from a SofLens Toric to a Purevision toric. It happens all too often; my contact lens assistant says “Sorry they don’t do it” and gives me that look that says “Can’t you remember? Can’t you look up the available options in the database?”
Even though we have asked for this range extension for many years it’s still not here and seems to defy logic. Although their new see through MPS bottles are nice, I’d rather they spent all that money on increasing their range so that -2.75cyls are available throughout the full plus and minus range and all axes. While they’re at it a -3.50cyl would also be a boon for a number of our complex and long suffering patients.
I strike this problem regularly as I used the SofLens66 Toric on many complex high-cyl patients over the past decade or two. Some had small residual cyls even with the -2.75DC lens but this residual becomes much more significant when we drop them another 0.50DC to a -2.25cyl when we are supposedly ‘upgrading’ them to PureVision!
They get oxygen at the expense of vision.
Which do you think they notice or care about more?
I had a similar issue with an Acuvue wearer as I was writing this edition. The patient concerned has a -3.50DC refractively but this gets largely corrected by a -2.25cyl. (There’s no -2.75 cyl in plus powers in either Purevision or Acuvue Oasys for astigmatism).
A Plano/-1.75x90 trial lens provided an over-refraction of +0.50/-0.75x90 so I ordered a +0.25/-2.25x90 only to be told “Sorry, not available”. (As J&J don’t have a -2.25cyl in plus, yet) so I therefore ordered a Plano/-2.25x90. This worked satisfactorily however it is obviously more of a problem for significant hyperopic astigmats. Although we can get custom disposables from the amazingly wide range that Cooper offer we then have to compromise oxygen to get vision.
It’s all rather frustrating. Yes I know all about the bell curve and inventory issues and how many SKUs are feasible and economical but unfortunately the patients in my chair have what they have and need what they need and we simply need to have range extensions.
End of story.
Vote with your Feet
For over a decade I have warned people about the risk of the internet siphoning off sales of contact lenses and what countermeasures they could implement. One cannot however consistently beat the internet on price unless you plan on bankruptcy. There will always be someone cheaper. A guy selling lenses out of a garage on the Gold Coast with no overheads will undercut you every time, as will the big boys who sell millions of boxes and get massive discounts. Another way they are often able to sell lenses on the internet at less than what we pay local suppliers is to play the third world exchange rate game; essentially some companies sell product into lesser economies at lower prices. These countries also often have weak currencies so one can pick up lenses cheaper and then score another 20 to 30% by buying them with a strong currency, which the NZ dollar currently is. There are also short-dated stock clearances and counterfeits that one has to contend with.
As NZ is an early adopter of technology, Kiwi’s are very confident internet shoppers. It’s clear to all in the industry that internet sales of contact lenses here are rocketing and among the highest in the world. We’ve been tracking this increasing trend over many years.
I’ve had much discussion with many people on this subject over many years.
Prescribers are now however becoming more savvy and prescribing lenses from companies who have more consistent wholesale prices internationally and whose lenses are not available on the Net for less than they pay the suppliers. Essentially is seems that of the ‘big four’, two of the companies have lens pricing to practitioners that is above what they sell for on the internet. How crazy is that! Numerous practitioners tell me how their prescribing habits have thus now changed. As all of the ‘big four’ make good lenses, it is not an unethical compromise to pick one brand over another - based on price competitiveness - but an economic survival tool.
For those concerned about this trend, I suggest you logon to a few of the popular sites, compare their retail prices to your wholesale prices and seek out the companies that at least make it possible to be competitive.
Simple really.
Of course that still isn’t enough but it does seem to be making a difference for some of the proponents.
I do, of course, go back to what I’ve always said; charge professional fees that are commensurate with your professional status and for skill and time spent. Also consider the economic benefits of charging decent fees for additional specialised tests with equipment such as OCT, retinal imaging, topography and so on. It will help compensate for the percentage of CL sales that you have lost. There’s more yet but beyond the space available and scope of this column. It’s really a topic that CE providers should be adding to their conferences and one that should guarantee a decent turn out?
Cough, Cough, Splutter, Splutter....
Well here it is. The bit I think a number of readers have been waiting for.
I am told there was some rugby played in July in NZ between the All Blacks and Springboks?
I was in fact there, hoping for some history making rugby from the Boks in shaking off the jinx that has prevented them winning at Eden Park since 1937. It was also the first encounter between these great foes at Eden Park in a decade. I think the Boks were stranded somewhere with engine failure as the imposters that fronted up were never in the game. Of course Brain Box Bakkies managed to have a brain melt and was (thankfully) banned for nine weeks. The pies we ate en route to the game were great but the humble pie I was fed for many hours thereafter was not as tasty…
Yes, the Boks did choke.
The ABs to their credit played some of the best rugby I have seen them play since well before their meltdown in Cardiff three years ago. They gelled into a giant beating team. They did what they had to do and did it well. Full credit.
The second game in Wellington was a little better and the Boks didn’t look too bad but that was largely thanks to Dan, who I suspect had his Jockeys on too tight?
Unfortunately the Boks also have a bad track record at Suncorp stadium so I am not holding out much hope against the Wallabies. If they can win there then they may still have a chance in the Tri Nations. If not we may as well hand over the cup right there.
Of course one should never underestimate the bloody Ockers.
There are however a few questions yet to be answered this season and next.
Will the Bok coach wake up and play his star players? Are the ABs peaking too soon (ala RWC 2007)?
At any rate I expect we will see a much better, more complete and well rounded team from the Boks in 2011, including at least two star players missing this season as a result of injury and politics. I also think we’ll see some dunderheads retire as well as one or two older players who would do better to front up on the coaching team, as we saw with Percy as a kicking coach, when he had reached the end of top level playing.
Rugby’s the winner.