You can’t escape. Turn on your TV, log onto Facebook or pick up a magazine and you’ll find them. Direct-to-consumer (DTC) advertising has exploded over the past decade. And with the advent of social media, your patients are being exposed to a constant bombardment of ads that try to influence their decision making about contact lens products.

Patients are becoming more educated on potential options as a result, and some ODs point to a changing dynamic of patient/doctor relationships.

“There is something wrong with a 30-second TV commercial making the patient believe they know better than the doctor’s years of professional training and clinical experience,” says optometrist Brian Chou of San Diego. “While consumer-driven marketing can increase patient demand for eye care services, these patients sometimes view the time and cost of these services as an impediment to receiving the contact lens rather than something necessary and desirable.”

Here, your colleagues weigh in on the positives and negatives this type of advertising ultimately has on your patients and your practice.

Positives of DTC
Besides New Zealand, the United States is currently the only other country that permits direct-to-consumer advertising for drugs and medical devices.

In 1981, Merck ran the first DTC print ad for its then new antipneumococcal vaccine, Pneumovax, in Reader’s Digest.

Although DTC ads for contact lenses had being used off and on for years, in 2005 a silicone hydrogel contact lens hit the big time during the Super Bowl, when advertisers paid an average of $2.4 million for 30 seconds of airtime for a prime time slot.1

Today, direct-to-consumer advertising is easily a multibillion-dollar-a-year investment for pharmaceutical companies; now medical devices, such as contact lenses, are also quickly gaining steam in the marketing landscape.

Despite some misgivings, ODs say there are tangible benefits:

Informs the patient. “Direct-to-consumer advertising does a good job of bringing contact lenses to the top-of-mind,” says optometrist Jeffrey Sonsino of the Vanderbilt Eye Institute in Nashville. “It may drive patients who are dissatisfied with their lenses into our offices for a trial of a newer material. The lens manufacturers are always careful to say, ‘See your eye doctor.’”

DTC advertising can raise public awareness about new contacts, such as multifocals, single-use lenses and silicone hydrogels. Consequently, today’s patients are much better educated on soft contact lens modalities than a decade ago when Ohio optometrist Mile Brujic first began practicing, he says. The knowledge gained through DTC advertising can simplify the patient/doctor conversation in the exam room.

“Now you often can jump right into a discussion of what you think is the best modality for a patient, as opposed to going over some of the basic fundamentals of contact lenses that we used to have to explain,” Dr. Brujic says.

This goes beyond contact lens products, too. “I can’t remember the last time I told someone about Restasis to treat their dry eye and had them say, ‘I’ve never heard of that product before.’ The prevalence of direct-to-consumer advertising makes communicating about the technology easier,” he says.

Drives patients to your office. Another argument for direct-to-consumer advertising is that these types of ads encourage patients to seek the advice of their doctor.2 This is especially helpful for people who otherwise would have have neglected to do so, Dr. Chou says.

“In turn, some of these patients will have undiagnosed eye conditions and underlying systemic conditions with ocular manifestations detected, which may have never occurred without the DTC advertising,” he adds.

“That it brings patients into our office is a good thing,” says optometrist Joseph Shovlin of Scranton, Pa. “I sometimes object to direct-to-consumer ads because it places me in an awkward position if I don’t use the product. But, I’m always happy to point out to patients that they may be best served by another option or product—even if that’s from a different company.”

Jason Miller, OD, of Powell, Ohio, agrees that ads that drive patients to a practice—whether they are a fit for a specific lens or not—is a positive. “If a patient is in my chair, I’ll say, ‘You know what, that lens may not be the best one for you, but here are some other options that would be perfect for you.’”

We can control patient perceptions to some degree. If optometrists allow DTC advertising to control what patients are doing, then they’ve missed the boat, Dr. Miller says. “Every patient creates an opportunity for their eye doctor to educate them on their eye health and how often they need to be seen when they are in our office.”

And the Cons
“Free” trial lens. A sticking point for most ODs interviewed is the promise to patients of the “free trial lens,” especially if the manufacturer does not build in the value of the required contact lens service and the patient doesn’t see the fine print about the cost of the exam. Then, the practice’s staff has to deliver the bad news that services with an associated cost are required.

Excess chair time. Additionally, patients may think that they are candidates for lenses that aren’t suitable for their prescription, which then requires re-education in the exam room, Dr. Brujic says.

Because it must reach a mass audience, “DTC advertising is not specifically tailored to any given patient, meaning it can lead consumers to request inappropriate contact lenses, resulting in patient dissatisfaction if the practitioner prescribes something other than what the patient wants,” says Dr. Chou.

He gives this example: A patient with uncontrolled blepharitis and a history of marginal ulcers would not be a good candidate for continuous wear.

Yet, DTC advertising of a 30-day continuous wear-approved lens may lead this patient to wear their silicone hydrogel lenses continuously for 30 days, even if the practitioner advises against doing this. “In these cases, the additional discussion absorbs chair time that could have been better directed to a more important issue that benefits the patient without further taxing the doctor’s limited time,” Dr. Chou says.

Every patient who sees a direct-to-consumer advertisement for extended wear wants this modality, adds Dr. Sonsino. “However, we know from well-designed clinical studies that extended wear increases the risk of microbial keratitis six- to seven-fold over daily wear lenses. That risk is no better with silicone hydrogel,” he says.

When patients point out that these lenses must be OK because the companies advertise it, Dr. Sonsino responds, “They advertise Big Macs but that doesn’t mean they’re good for you.” Though safely used by many patients, they may not be ideal for every patient.

Losing faith in you. Additionally, as consumers increasingly trust information from social media and manufacturers, the value they place on practitioners may decrease.

“The efficacy of this marketing can establish a greater bond between the consumer and the manufacturer, ahead of the doctor-patient relationship,” Dr. Chou says. “When this happens, the consumer ends up caring more about where he or she can get the specific advertised contact lens than caring about the quality of service.”

It is incumbent on doctors to inform patients about their best options, Dr. Brujic adds. So, when patients see direct-to-consumer ads on television, they aren’t second-guessing the quality of care they are receiving from their doctor.

Too cost conscious. Another con: Some advertising directs a consumer to order contacts online, which encourages the patient to do a lowest price comparison, says Brooklyn’s Justin Bazan, OD. “The chances of losing the sale are high if you are not competitive. And in this day and age, it’s becoming increasingly harder to be competitive and remain profitable.

The frequency of people buying elsewhere has noticeably increased, he says. “Patients are bombarded with ads, deals,
coupons, discounts, sales, etc. They are now super-aware that they have options, and they must consider looking online if they want the best deal.”

Dr. Bazan easily spotted ads on Facebook and YouTube for certain brands of contacts being sold at or near his practice’s cost. “As this dwindling product profitability continues, contact lens companies must realize that there are other clinically equivalent products that maintain profitability better, and it’s those products that docs will fit with preference if need be,” he says.

To stay competitive with the heavily advertised online alternatives, Dr. Miller ships contact lens orders directly to his patients at no extra charge, even if they order only a three-month supply.

Ranking the Ads
“I welcome the ads that emphasize the need for routine eye health exams and follow-up care for contact lens wear because they don’t trivialize the importance of eye health and what can be detected with a routine examination,” Dr. Shovlin says. He points to the dental profession’s success with this strategy. “They have everyone worried that your teeth might fall out without seeing your dentist every six months.”

These “see your doctor” ads are excellent for fostering the relationship between doctor and patient, Dr. Brujic says.

Dr. Bazan has implemented his own such ads on his practice’s Facebook page, and says they have been successful in targeting patients who are overdue for their eye exams.

However, “see your doctor” ads are too few and the ones that promote a specific product are too many, according to Dr. Chou. “This is understandable, because the contact lens manufacturers want return on investment for their advertising dollars. Unfortunately, most ads emphasize products while minimizing the value of the doctor’s services and clinical judgment.”

No Rx? No Problem!

Just because nobody replies doesn’t mean the Rx is OK. That’s the sentiment of a recent blog post by Dr. Bazan after he took on direct-to-consumer-advertising behemoth 1-800-Contacts.

Curious as to whether the company that advertises, “We beat any price on contact lenses” would ship him an order of contacts without a valid Rx, Dr. Bazan went online and placed a bogus order. He provided an inaccurate prescription and chose a random doctor from the drop-down menu on the 1-800-Contacts order page.

The result? “I was able to order contacts that are not even close to the right power, size, shape or material for my eye. Dangerous! And, I was able to choose a doctor whom I never heard of,” he says.

Because of a loophole in the Fairness to Contact Lens Consumers Act, Dr. Bazan’s mock order did ship, because the doctor he selected did not respond to 1-800-Contacts within eight business hours.

“The passive verification system is a joke,” Dr. Bazan says. “If you want contacts, you can get them––no need for a valid Rx. Patients will bypass care if we fail as doctors to motivate them to return for their annual exam.” ODs need to do a better job at educating their patients and demonstrating the value of the annual exam, he says. “If docs continue to make it seem like an annual contact lens exam is no big deal, then the patient feels the same way. They think, ‘Why do I need to go in for that? I know my Rx and I’m seeing just fine, so I will just order them online.’”
Product-specific ads can cause confusing messages for the patients who may think they are ideal candidates for a particular lens they saw advertised on TV. And often the messages that these ads put forth should instead be conversations held between the optometrist and the patient, Dr. Brujic says. As a result, you need to recalibrate patient expectations that are driven by this product-specific marketing, he adds.

As for corporate advertising from alternative distributors such as 1-800-Contacts and Walmart that tout inexpensive pricing on contact lenses, optometrists need to communicate with patients: What you offer is indeed different.

“I think all the advertising by 1-800-Contacts and other alternative distributors continues to create the consumer perception that contact lenses are a retail good that is non-prescriptive and can be selected like a pair of shoes,” Dr. Chou says.

Whenever someone advertises on price, they want the consumer to have the perception that what he or she is getting is pretty much the same regardless of the distribution method—they are just offering it at a lower price, Dr. Brujic adds. “This gives ODs the opportunity to say, ‘No, they actually aren’t the same.’ It gives us a different way to differentiate ourselves and the services we provide.”

Dr. Miller echoes this sentiment: “I try to play in a different field. I’m not going after the same patient. There are some patients who want to go to a quick in-and-out place or a type of place that isn’t service related, but price driven.” He differentiates visiting his practice with superior service. “I recently saw an ad on TV from an optical chain offering two pairs of glasses and a free eye exam for $79.99. I think that’s embarrassing to our profession, and not what’s happening in most optical and optometry offices across the board.”

And, as Walmart is ready to launch a new daily disposable contact lens called Equate (as part of its in-store brand), a heavy DTC pitch will likely ensue. “I believe the effort will generate widespread ire among eye care practitioners when this lens is marketed directly to patients,” Dr. Chou says. “It’ll be interesting to see how private practitioners will respond to requests by patients to prescribe this lens so that they can go purchase them at Walmart.”

As for the future, Dr. Chou predicts: “One of the consequences of DTC advertising is that, in the consumer-driven mindset, the consumer will attribute successful contact lens wear to their brand of lens. Yet the ideal situation is for the patient to attribute success to their practitioner’s expertise. My strong conviction is that a thriving contact lens practice requires the latter.”

1. Chou B. Direct-to-consumer advertising of contact lenses: help or hazard? Rev Cornea Contact Lenses. 2006 May;37-44. 
2. Boden WE, Diamond GA. DTCA for PTCA: Crossing the line in consumer health education? N Engl J Med. 2008;358(21):2197-200.