Developing the MyDay Multifocal with Drs. Michele Andrews, Aldo Zucaro, & Shane Foster

Dr. Christopher Wolfe: [00:00:00] Introduce yourself. Tell us, um, tell us what, what your role is in CooperVision kind of your background and then how do you solve that problem? That, that Shane and I were discussing. More info to come on developing the MyDay Multifocal. Aldo Zucaro: Yeah. Thanks, Chris. Um, so a little bit about myself and then I’ll jump into that question. Um, I have a PhD in behavioral. Um, it’s, uh, it’s kind of a, hold on, Dr. Christopher Wolfe: hold on, hold on. I’m going to stop you right there. So tell me about behavioral economics. It sounds kind of like Freakonomics, so you’re you’re basically then, is it true that you’re you would be analyzing, uh, the why people do things behind or the financial motivations behind why people do things? Is that right? Aldo Zucaro: Well, uh, the folks at Freakonomics took a financial view, uh, of that, uh, The more general sense of it is. Um, there, there are reasons people do things, uh, that are, that that may or may not seem rational. [00:01:00] Um, but they’re also not very good at remembering the things that they do. People are great at justifying. Um, but they’re not really good at remembering exactly all the things that w we do. We live our daily. You know, in our moments that most of those things are just sort of lost to us. We’re not recognizing all those, all those moments in time. And so what would it be? Dr. Christopher Wolfe: I get up and, sorry, I don’t mean to interrupt you, but this is very interesting to me. And so I’m going to take it where it goes if I think this is so, um, I get up in the more. And, uh, I get back from working out and I want a cup of coffee. And depending on, if I go to Starbucks or, you know, the coffee shop down the street, or I make it myself, there’s something behind why I do that. Every like which one I pick. Right. Is that correct? And I just don’t, I’m not aware of that thing. That triggers. Exactly. Aldo Zucaro: And, and, and typically in the field, we call those system one [00:02:00] and system two decisions. Most of our day, we work on system. One decisions. We know that around noon time, I’m going to eat lunch. Not because I’m hungry, but because I know that around noon time I lunch, it’s it relieves my brain from doing a little. And people go through the day sort of relieving their brains of doing work system to decisions. They’re, uh, they, they take work. In fact, it’s funny, uh, you spoke just a few minutes ago and said, well, you know, uh, you know, it it’s, it’s like doing that wonky research. Well, that wonky research comment was really a system to. Comments like that takes a lot of work. And so I won’t do that. I’ll do sort of this system one work, which I know it sort of works and I’ll start there and if it doesn’t really work, then I’ll engage in this thing called work. Dr. Christopher Wolfe: Shane, we do too much system one work. You got to do more wonky research. Okay. No, that’s great Alto. This is awesome. So please keep [00:03:00] going. And so, uh, so how much, how much do you have to train your brain to do more system to work or, or do we all do system one off? We Aldo Zucaro: all, we, we could not survive if we were working on system two. I think that the thing that, um, the thing that’s important is engaging system to when it needs to, um, otherwise system one always wins and you go, well, I don’t care anymore just to do this. Um, or I’m going to stop cause I’m, I’m, you know, I’ve reached a level of frustration or it’s just not worth it or whatever else comes into play. Um, and that, that, that really, that idea was the Genesis of this. In fact, um, I’ll tell you a little bit more about my background. Uh, before I jump into the research, as I said, I have a PhD in behavioral economics. I’ve been with CooperVision, uh, about seven years going on eight and, uh, yeah, Bausch and Lomb before. For about 12 years. Uh, so about 20 years almost crossing [00:04:00] 20 years in the industry. Prior to that, I worked for, um, uh, a defense contractor. So, uh, it was, uh, it was a government agency, which was really interesting and probably, uh, a talk for another time. Um, yeah. Dr. Christopher Wolfe: So, uh, is that a promise? Can I get you back on and talk about it? Absolutely. Aldo Zucaro: I’d love to come back. Anyhow, uh, as we talked about sort of what we wanted to do with this land, one of the things that crosses my mind all the time is that, you know, we’re, we’re really good at, at doing things like surveys and focus groups. But unfortunately what happens in those things is that people do their best. They’re being as truthful as they can possibly be. Um, but, but unfortunately it misses an enormous amount of information. It’s, it’s just wide gaps and what what’s really going on. So I turned to, to friends of mine at Carnegie Mellon university and, uh, Carnegie Mellon has a human design school, which really focuses on what people do and how they do it.[00:05:00] So I actually turned to those guys and say, Hey, look, here’s my problem. Um, I know that, uh, things are going on. We are doing a variety of coping, uh, in order to live with presbyopia. Although when I asked them, I feel that I’m, I’m probably only scratching the surface of what’s actually going on. Can you help me figure this out? And that’s when they introduced me to the idea of, well, maybe we should do some ethnography research now for those of us that are non graphy. Okay. Yep. Uh, so can you explain that? Yeah. Yeah. So it’s not, is really interest. It it, what it does is it says, Hey, how about I just observe you? I’m not going to ask you any questions. I’m actually going to try to be as invisible as I can possibly be to the situation, because I really want to just understand why you’re doing. Um, I don’t want you to process it because if you process it, unfortunately, system two jumps in and then you’ll give me a lot of reasons why most of which are probably not the right thing.[00:06:00] Dr. Christopher Wolfe: Hello and welcome to the Criswell podcast. And I could media today had a great conversation with Dr. Michelle, Andrew, Dr. and Dr. Shane foster about the research and the approach that CooperVision took to incorporate people’s experiences in their daily lives, into solving those problems from a multifocal standpoint. So we talked a lot. How did they come up with, with a mechanism to evaluate that for patients? And then how do they translate that into a lens that’s going to be usable. And then Shana and I talked about how do we take that information clinically and help us refine our approach to understanding a patient’s visual needs and practice. So please enjoy our conversation as always be sure to subscribe to the podcast, write a review, share it with your friends and support. Who support us. So what I wanted you all to talk about today was [00:07:00] the development from a conception standpoint of the new product. And specifically, I want to talk about the MyDay multifocal, uh, but, uh, how. We’ve have this new product and then how it gets filtered into how do we know this is going to be good for patients? And then how can we test that? It’s good for patients. And that’s why I think that it’s important, Michelle, that we have all of you on today. Uh, so Michelle, give me, uh, a sense of Cooper’s approach to, uh, to new products and new designs. And, and how does that, how does that work? Dr. Michele Andrews: Hey, Chris, great to be here. For having us, you know, when we at, um, bringing new products to market, we always talk to the eye care professionals that prescribed him. And we talked to the where’s that where, and it’s important for us to get those two perspectives. It’s important to understand, ultimately, the person who’s wearing the lenses, what are they doing? About what’s currently available to them in the marketplace. What do [00:08:00] they wish that they had that they don’t have and make sure we do more of what they like, um, and, and sort of correct. And fill the gaps where there’s various things that they wish for, that they don’t have. And really the same thing from the eyecare profession. Perspective. And so we always go about it from those two points of view. And what’s unique with my day multifocal is that we looked at the consumer research in a very different way, which shared it really revealed a, uh, a necessity to understand the wearer’s experience when they leave the practice. And it was that, that information I think really was informed the design of this lens in a unique and Dr. Christopher Wolfe: different way. Well, I think that’s, that, that is helpful to understand because, you know, from a, from a clinician standpoint, I understand there’s all these nuances and Shane, maybe I just, um, bring you in here as well. Like I think I [00:09:00] understand the nuances of different types of designs in general. But mostly once I get out of school, um, my, my approach has been well, functionally, based on this understanding of this particular lens, I think it’s going to work best in these patients, but what is really helpful to me and Shane you’ve been involved in. Of research, uh, clinical research as well, um, is to say, okay, well, what about these designs on the backend work? Um, but you’re saying Michelle, that, that you’re saying we can figure all of this out on the front end. If we ask the right questions and get the right information, is that correct? Yes. Dr. Christopher Wolfe: Shane. Do you ever think about that? Like if you think, because we’ll get into the clinical stuff in just a second, but Shane, do you ever think about all those other designs when you’re fitting a lens? Um, or, or do you take, uh, a little bit of a, like, what’s your approach when you’re fitting a, uh, multifocal contact lens in general? Are there things you’re looking for in a patient?[00:10:00] Dr. Shane Foster: Great. I think it’s going to difficult because I explained this to patients too. When we start a fitting. All these lens designs are kind of proprietary. Uh, so we don’t know exactly who they work best for. So we start with our go-to that seems to work for the majority of patients and we go from there. So if a patient has difficulty with the first design, then, you know, we can tweak things, adjust the power here and there. And if it just really seems like we’re not getting anywhere, we’ll move to the next design. So, um, I think that’s, what’s been missing is kind of a. Figure out which lens is appropriate for which type of candidate. And I don’t feel like I’ve ever had a good understanding of that, um, from, from the fitting guides or from, from the Dr. Christopher Wolfe: industry. Yeah. And I think, um, I think the more, the better questions we ask on the front end. Of what the needs are of our patients. I think the, the more we can understand, if we’re going to design a lens that will fit that type of patient, [00:11:00] what then? Okay, well, what is it about that patient that makes them unique and makes it work for so many? I think that’s, you know, cause you get into and we’ll get probably into this a little bit more. Shane. You know, I’ve always thought about, well, do I measure pupil sizes and different lighting and how accurate do I need to be there? If I, if I were going to measure pupil sizes, is, is just my estimation in a clinical exam room. Is that appropriate or would it be best if I used a. Uh, on the front end and measured Misa topic and photopic and scotopic conditions. So then I can say, okay, well, this design is going to be better or that design is going to be better, but nobody does that. I mean, unless you’re, unless you’re actually doing really like a wonky research, which we need, but if you’re, unless you’re doing that, nobody’s going to actually do that in clinical practice. So. I think the cool part about this lens from my understanding is that, look, we have people that said, look, what do we need to solve? Uh, and that’s where I want to ask you, uh, Aldo is how do you understand, uh, it’s taking, um, [00:12:00] thinking that idea of what do we need to solve for, and then how do you aggregate that information? How did you go about, um, first of all, Alto. Introduce yourself. Tell us, um, tell us what, what your role is in CooperVision kind of your background and then how do you solve that problem? That, that Shane and I were discussing. Aldo Zucaro: Yeah. Yeah. Thanks Chris. Um, so a little bit about myself and then I’ll jump into that question. Um, I have a PhD in behavioral economics. Um, Dr. Christopher Wolfe: well, hold on, hold on, hold on. I’m going to stop you right there. So tell me about behavioral economics. This sounds kind of like freaking out next. So you’re you’re basically then, is it true that you’re, you would be analyzing, uh, the why people do things behind or the financial motivations behind why people do things? Is that right? Aldo Zucaro: Uh, well, uh, the folks at Freakonomics took a financial view, uh, of that, um, The more general sense of [00:13:00] it is, um, there, there re people do things, uh, that are, that that may or may not seem rational. Um, but they’re also not very good at remembering the things that they do. People are great at justifying. Um, but they’re not really good at remembering exactly all the things that we do. We live our day. You know, in our moments that most of those things are just sort of lost to us. We’re not recognizing all those, all those moments in Dr. Christopher Wolfe: time. And sorry, I don’t mean to interrupt you, but this is very interesting to me. And so I’m going to take it where it goes if I think this is so, um, I get up in the. And, uh, I get back from working out and I want a cup of coffee. And depending on, if I go to Starbucks or, you know, the coffee shop down the street, or I make it myself, there’s something behind why I do that. Every like which one I pick is that correct?[00:14:00] And I just don’t, I’m not aware of that thing that triggered. Aldo Zucaro: Exactly. And, and, and typically in the field, we call those system one and system two decisions. Most of our day, we work on system one decisions. We know that around noon time, I’m going to eat lunch. Not because I’m. But because I know that around noon time I lunch, it’s it relieves my brain from doing a little bit of work and people go through the day sort of relieving their brains of doing work system to decisions. They’re, uh, they, they take work. In fact, it’s funny. Uh, you spoke just a few minutes ago. Well, you know, uh, you know, it’s, it’s, it’s like doing that wonky research. Well, that wonky research comment was really a system to comments like that takes a lot of work. And so I won’t do that. I’ll do sort of this system one work, which I know it sort of works and I’ll start there and if it doesn’t really work, then I’ll engage in this Dr. Christopher Wolfe: thing called work.[00:15:00] We do too much system one work. We got to do more wonky. Okay. No, that’s great. This is awesome. So please keep going. So how much, how much do you have to train your brain to do more system to work? Uh, or, or do we all do system one all the time? Aldo Zucaro: We all, we, we could not survive if we were working on system two. I think that the thing. Um, the thing that’s important is engaging system too, when it needs to, um, otherwise system one always wins and you go, well, I don’t care anymore just to do this. Um, or I’m going to stop. Cause I’m, I’m, you know, I’ve reached a level of frustration or it’s just not worth it or whatever else comes into play. Um, and that, that, that really, that idea was the Genesis of this, in fact. Um, but I’ll tell you a little bit more about my meds. Uh, before I jump into the research, as I said, I have a PhD in behavioral economics. I’ve been with CooperVision, uh, about seven years going on [00:16:00] eight and a bow Chalan before that for about 12 years. Uh, so about 20 years almost crossing 20 years in the. Prior to that, I worked for, um, a defense contractor. So, uh, it was, uh, it was a government agency, which was really interesting and probably at a talk for another time. Um, Dr. Christopher Wolfe: is that a promise? Can I get you back on and talk about it? Aldo Zucaro: Yeah, absolutely. Um, anyhow, uh, as we talked about sort of what we wanted to do with this land, one of the things that crosses my mind all the time is that, you know, we’re, we’re really good at, at doing things like surveys and focus groups. But unfortunately what happens in those things is that people do their best. They’re being as truthful as they can possibly be. Um, But, but unfortunately it misses an enormous amount of information. It’s, it’s just wide gaps in what’s really going on. So I turned to, to friends of mine at Carnegie Mellon [00:17:00] university and, uh, Carnegie Mellon has a human design school, which really focuses on what people do and how they do it. So I actually turned to those guys and say, Hey, look, here’s my problem. Um, I know that, uh, things are going on. Are doing a variety of coping, uh, in order to live with presbyopia. Although when I asked them, I feel that I’m, I’m probably only scratching the surface of what’s actually going on. Can you help me figure this out? And that’s when they introduced me to the idea of, well, maybe we should do some ethnography research now for those of us that ethnography. Okay. Yeah. Yeah. Yeah. So it’s not, graphy is really interesting. It, what it does is it says, Hey, how about I just observe you? Um, I’m not going to ask you any questions. I’m actually going to try to be as invisible as I can possibly be to the situation, because I really want to just understand why you’re doing. Um, I don’t want you to process it because [00:18:00] if you. Unfortunately system two jumps in, and then you’ll give me a lot of reasons why, um, most of which are probably not the right answer. Um, so I just kind of want to watch you and then if it’s not gruffy does that. And so, you know, it takes a little bit of time to set this up and it takes a little bit time to get the right participant, but imagine a participant. What we did to this part is we outfitted them with a camera so that they, they, there was a camera on the. And then we also outfitted cameras in all of their rooms in their house. So not only were we seeing what they saw, but we saw the environment that they were in. So I was the proverbial fly on the wall, um, for 14 people over an extended period of time. So we had 14 people and we generated some 98 hours of video footage of just people engaging in. And we saw some crazy things and we saw [00:19:00] some really hilarious Dr. Christopher Wolfe: things, but they were recording everything wasn’t any of that? No, Aldo Zucaro: no, no. Everybody knew what was going on. In fact, they were, it’s funny because Dr. Christopher Wolfe: do you think they, how long did it take them, do you think to kind of get into their normal routine? Because, you know, if I had a camera that was always watching what I was doing, I think at first I’d probably, yeah. Make sure I’m doing, you know, I’m like organized and then you can walk into my office right now and it’s, you know, there’s stuff everywhere. Do you, did you see any more kind of normalization after the first couple hours of or whatever? Yeah. Aldo Zucaro: Yeah, actually it wasn’t even a few hours after a little bit, people forgot. Uh, they forgot there was the camera in the room. They forgot they were wearing the camera. They, they sort of, but what was really interesting is, um, we had these conversations with people beforehand about their vision and what they, what they did. And, and, [00:20:00] and then we looked afterwards and nobody actually was able. Properly recollect all the things that they were doing, all of their coping mechanisms in order to get by the amount of time they switched between their distance vision or their near vision or the frustrations that they encountered, uh, just in, in being able to, to, to, to, to read a bottle, um, to, to, to do the most basic and simplest of things. The one example. Just sticks with me because the lady was just, so she was, she was beautiful in describing it, but she was cooking chicken and she had a recipe and, and she was in the kitchen and she starts out by just kind of talking to us about doing. This, this recipe, and that was about two or three minutes of conversation. She’s just having with herself sort of knowing that we’re there. But, but slowly she forgot all about that because she [00:21:00] started to get frustrated. She was like, I got to wash my hands every time I have to change a page, I have to change the page and I have to get my glasses. I have to get my glasses. I’m wearing contact lenses and they’re not working. And now I have to wash my hands and I have stuff frying. I am, and you can see her, her anxiety level just increase any increase. And she’s getting frustrated with the process of cooking and then near the end, she just starts. She’s just talking. She’s not even talking to us anymore. She’s just talking. And she was like, I still really like. And I don’t like cooking anymore, like all of these things. And when you start to see people in this unfiltered fashion, when you start to sort of understand how vision and the tasks that they’re doing are so intertwined into like their, their happiness state, their, their willingness to engage in other things. Um, it, it changes the way we look at it. It absolutely changes the way that, so Dr. Christopher Wolfe: I have never [00:22:00] had anybody tell me that detailed of a story about the problems or the challenges they’re having with their vision. How do I ask better questions to, to draw that out of patients? Because certainly I’ve got patients in shame. You probably have patients that might say, oh yeah. When I read a cookbook, And like, but for me, I’m like, I’m not going down the, the fact of, oh yeah. She’s having to put on reading glasses, wash your hand. I mean, like, I’m not thinking about all those other little nuances, so how do we tease out as clinicians? Those stories, uh, without telling somebody they’re going to be involved in a, in a trial that we’re going to watch them do all these things. What’s your perspective on that Alto? Aldo Zucaro: Yeah, I think for us is that, um, that we’re helping the clinic clinician know that the shortcut that people are saying has a list of things behind it. And so what we want to be able to do is we want to be able to say, you asked the simple question, do you do a lot of cooking? [00:23:00] And if the, if that individual says, yeah, I do a lot of cooking, you know that they’re going to be engaged in all these steps, and this is what’s going on and helping. You understand how to get there much quicker. Um, it’s not that, you know, you don’t need to have a therapy session with people, but, but it is triggering all of the things that are behind it. So it’s not as simple as, uh, or, or your level of understanding, even though the question is fairly basic and before. Has a much deeper, a much deeper part to it. And that’s really what we did with the research. I mean, we, we spent the folks at Carnegie Mellon are great. Ashley, Ashley and Ray Lynn are amazing professors at the school. And, and, you know, I learned quite a bit about. How to interpret the data coming back and how they apply empathy and how they apply compassion to the things that they’re, that they’re seeing. But what we did with their help is we created, [00:24:00] uh, archetypes. We co created these fictitional people, um, and each one of these fictitional people had this role in, in, in, in life that they, that they played and they put. And that’s the kind of information we gave our R and D team. And we said, you’re not, you’re not fixing, um, a problem about vision because you’re, you’re, you’re trying to work some, some, uh, technical requirement. Um, Dr. Christopher Wolfe: and when you say technical requirement, you’re saying not to just see a line on a chart. Dr. Shane Foster: Yeah, Aldo Zucaro: exactly. Because the way Cindy in engaged was I need to be able to see and to, and Cindy, Cindy is a real person. Uh, she’s the woman with, uh, that did the cooking, but it’s funny because I got to know them by name. I’m like what’s Beverly doing today. How’s Dean what’s Dean doing today. Do you tell them you should, you should just shut down. Dr. Christopher Wolfe: [00:25:00] We learned actually Shane and I, when we were at the vision. So I’m going to mention this because we were at the vision source exchange. And one of the things that stuck with me, Jesse Itzler talked. And, um, and do you know who Jesse Itzler is? He sold like some airline company to Warren buffet and his conglomerate and made like $200 million. Uh, started Spanx they’re worth like a billion dollars. And, um, anyway, he, he came and he gives a keynote. And one of the things he said that was really impactful to me was just, you know, the, and I, and you don’t do this. Like I wasn’t his reason for doing it. Not because it was like he was going to get something out of it. Long-term but he was reflecting to say, I did get things out of it by just staying in contact with people. So like sending three texts a day, you know, just checking in on people. I just thought that’s why that’s why it came up. And I I’ve been trying to do that more. Not because I think I’m going to get something out of it, but because like, it just makes me feel more connected to the people that I like to be connected to. So anyway, um, yeah, you should text them. [00:26:00] Sorry about that. That’s a total, that’s a total sidebar, but keep going, please. So Cindy and yeah. Aldo Zucaro: Yeah. So, so what we did for the, for the R and D team is we, we, we made, we made these people with these, these tasks and these lives, and we said, look, the product. You’re developing is for, for those tasks, the clinicals that you’re setting up as you’re, as you’re working through, whether you think the product is meeting those needs or not, you’re, you’re sending that clinical up with an individual. That’s like Cindy, that’s like Beverley. That’s like Eileen. These are the people that you’re solving. These are the problems that they have. These are very simple things. Um, can we, can we think about solving the problem? In a clinical setting, but let’s make sure that as we start to develop our product, we’re making sure that the Eileen’s of the world, the Beverly’s, the Cindy’s, they can do that task. And if they can do that task and they feel good about it, that’s going to [00:27:00] relate to the emotional sense that they have towards their vision, which means that I might not see 20, 20 perfectly, but the things that I like to do each day, I get done really. And so my vision is Dr. Christopher Wolfe: great. Yeah. So that’s interesting to me because we get so hung up clinically and Shane, you can jump in here too, if you have additional perspective, but we get so hung up clinically on the number. And I think when we get hung up on the number, I do think this is true, that, um, that then our patients get hung up on the number. So like patient comes in and they’re doing totally fine. And or their, their perception is they’re doing, they’re doing fine. And they come in and they’re seeing 20, 25 at distance and 2030 at near. But, but they wouldn’t even be aware of their 20, 30 near vision. And, and then I stick this card in front of them that has three lines that they can’t see 20, 25, 20, 20, 20 15. And they’re trying to hit those. And all of a sudden in their mind, did I already just plant something that made them feel like, oh, well, I can’t see. Like I thought I could see. [00:28:00] And so like, how do we. As clinicians, because we gotta get, we gotta check acuity at least at distance, but how do we get that information to see whether they’re doing well? If they are a Cindy that, that there’ve been happy in their environment without like spoiling the cake, you know what I’m saying? Aldo Zucaro: Yeah. Um, you know, I, I like asking very simple questions and, and, and quite frankly, when we were doing the work, it was really in the, in the simple. Just tell me the things that, um, that, that are bothering you, where, where, where is it not working? And if, and if it’s, and, and, and tell me the activities that you do, do you cook, are you having fun cooking? Do you, do you watch TV? Do you do crossword puzzles? Do you drive at night? Do you, what are the things that you’re doing and where are you bothered in it? And I am, we didn’t look for an M an immense amount of detail underneath that from a clinical perspective when R D team, because what. I understand I’ve, [00:29:00] I’ve seen what, what, what they, I know the, the very detailed steps that are going on. And if somebody says they’re okay, and that level of frustration isn’t there and that level of enjoyment is there. Um, you got it right stop. Dr. Christopher Wolfe: So then we’re asking more emotional questions. Here’s what I already buy from you. Aldo Zucaro: Yeah. What we, one of the things that we discovered is that the emotional connection to vision at even when, and, and these were presbyopic, people was much higher. It’s the ability to accomplish. What I want to do is much more important than the numeric number of I can see 20, 20 and near. Um, that was less interesting. It was. Am I emotionally satisfied? And when people were emotionally satisfied, regardless of the exact number of their vision, um, that product worked, Dr. Christopher Wolfe: that is so interesting.[00:30:00] And that so interesting. Yeah. I mean, Shane, although I’m probably going to come back to you in just a second, but Shane, I want to get your perspective here. Have you, are you doing any of that kind of stuff? Cause you know, as we talked before, as you and I have discussed many times about clinical research and your involvement in clinical research, you know, one of the things that I thought was really cool and doing this in our practice at, uh, this summer was even just the idea, that kind of questions that we were asking people to rank their existing vision with their existing contact lenses and then their new vision. Well, there’s a lot of what I’ll do is talking about is invoking their emotional attachment. And what I did, what we found often was patients. And I, and I asked them, you know, how do, how, how are your contacts? Oh, they’re fine. Well, is there anything I can improve about them? No, they’re they’re good. And then you asked them to rate rank. Their vision and they’re maybe a seven, their comfort might be a seven. And so that actually informed me to say, well, we probably need to have these types of questionnaires on all of our contact [00:31:00] lens of patients all of the time. So first do you do that on a regular basis with a kind of a study? Questionnaire on, on your contact lens patients just to get an assessment of how well they are doing. Dr. Shane Foster: No, we never had it before. Um, but you know, after seeing some of those questions and I had the same experience that you did people that said, oh yeah, everything’s fine. And then they ranked them a six or a seven and I’m like, everything’s fine. Should be a nine. I think, um, so I’ve kind of gotten into the habit of asking, you know, asking the question, how are you doing with them? But then, um, even when somebody says everything’s okay, you know, I’m going to go in, I’m going to over refract a little bit. I’m going to see if I can make it better because I tell them, okay, is good. But if we, if we can make it better, would you like that? And of course, everybody says, well, sure. If I can see better, that would be great. Um, one of the other things that I’ve done. Is making sure that I, when I dispense, um, a pair of lenses and, you know, say, Hey, you’re going to have to really try this out in the real world. You know, we can, you can read the chart in here, but [00:32:00] that doesn’t give us the information. We need to know if this is going to be successful for you. So, um, I encourage the patient to, you know, kind of like what I was saying is you forget about the things that you’re having trouble with because you just get through your day. And I tell patients to be really cognizant of when are you having trouble make note of that. So if you’re saying, gosh, every time I sit in front of my computer, I struggle and I’m sure. You know, move forward or move back to try to find the right spot. Um, you know, that’s what that can be the glasses or contact lenses really, but it’s, um, a measure of their satisfaction in those different, different areas. And I want that feedback from them. So I know where I need to work when they come back for their follow-up. So, um, I’ve tried that. Having people make note of that. And, um, it does, it is helpful because patients will say, okay, you told me to think about the activities and gosh, you know what I get through almost everything. Except when I drive at night, well, then we know where we need to focus, [00:33:00] or if we need to tweak the design or change to, you know, um, a single vision only in one eye, something like that. So that’s, that’s been really helpful. Um, but also using real-world things. So like you said, we don’t care if you’re 20, 20, 20, 25, we want you to be 20 happy as I tell patients. And, um, they kind of sign onto that. They’re okay with that. Um, tips for that are just, don’t give them the little J card with the tiny, tiny print, have them pull out their cell phone. Can you read your texts? Can you read. Dr. Christopher Wolfe: Okay. That’s good. Yeah. It almost makes me think that like, for those, I don’t know how you’d articulate it in your chart. Cause we always like to know. Okay, well how well were they seeing here? But it almost makes me think that on those checks, the only thing that we look at, like from a numbers standpoint is put up the 20, 40 line and ask them to read it because that from a liability standpoint, we’re basically covering our basis by saying, look, you’re legal to drive [00:34:00] if something right, right. I mean, that’s really what you care about unless the patient’s having a challenge. Cause then you just say here, can you read that? You know, that’s, that’s what your tech does, the 2040. And then the doctor comes in and, and ask the other questions like, so we don’t even give them an opportunity to see all the other lower lines. You’re just giving them one line and then asking them more and more about their visual day and what they need help with. And then you can introduce smaller lines if they need smaller lines and all that other stuff. That’s really interesting to me. Um, yeah, that’s how Dr. Shane Foster: we always did it is we may instruct our technicians not to start with the 2020. Yeah. You want to start at 20, 40, 20, 30. If they can, if they do that really easily, you can go to the next one. You know, if they start missing a letter or two, well, don’t go onto the next line because then it’s going to feel like a failure to them. Or a disappointment when really they’re coming in with no complaints, but then they say, oh, well, I couldn’t read that smallest line. There’s something wrong with these. Yep. So, Dr. Christopher Wolfe: um, that’s changing our systems on Monday for sure. We will change [00:35:00] those in our practice. I mean, we, we, we walk them down, but I think on, on contact lens checks, When we have them back on these new designs, I think that’s Alto to your point, that that’s really key. And we can, again, we’re going to know whether or not we need to go further by what the patient tells us, but what we don’t need to introduce uncertainty in this situation when a patient’s completely happy. And I’ve done that before, you know, a patient walks in and I ask them how they’re doing well, I’m doing great, but I’m not sure how well I’m doing because I can’t see, you know, and then they, they look at the 2015 line at near you’re like, you’re, you’re fine. You’re doing great. Um, So, although, um, the things that, that Shane’s talking about when you get that information, um, how do we, uh, how do you then translate that into the R and D to tell the story to the R and D team to say, this is how we need to design that lens, or this is what we’re after and do, you know, kind of what they’re modifying and what things they’re changing. So those lens. [00:36:00] Achieve those, those types of things. Aldo Zucaro: Yeah. So, um, I don’t know exactly what their Mo I mean, they’re working in a variety of different pathways to sort of get at what offers sort of the, the cleanest or best. For them. Um, but what, what they are doing is they are testing those lenses on, on these patients who are, who are, who are doing these tasks and sort of going, Hey, are we, are we, are we creating something that one. Um, easy enough to do. I mean, we, we can create, uh, you know, and some degree of complexity, but is it any marginally? Is it marginally better than, than, than one that that’s not? And I think one of the things that came out is this design that’s a much simpler design. Then, uh, then others would think, um, mostly because they’re working towards making sure that people under certain conditions can, can do certain tasks and you know, what they were able to do it, they’re able to do it really well.[00:37:00] Um, and so. We from, uh, from, uh, from, uh, uh, you know, standing back perspective ago. Wow. That lens seems to really work or it’s doing its job or great design. Um, it’s actually, it’s actually a little different than that. It’s actually being extremely thoughtful about what the lens is going to do and how, how it’s, how it’s going to solve that problem. Um, and they didn’t have that before, before we. In the past is we created these requirements. And, and as a result of creating those requirements, they became very complicated in how they were solving that. Cause they were trying to get right into that requirement and solve it as best as they could with, with as much specificity and detail around that. Um, and, and I don’t know if it made a better lens, it made a more complicated lens. Um, but I’m not sure, quite sure it made it a better lens. I think what you’re seeing with what they develop with this lens and the work that we sort of shared with [00:38:00] them. Um, uh, a number of degrees of complexities went away. Uh, it, it made it easier for practitioners to think about. Uh, but at the same time, it makes it a lot easier for, um, people to sort of engage with. Um, and at the end of the day, Yeah, quite frankly. That’s what matters if people are wearing the lens and go, you know what, this is great. I can do everything I wanted to do. Perfect. You know, tell a friend. Dr. Christopher Wolfe: Yeah. Yeah. I mean, I think that’s, and that’s where, you know, once we have that, uh, That device that we can offer to patients, then we get, then we get to see how this all works. And, uh, and that’s really Shane, you know, we, you and I can talk more about that is, is what you said before is that, you know, kind of Glenn’s companies always say, we’ve got this new lens, it’s going to be newer and better, but in your experience so far, we, you you’ve had this since the summer. We’ve had it since the summer, and we’ve been blown away as well. It is it, is that good? So tell me a little bit about, um, kind [00:39:00] of your appraisal of that and where you see it working, um, where you’ve incorporated into your practice. Dr. Shane Foster: So I think one of the, um, the ways it’s wild to me the most is with these really early emerging presbyopes, uh, that maybe aren’t even, you know, you might not even classify them as a presbyope yet, but almost, uh, you know, somebody who’s doing a lot in the. Like everybody is, but, um, you know, they’re 40, uh, maybe they’re not, uh, you know, measuring off a full plus one and a quarter on the binocular cross cylinder or something like that, but they’re, they’re struggling a little bit. So they’re having that difficulty adjusting focus, um, from near to far. And, um, I’ve had difficulty with those in, um, in other lenses because it just, it distorts the distance vision too much. So a lot of complaints on these people that are like, okay, it’s fine. I can just pop on readers real quick, [00:40:00] or I just hold things out further, but this has worked amazingly well in those young emerging presbyopes in my experience. Anyway, um, I have a patient that’s always been. Over minus. Um, since I started seeing him a few years ago and I keep trying to remove the minus, cause I know he was getting closer to 40 and it’s going to be more difficult and he just always rejects it. He will not kick out that extra minus. And um, so with this. I, when I went to put the lenses or gave him the trials, I kind of wrote over the power. So he couldn’t see it because I knew that he would look at the power and say, these are going to be these aren’t going to be strong enough. He adapted to it. No problem. Put them in boom. He said, these, these feel wonderful. I’m seeing everything perfectly. Um, and then later realized that, well, you’re actually in the correct power for you. So maybe that maybe that’s part of the issue Dr. Christopher Wolfe: too. I would share. Oh, go ahead. Dr. Shane Foster: I was going, the only other one was going to say it was actually one [00:41:00] of my technicians. Who’s a, um, she just turned 40 and she’s a hyperope. She’s like a plus four. So she’s, um, obviously starting to struggle with her near vision too, but. She could, I mean, she’s tried many other multifocals and just can’t do it. She said it, it just made her distance, um, to the point that she just couldn’t function. So she put those on and she looked out the window and she said, oh, I can see the street sign up. Is it the way it’s supposed to work. Yeah. So, um, and then she’s like, wow. And I can focus on my computer now, too. So, um, you know, had those people that were just, they really were, we had them in like a really low amount of it or yeah, really low powered monovision or something like that. Uh, just because they couldn’t handle, um, the distance blur. And I, I just feel like this is whatever is in that low at design is working really well. Dr. Christopher Wolfe: For those early presbyopes, you know what I like [00:42:00] about that? And I share your same experience. So w what I, my approach always has been for early presbyopes, especially with the type of work that we’re doing is to try to get them into a multi-focal lens as soon as possible, because I know that when they’re 45 and 50, it’s a lot easier for me to adjust those powers, because they’re more accepting of, of, um, because they’ve already adapted to a component of that additional multifocal and. And so, uh, but, but the biggest challenge is almost every single one of them that we’ve had before induces some degradation of distance acuity and, uh, you know, for whatever, whatever you and I really fully understand, like, okay, well, our day is doing this all day long on a computer, so I don’t need to see like a Hawk all the time. So we’re more accepting of it, but our patients aren’t. And so, um, that’s the been, the beauty is getting those. Earlier into it. And then we should have this whole, you know, ability to transition them over the next five and 10 years is [00:43:00] so much easier than waiting until they’re finally like fed up enough with whatever their other, and they’re willing to now compromise some of their distance vision. Um, and so I totally agree with you. I think that’s kind of. The pinnacle of what we can do also want to talk a little bit about, cause we haven’t had this issue, but Michelle, um, we did have, uh, a panel discussion last month. Uh, actually it was two months ago now where we, where we sort of, um, got a perspective of. Presbyopia in general from, uh, from the public. And I think there were five or six people on that. And, uh, Shane, um, that panel discussion, what was interesting to me was first, uh, one of the things that kept coming up was that their doctors weren’t talking to them about. Options. And one of the things I thought about was probably that’s, I don’t think they were lying about it. I think, I think what happens is just like you and I, when we go to the doctor, you know, we might, we might [00:44:00] hear the thing that’s really important or bothering us, but we don’t hear all the other stuff they talk about or we hear about it. Doesn’t stick. So one of the things that I gathered from that is not to not to say that the doctor that they’re seeing isn’t doing a good job it’s that they, that we probably need to do a better job when they are in their late thirties by saying, look, this is what you’re doing now. And we’re going to do X, Y, and Z. Uh, now to fix, to make it so that you can do those things easier, but we’re also going to do, uh, ABC in a year or two years, because it’s going to be more of that. Um, where, as opposed to just saying something like, well, in a year, you’re going to get presbyopia and then we’ll address it at that time. It’s like in one ear and out the other, but I think the point is, is trying to make it concrete to them early. So that they don’t feel like we never talked to them about it because my, my worst fear is a patient hears about a new technology and they didn’t hear it from me. [00:45:00] And, um, and so what are your thoughts about how do you plant that seed early enough? So when those emerging presbyopes come back, they’re not waiting to get frustrated to talk to you about those. Dr. Shane Foster: Yeah, I totally agree with that. I start, um, you know, in the late thirties, start talking about how, Hey, you’re doing great with these. Hey, your near vision is still good, but it’s, it’s going to be coming. And I start to have that conversation about presbyopia even in the mid to late thirties. Um, because you know, between 20 and 30, I mean, most people they’re. Changing a whole lot things are working pretty well. So it’s a, it’s a great way to celebrate. Hey, things are stable, your prescription’s not changed, but just so you know, the next thing that you’re going to be looking for is some, a little bit of trouble with near work work. And, you know, I say, oh yeah, my parents were readers or something like that. So. It’s a good way to start that conversation with them. And then they’re not taken aback by it when it actually happens. Uh, what is it? [00:46:00] I think they say people have to hear things how many times, three times or something to really let it sink in. So if you have that conversation, you know, starting at 37 and then say it at 38 39, they’re going to, they’ve heard it enough times that they’re, they’re not caught off guard. And they’re more accepting of it. And then the other thing is when they’re already wearing a contact lens and they’re doing great with it, especially if that contact lens is available in a multifocal, you just let them know, Hey, when, when you get to that point, it’s a really easy switch. They make this same lens, uh, in a multifocal that’ll allow you to just keeps your eyes relaxed a little bit. You know, I try not to. Say the bifocal word. Yeah. I know me too early on to say this lens is going to relax your eyes a little bit with your computer work because let’s face it. We’re all staring at a screen, you know, hours and hours every day. So everybody gets the concept. Uh it’s just like you said, introducing it early and then walking them through that process. Dr. Christopher Wolfe: Well, [00:47:00] yeah, exactly. Right. And the other thing that I, um, gathered from it, and again, I think there was only one person that was. That was, um, of the, of the panel that was really on this, but it was, um, he kept making the point that it has to be convenient. It can’t interrupt his life and it has to be, I think he, he said cheap, but I don’t think that’s what he meant. It just has to like work in his budget. And then the other thought, the thing I think about that is that as doctors, oftentimes we think, okay, well a daily multifocal lens, that’s going to be expensive. My patients aren’t yet. Right, but you’re, but, but tell me about that and tell me your approach to thinking about like, look, first of all, these things, aren’t expensive relative to all the other things that we do, the cup of coffee, that almost everybody gets on their way to work as I was just suggesting, uh, or, you know, most of what, what people are doing, but how do we, how do you frame that in your mind? Cost. [00:48:00] And how do we have those conversations with patients so that it’s not detracting to offering them the best technology available? Dr. Shane Foster: Right. I mean, it’s, it’s our practice philosophy to always recommend what is the best treatment option for that patient? Uh, we’re in an area that’s, you know, a little, uh, economically depressed. So we, we understand that there going to be some financial concerns from our patients, but. I think our duty as a clinician is to always offer the best treatment option. So that’s what we do. And if that means it’s a, um, a daily multifocal lens, that that’s what I’m going to offer them. And then knowing that there are different ways that, I mean, we talked to them about the rebates we talked to them about, um, you know, kind of like you said, comparing it to a cup of coffee. If we break it down and say, Hey daily, this is what this costs you, what’s it worth to you to be. Just the distance and up close to everything, um, and have the convenience of a daily [00:49:00] disposable, and the fact that it’s the cleanest, sickest and healthiest option for your eyes. I have that discussion with every single patient and, um, you know, if that’s, if it’s still is not something that works for them, well, then we go to a monthly. The two week or something, but, um, again, I think we made it a philosophy in our practice. All of our doctors agreed that dailies are the way to go. Um, and you know, when you get a material like, like the, my day, that’s so comfortable again, that’s, you’re not going to have the dryness issues and you’re not going to have the. The day dryness, like you would with something else. So having that discussion it’s, it’s just a philosophy you have to get into is always to offering the best treatment option and then going from there, not pre-judging the patient thinking, oh, I don’t, I don’t know if they can afford this because it’s just, that’s a disservice to your patient. Dr. Christopher Wolfe: Well, and it also, um, it assumes. If you just go with that right away, you’re making the [00:50:00] decision that they can’t afford something immediately. Like if I’m just like, look, it’s a, it’s a, it’s, it’s an expensive lens. And then I think, oh, well it’s expensive. The doctor thinks is expensive. Hmm. Well, as opposed to like, not even having that conversation and if a patient brings it up, well, how much more is it? You can say, you know, with rebates and discounts on annual supplies, this is not that much more expensive than a monthly lens or a two-week lens that you have that you’re having to clean and store by the time you factor in all of those other things. And, oh, by the way, if we can avoid one infection or inflammation event per year, you’re you’re, you’re on the plus side of it. Right? So by, by making all, like having that conversation with patients, you get, you. Um, you offer them the technology and then they get to experience it. And once they experience it and they say, whoa, oh, it’s that much. That is too that’s over my budget. Okay. Well, we can put you in something else and it might not work as well, but we’ll do it. Um, but you don’t have to say that, but that, that might be your approach. I’m [00:51:00] gonna put you in something else. Now they’ve done that. They’ve at least seen. Okay, well we can do this and it can solve the problem that I have. But maybe it is too expensive for that patient, but we’ve allowed them to experience it first and then make the determination that if it is too expensive, fine, we have these other options and they can, they can balance out that as opposed to, I think oftentimes when. When the first thing that comes up is price or cost, then it can make us avoid all these other treatment options. That might be really great for that patient. And actually not an actually quite cost-effective, um, with, uh, w without a. We are giving them the ability to at least see, cause now they can judge, oh, this is worth it to me. I think that’s so important. And that’s been our practice for us as well. Dr. Shane Foster: Yeah, we have the same, um, you know, we, we basically discuss our fitting costs with the patient upfront. It’s going to be the same fitting cost, regardless of what design you go into. That’s the way we do it [00:52:00] in my practice anyway. And then from there, yeah, let them experience the greatest, um, latest, greatest, best technology, most comfortable lens out there. And then the patient can decide. I mean, it might take an extra visit a little bit more time in your chair, but I. Once you give patients that premium lens, they understand why it costs more. And they, you know, nine times out of 10, they’re going to go with that one because they see the value. Dr. Christopher Wolfe: Yeah. I mean, I think, you know, you and I could probably, oh, go ahead. Dr. Michele Andrews: It’s this conversation is reminding me of something, Chris, that you said earlier in the story that Aldo shared about the woman cooking, you know, Chris, you asked the question about how can we ask a better question to help our patients? And, you know, the value proposition is really the value to the patient in the same way that although talked about, if the patient’s happy with their vision, that has an emotional component. And so a question to a patient, tell me [00:53:00] about the last time. Frustrated wearing your glasses, for example, or tell me about the last time your vision really frustrated you. If that woman had said, oh, I love to cook and I can’t cook anymore. And here’s, it might evoke wouldn’t otherwise get, because people don’t remember. And then these to be able to offer a product to say, well, what if I could give you a contact lens that would, would change that for you now you’re having a conversation about a premium lifestyle and a quality of life. Versus a premium product and the cost of that. And that puts everything back into the hands of the patient and gives them the opportunity to decide how they value, how they live their lives with different options, for visual correction. And it changes the conversation completely. I think it really ties back to what we learned from the ethnography research, which is there’s a high emotional value to visit. And it is exceeds the cost of any product [00:54:00] regardless of where that product is. And it’s it’s for the patient to determine. And so tying it back to lifestyle and giving them the option to live their best life, they’ll decide where that bad. Dr. Christopher Wolfe: Michelle, you always summarize our conversation. So, well, I, I don’t think, I don’t think we should. We should continue that. That was perfect. That was a perfect, I’m going to be respectful of your time. Uh, Shane, Michelle Aldo, this. This gave me a ton of insight. Uh, although I am going to plan on picking your brain more about, uh, behavioral economics, um, and, uh, thanks. Thanks so much for being on and, and taking the time today, uh, to give us your perspectives about, um, about this new technology and how we arrived. At the multifocal. Thanks. Thanks Chris.[00:55:00] [00:56:00] [00:57:00]

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