editor's perspective

Is Shorter Better?

BY JOSEPH T. BARR, OD, MS, FAAO, EDITOR
June 2001

When disposable soft contact lenses were introduced in a big way just over a decade ago, we predicted that compliance with lens replacement would be a big problem. We were wrong ­ and right. Just like disposable razors, people often use their disposable soft contact lenses beyond doctors' and manufacturers' FDA-approved recommendation. Why? Because contact lenses are not like cotton-tipped applicators you use to clean out your ears. You know what I mean, the ones with the orange yuck on them after you use them.

When disposable lenses were first introduced, many practitioners thought compliance would be so bad that we would never see the patients again, or at best, not for a long time. Dispense two six-packs and the patient is gone for six years, some thought. We learned very rapidly that this did not happen in most instances. Manu-facturers claimed the compliance rates were very high ­ over 90 percent. We didn't believe this, but we did think it was better than expected. Objective measures more than once said compliance with two-week replacement was about two-thirds. Instead of eight six-packs per year, people used six on the average.

Last year one manufacturer reported reduced compliance, and this year two manufacturers reported poor compliance based on expected lens sales and market research. One report indicates that compliance has fallen to 54 percent in 2000, down from 56 percent in 1999. Sure, you say, manufacturers are just worried about their profits. Yes, that's their objective. But you and your patient share another common objective with the manufacturer: healthy, more comfortable, long-term contact lens wear. This win-win-win scenario should result in better all-day comfort, less inflammation and maximum vision with disposable contact lens wear just as it would with a clean RGP or a clean custom toric lens. I know many patients complain about contact lens cost and want their insurance to pay for it. But I also know a lot of those same patients spend more money on cappuccino and their children's video games than they do on their contact lenses.

If you want the healthiest way to wear disposable soft contact lenses, something the vast majority of new wearers now do, then get your patients to comply with their lens disposal schedule, whether it's daily, weekly or monthly. United Kingdom practitioners are using mass quantities of daily disposables. Daily disposable lens use accounts for 82 percent of lens volume and 38 percent of lens market value in the U.K. Do they care more about the health of their patients and less about the cost than U.S. practitioners?

The facts are simple: toss lenses more frequently, and fewer cases of inflammation such as GPC and better vision and comfort due to few deposits are logical. Sure, it may be rational to prescribe a longer wear time and more aggressive lens care to reduce cost, but remember that over time, people comply less with lens care, too.

Are shorter, planned limits on soft contact lens life better? I'd say yes.