readers' forum
Choose an Advanced Lens For Your Patients
BY JAMES A. SIMONSON, OD

The art of successful contact lens practice is not just putting lens to cornea. It is finding the balance of material and design for the patient's lifestyle and environment. The challenge for contact lens fitters is melding their knowledge with the patient's needs and condition. This is why contact lenses are still prescription devices. That said, there are some occasions when you realize that a certain lens or other product is being underutilized simply because in the mind of the practitioner it is perceived as a niche product. By bringing it out of that niche, you can enhance the lens-wearing experience of a great number of contact lens wearers in your practice.

Extreme Environment, Extreme Patients

I practice in suburban Denver, one of the least contact lens-friendly environments in North America. Our high altitude and thin air, coupled with winter smog and low humidity (we're classified as semi-arid desert), defines a poor climate for contact lens wearers. We need a lens that delivers maximum oxygen and will resist dehydration. Unfortunately, most conventional hydrogel lenses are also thin, high water content lenses that tend to dry on the eye, reducing comfort and wearing time.

In addition, the demographics of our patients are changing. The influx of high technology industry has brought us a large number of young athletic contact lens wearers who ski and mountain climb when they're not in the artificially dry climate of their offices. Many are contact lens wearers who were comfortably able to wear their lenses in their prior residences, but come to me complaining that since they've moved here, their lenses are no longer tolerable. Several years ago, I decided that such extreme patients called for extreme measures on my part. A new lens was available, designed for continuous wear. Perhaps I could adapt that to my patients.

Why Limit Yourself?

The PureVision continuous wear lens from Bausch & Lomb has been designed for the intense requirements of continuous wear. The material was unique: a silicone hydrogel polymer which delivers far more oxygen to the cornea yet its low water content resists dehydration. I've never been a big fan of extended wear, but I began to see the possibilities of the balafilcon A material for my problem daily wear patients. This lens provided a combination of attributes essential for successful continuous wear: maximum oxygen transmission, fluid transport, material elasticity, dehydration resistance, surface wettability, deposit resistance and lens design. If maximizing these properties is good for extended wear, why not daily wear? Why shouldn't I be fitting it on every eye? PureVision, which most of my colleagues consider a niche product, has become my lens of choice for all spherical soft lens patients, the vast majority of whom wear their lenses on a daily wear basis. PureVision has the strength to stand up to daily wear in this rigorous climate as a workhorse lens. In fact, it's turned out to be a real practice building tool for me.

My patients, simply by virtue of our location, are very keyed into oxygen. They are very aware of our thin air. Although a few patients have balked slightly at the cost, not a single one has said "no" to upgrading to this lens. Currently we are using PureVision for every myopic new fit and refitting our prior contact lens wearers. Our high tech worker patients are fascinated with the combination of hydrophobic silicone and hydrophilic hydrogel and the surfacing technology to make the entire surface hydrophilic. For those less versed in technology, we use the "oil and water" analogy to explain why this lens is so very different from what they've worn in the past. Even those patients who don't understand plasma technology are impressed that they are going to wear the most technologically advanced contact lens available. Taking the time to explain the technology to them is very effective in minimizing discussion of cost.

Clinical Considerations

The current power ranges (+6.00D to ­9.00D) of PureVision fit most patient prescriptions. In addition, I have found that patients with up to 1.00D of cylinder can be successful with this lens. Although the vision may be slightly compromised for these patients, I feel that the comfort benefits are worth it. The 8.6mm base curve seems appropriate for most K readings. We've found it especially useful for patients who are beginning to experience dry eyes. A toric lens in the PureVision material would be a welcome addition for our practice.

We recommend that patients use the lens for daily wear with monthly replacement. Due to our initial concerns about the surface treatment and the fact that the lens will be replaced monthly, we prescribe only a multi-purpose care solution. We do not recommend an enzymatic cleaner. Although I have not changed my mind about extended wear, I am finding myself willing to allow flexible wear on more occasions than in the past.

The patient reaction to this new lens modality has been tremendous. They initially try it because it's high tech and a novelty, but it's not uncommon for them to return telling us that PureVision works better than their previous lens, even if they had been happy wearers. Typically our patients report that they see better than they did with their previous lenses and definitely experience better end-of-day comfort. Reports of lens dryness are much fewer than with conventional lens materials. An overwhelming majority of the patients I refit into PureVision will rave about it when they return for follow-up.

Get Out of the Niche

Most people think of PureVision as a niche lens, but I predict that this lens and others like it will become the standard of care very quickly. There is not enough difference in cost between premium contact lenses and conventional disposable or planned replacement lenses to make much difference to patients. This new generation of polymers will compel patients to try silicone hydrogel lenses.

Is this the ultimate contact lens? Of course not. New products will continually be introduced to contact lens fitters. The trick to using them successfully is not to look at them as they are presented to you by the manufacturer. Instead, judge each new contact lens with an open mind, and you might find that a product is really a workhorse that will make your contact lens practice that much better. And this is why patients won't soon replace us with a contact lens vending machine.

Dr. Simonson is in private practice in Littleton, Colo., specializing in contact lenses.