editor's perspective
Bandage Contact Lenses and Ethics or TANSTAAFL

Recently, a group of contact lens and primary care optometry educators and other optometrists, some from ophthalmology practices, discussed the issue of whether or not practitioners should pay for bandage or therapeutic contact lenses. Why is this an issue? Because most of the time (no one can be certain how often or how many), most lenses that are used as bandage contact lenses are taken from free trial lenses provided to eyecare practitioners for trial or diagnostic fitting of disposable soft contact lenses. No doubt there have been many thousands of Vistakon Acuvue lenses used this way. Silicone hydrogel lenses have become the lens of choice for bandage and piggyback treatments. Due to the European and U.S. approval of CIBA Vision's Focus Night & Day lenses for therapeutic use, this lens will be used quite frequently for this purpose.

One educator said it was certainly ethical to teach our students to use these lenses as bandage lenses. But if the lenses are not intended to be used for treatment but rather as free diagnostic lenses for fitting patients with normal corneas, and if the practitioner is paid for the treatment using a bandage lens or even charges for this lens that he did not pay for, is this theft or ethical? Should a reporting system be required to pay the manufacturer for lenses used this way? Could 30-packs of therapeutic lenses be sold labeled for that purpose, as mentioned by Bill Edmonson, OD? Would anyone buy these?

A number of practitioners in this audience did mention that after the first lens, they did buy lenses to sell to the patient beyond just using free diagnostic lenses. Could manufacturers really get practitioners to record what the free trials are used for: successful, unsuccessful and therapeutic cases?

What is TANSTAAFL? My college economics professor made us read the book There Ain't No Such Thing As A Free Lunch. Somewhere, every time, someone (usually everyone) has to pay for something that is "free." In this case, unethical use of diagnostic lenses for therapeutic purposes and being reimbursed for using the manufacturers' free lens is the standard of care. So is it really unethical? The only likely recourse the manufacturers will have is to keep the lens price high enough to cover their costs.