continuous wear colloquy
Selecting the Right Patients for Continuous Wear Success
BY N. REX GHORMLEY, OD, FAAO

In the past several years I've fit many successful continuous wear patients with silicone hydrogel contact lenses, particularly with CIBA Vision's Focus Night & Day lens. I've found that patient selection is key to successful continuous wear.

Fit These Patients

The following characteristics may indicate a good candidate for continuous wear:

► Excellent systemic and ocular health

► Normal corneal integrity

► Clean environment, both for work and leisure

► Wet eyes and stable corneal tear film

► A history of compliance (maintaining vision care appointments, contact lens care and lens replacement)

► A constant need for a vision correction, such as in patients who have moderate to high myopia and hyperopia with a minimal amount of astigmatism. Because of the higher Dk/t of silicone hydrogel lenses, hyperopic patients now make excellent candidates for continuous wear. I've had some of my greatest continuous wear success with "middle aged" hyperopic patients

► An interest in continuous vision, such as in continuous wear, corneal refractive therapy or refractive surgery. Many patients want "hassle free" continuous vision. We must educate them that new technology allows many patients to wear contact lenses for several weeks at a time

► Current one-week or flexible wear, low-Dk extended wear patients. Upgrade these patients to high-Dk silicone hydrogel lenses to give them the option of extending their wearing time

► Current daily wear, low-Dk soft lens patients. Educate these patients about new lens materials and ask them if they are interested in continuous wear. Many patients have heard that sleeping in their lenses is "bad," and they haven't heard about new contact lens technology

Handle with Care

With some patients we should proceed with caution when considering continuous wear. These characteristics may indicate that a patient is a poor candidate for this modality:

A History of microbial keratitis (MK). If your slit exam shows a prior MK scar, then that patient has a 4.1 times greater chance of experiencing another inflammatory event (CIBA Vision data). In addition, if a patient has a history of contact lens acute red eye, then that patient is 6.9 times more likely to have a recurring event

► External eye disease. Thoroughly inspect the eyelids for blepharitis or meibomian gland dysfunction

► Chronic smoker <30 years old. FDA clinical study data showed that these patients have a 2.7 times incidence of an inflammatory event

► Dry eye. A wet eye is important for long-term continuous wear success

► Systemic disease and medications that may interfere with corneal health or lens tolerance

► Allergies. A patient who has chronic allergies may need systemic medications that contribute to a dry eye. In addition, many patients use topical ocular medications not meant to be instilled during lens wear

► Poor compliance history. Examine continuous wear patients on a regular basis to ensure that they use the proper contact lens care products and replace their lenses each month

► Contaminated environment. A patient chronically surrounded by dirt, chemicals or bacteria is a "bomb waiting to go off." For example, a carpenter or a chemical plant worker isn't a good candidate for continuous wear.

Dr. Ghormley is in private practice in St. Louis, MO. He is a past president of the American Academy of Optometry and a Diplomate of its Cornea & Contact Lens Section. He is also the team optometrist for the St. Louis Rams (NFL) and the St. Louis Blues (NHL).