NEW LENS TECHNOLOGY
Clinical Experience with the Acuvue Advance
Here's what doctors are saying about their experience with this new contact lens.
By Thomas G. Quinn, OD, MS, Clinical Features Editor

This year was ushered in with the introduction of the Acuvue Advance with Hydraclear (Johnson & Johnson Vision Care, Inc./Vistakon), made of a 47 percent water, non-ionic silicone hydrogel material (galyfilcon A) with a Dk of 60. The lens also blocks 90 percent UVA and 99 percent of UVB light, making it the most UV-resistant material on the market. It's indicated for a two-week replacement daily wear schedule.

The Acuvue Advance features the patented moisture-rich wetting agent, Hydraclear, which permeates throughout the lens, avoiding the need for a surface coating and promoting, as described in promotional literature, a "unique, soft, silky feel" and "exceptional all day comfort."

To find out more about this new lens technology, Contact Lens Spectrum asked four leading practitioners to share their experiences with this lens.

Who Are You Fitting?

Mitchell Fink, OD, who practices with his daughter in Willingboro, NJ, first used the Acuvue Advance as a problem-solver for patients suffering from discomfort or hypoxia. "It has become my lens of first choice," he says. He presents it to virtually all appropriate patients.

The other practitioners we spoke with agree. "Silicone hydrogel lenses are my standard of care," says Joseph D. Udvari, Jr., OD, of Pittsburgh, PA. Similarly, John Wiener, OD, who practices in two locations in Cincinnati, Ohio, says he "aggressively" refits patients into silicone hydrogel lenses because of "the superior safety and comfort" they offer.

Numerous doctors say they feel that the Acuvue Advance is particularly beneficial to patients suffering from allergies. According to Dr. Fink, more and more patients are taking antihistamine medications, which exacerbate dry eye problems.

Dr. Wiener uses a three-step process when working with the allergy patient. "I fit my allergy and GPC patients with the Acuvue Advance lens using a hydrogen peroxide-based disinfection system." He continues, "I then prescribe an antihistamine/mast-cell stabilizer drop for use once before the patient applies the lens and then again after he removes it. I've had great success with this approach."

The Comfort Factor

Vistakon has positioned the Acuvue Advance as offering "exceptional long-lasting comfort." When asked whether the lens delivers on this promise, all doctors we talked with were unanimous: Yes.

"The Acuvue Advance has proven to be more comfortable late in the day on the vast majority of patients," says Dr. Udvari.

Brian Rast, OD, who practices in a four doctor clinic in Dallas, Texas, estimates that eight out of 10 of his patients report significant improvement in day-long comfort.

"With my background, I consider myself a bit of a skeptic," states Dr. Fink, who taught in the Contact Lens Service Clinic at the Pennsylvania College of Optometry for nearly 30 years. "By now, I've probably fit 800 patients with the Acuvue Advance contact lens. I'm convinced it makes a real difference in comfort."

When asked if any patients prefer the comfort of their original lenses, the doctors say this rarely happens. "Maybe two out of 800 patients didn't like the comfort. This was determined before the patient ever left the office," Dr. Fink states.

Dr. Wiener says that a low percentage of patients in his practice who are habitual wearers of the original Acuvue Brand lens prefer how the original feels on the eye. He attributes the difference to the stiffness of the Acuvue Advance polymer.

Dr. Rast reports that a few patients felt the Acuvue Advance lens was slightly drier than the Acuvue 2 lens. His partner had one patient who coated the Acuvue Advance lens heavily. His partner had one patient who was unable to wear the Acuvue Advance lens due to problems with heavy surface coating.

The doctors we spoke with emphasized that these reports were rare, and the vast majority of patients found the Acuvue Advance contact lens to perform better in nearly every way.

"It even provides better vision for low cylinder patients by masking the astigmatism," Dr. Fink adds.

Searching for Dryness Symptoms

We also asked whether practitioners solicit comments from patients on late-day dryness with their habitual lenses. "Patients have gotten used to the downsides of contact lens wear, so they may dismiss late-day dryness as 'normal.' So, we ask, 'Have you been experiencing late-day dryness or reduction in your vision? Have you found you are using more wetting drops to keep your lenses comfortable?' These questions can help you uncover dryness problems," Dr. Fink says.

"I often say to the patient, 'I know you're ready to tear your lenses out of your eyes at the end of the day.' Now we have a lens that can help. And it really does," says Dr. Udvari.

Presenting Acuvue Advance to Patients

All four doctors we spoke with indicate that they introduce and review the benefits of the Acuvue Advance with patients after completing the initial evaluation.

"I take time to personally discuss the Acuvue Advance Brand Contact Lens with the patient," says Dr. Rast. "I think it's the best way to educate the patient and I enjoy it."

Dr. Udvari always reinforces his presentation by providing the patient with a brochure on the Acuvue Advance. "I really emphasize the comfort benefits of the Acuvue Advance lens."

According to Dr. Fink, many of his patients have been refit with contact lenses in the past. He explains to the patient why this refit is different. "I tell these patients that prior refits involved mechanics of the fit, such as changing the curve or size of the lens. Now we can do more. Now we have a totally new material with superior features," he says.

Dr. Wiener tells his patients, "It's the newest thing on the market. It offers a major increase in oxygen, which improves comfort and eye health."

Oxygen Performance

The Acuvue Advance offers an edge-corrected Dk/t of 85.7, assuming a lens center thickness of 0.07 (at ­3.00D). Most hydrogel materials, which have been the mainstay of two-week replacement daily wear fittings, provide oxygen transmission at significantly lower levels. For example, the Acuvue 2 Brand Contact Lens has a Dk/t of 25.5.

Dr. Wiener tells patients who may not necessarily be experiencing discomfort with their present lenses, "Even if you don't experience an improvement in comfort, you'll still be better off because it's safer."

Dr. Fink explains the oxygen benefits to the patient by informing them that the lens is "forgiving if you fall asleep on the couch while watching TV."

According to Dr. Rast, the Acuvue Advance can be a helpful tool in managing contact lens abusers. "It's been a great solution for patients who have been sleeping in their Acuvue 2 or Biomedics 55 lenses against my recommendations."

Ultraviolet Filtration

Dr. Rast says he feels patients should focus not only on the comfort of Acuvue Advance, but also on its health benefits. "I tell patients it's the first lens we've had in a long time that's really different. In addition to greater comfort, it triples the oxygen level supplied to the eye and offers the best UV protection of any lens on the market."

While some of the doctors we interviewed barely mention the UV absorption benefits of the lens, Dr. Rast reports, "I probably talk about UV more than the comfort." He reports this feature really clicks with parents whose children participate in sports such as soccer and football. "These kids are out in the sun all day. Parents love the safety benefits of UV filtration."

Dr. Fink says he feels that most patients now expect UV protection in their contact lenses. "This is a one liner with the Acuvue Advance," he says. "It's the best in industry."

Lens Handling Characteristics

"I have lots of patients in Vistakon's Surevue lens and, up until now, I've never been able to get them to switch to a lens that was healthier for their eyes," reports Dr. Udvari. "It's because these new lenses were always thinner and harder to handle than the Surevue lens." The Acuvue Advance lens has been the answer. "These patients have no problem handling the Acuvue Advance lens."

All the doctors spoken to agree that patients enjoy the handling characteristics of the lens.

According to Vistakon, the Acuvue Advance contact lens is slightly thinner than even the Acuvue 2 lens (0.070mm versus 0.084mm center thickness at ­3.00D). It is thought the higher modulus of elasticity of the galyfilcon A material in the Acuvue Advance contact lens helps it retain its shape during handling (See chart "Modulus of Elasticity," page 44).

The Fitting Process

The Acuvue Advance is available in an 8.3mm and 8.7mm base curve in a single 14.0mm diameter. It follows the design of the Acuvue 2. Dr. Udvari says, "I tell patients it's like a car. It has the same frame as the Acuvue 2, but with a new body. It rides the same but with better features." He adds, "If I fit flat in Acuvue 2, I stay flat with the Acuvue Advance."

"I've always been an 8.3 fitter with Acuvue 2,"says Dr. Rast. "It's the same with the Acuvue Advance."

Dr. Fink explains his approach this way: "We've been an 8.7mm Acuvue 2 practice. We fit flatter to optimize physiology. With the superior oxygen performance of the Acuvue Advance, I'm finding I'm fitting more 8.3mm base curve lenses, but the 8.7mm lens still has a slight edge."

Dr. Wiener has a slight preference for the 8.3mm base curve design. "I want less movement when fitting a silicone hydrogel lens to minimize the chance of inducing GPC from mechanical irritation of the superior tarsal plate. The higher oxygen profile gives me the freedom to bias the fit a little tighter."

Follow-Up Schedule

Dr. Wiener has all of his patients return for follow up one week after fitting. "I want to see their eyes as well as talk to them about how they are getting along," he says. "I want them to appreciate the difference in comfort and to notice how much clearer their eyes look."

Dr. Rast initially saw all patients back "no sooner than one week and no longer than two weeks." Now he feels it's only necessary for patients who had been wearing lenses other than Acuvue 2.

Dr. Fink concurs. "I had the first 200 or so Acuvue 2 refits back and found it unnecessary. I always tell the patient the lens comes with a Satisfaction Guarantee." He instructs his patients to wear the lenses for a few days, and if there are no problems, then he orders the lens supply. Dr. Rast has his technicians telephone the patient a week after fitting to confirm patient satisfaction and then places the order for a year's supply.

Dr. Udvari uses his certified technician staff for the Acuvue Advance fitting and follow up. "This frees me up to spend time performing more advanced fittings such as multifocal contact lenses. These technicians have received advanced training through the American Optometric Association certification process. They are knowledgeable and good at what they do. If there is ever a question, I'm available."

Supplying the Lens

All of the doctors we spoke with encourage patients to purchase an annual supply of lenses and offer free shipping to the patient's home or workplace. Dr. Wiener tries to dispense annual supplies from stock, but if the parameters he needs aren't in-house, he offers the free shipping plan.

Dr. Udvari's office offers the option of ordering lens supplies on its Web site. "Patients love the convenience of using the Internet to order their lenses," he says. "Now they can enjoy this convenience and still get their lenses from us."

According to our practitioner panel, cost hasn't been a deterrent in switching patients to the Acuvue Advance. "My material cost is higher, so I have to pass that on to the patient," says Dr. Wiener. "The difference in cost is around $30 for an annual supply. When I supply the $30 rebate, patients tend to perceive it as a wash."

Compatible Care Systems

The doctors we spoke with use a wide variety of care systems with the Acuvue Advance. "Per Vistakon's recommendation," states Dr. Rast, "I just stay away from the SOLO Care System."

Something Truly Different

The doctors we interviewed are enthusiastic about the improved performance of the Acuvue Advance over prior hydrogel designs. "It's the first lens in a long time that's really different for the daily wear two-week replacement market," Dr. Rast says.

Says Dr. Udvari of Dr. Gary Gerber of Westwood, N.J., "Gary advises us not to become contact lens vending machines because patients will leave us. To maintain patient loyalty, we need to continue to offer the latest innovations in the field. The Acuvue Advance is the latest innovation."

Dr. Quinn is in group practice in Athens, Ohio, and has served as a faculty member at The Ohio State University College of Optometry.