DAILY DISPOSABLES

Daily Disposable Advantages and Options

Daily disposables are convenient and comfortable for many patients as well as profitable for your practice.

By Mile Brujic, OD

Dr. Brujic is a partner in a multi-location group practice where he sees patients in Bowling Green and Lima, Ohio. He lectures nationally on contemporary topics in eye care.

Daily disposable contact lenses play an important role in our practices. This modality of contact lens wear provides a viable option for a wide array of patient needs. It's important that you understand the benefits of this modality as they apply to both your patients and to your practice.

State of the Market

Significant differences exist in contact lens prescribing habits. According to data from Health Products Research, in Japan an estimated 56 percent of the contact lenses fit are daily disposables. In the United Kingdom it's about 35 percent. In the United States we fit a mere 4 percent of our patients with daily disposable contact lenses. Although this number will vary significantly among individual practices, in general we fit this modality much less than our colleagues across the globe.

Why is there such variance in prescribing habits when there are many benefits to this modality of wear? Daily disposables are convenient, they represent a great option for allergy sufferers and they demonstrate high rates of compliance. No one contact lens modality will suit all contact lens wearers, but we need to appreciate daily disposables as a viable option for many of our patients.

This article will review some of the benefits of daily disposable contact lens wear and will provide an understanding of the available options. I'll also address the financial importance to our practices of prescribing daily disposable lenses as well as common cost objections that you may encounter and how to overcome them.

Convenience and Safety

Daily disposable lenses represent the most convenient contact lens option available today. From a convenience standpoint, daily disposables offer many advantages. They are easy to care for and may provide patients with advantages over their current contact lens regimen.

As their name implies, daily disposables are replaced on a daily basis. This allows wearers to avoid any type of cleaning and disinfecting steps that are important components to any frequent replacement contact lens regimen. Daily disposables are a logical option for those patients who are noncompliant with cleaning and disinfecting their contact lenses.

The convenience of this modality also makes it a logical option for patients interested in wearing their contact lens on a part-time basis. Part-time wear of frequent replacement lenses could result in noncompliance because it becomes difficult for patients to remember how old the lenses are.

There are no contact lens care solution complications to consider for daily disposable lens wearers. Contact lens solutions have gained much attention over the past few years in the aftermath of recent recalls. This is a non-issue for patients wearing daily disposable contact lenses.

Figure 1. Example of microbial keratitis in a contact lens wearer without and with fluorescein stain.

The underlying mechanisms of contact lens-related microbial keratitis (Figure 1) are complex and still under investigation. Stapleton et al (2007) examined the incidence of microbial keratitis in contact lens wearers and found the incidence to be 2 per 10,000 for those wearing daily disposables and 1.7 per 10,000 for those wearing frequent replacement contact lenses on a daily wear basis. This study shows that, although a new lens is placed on the eye daily, there is essentially no difference in the incidence of microbial keratitis between daily disposable wear and frequent replacement contact lenses worn on a daily wear basis.

Although much information is available on the mechanism of contact lens-induced microbial keratitis, more research is needed in this area. It's clearly not as simple as eliminating solutions to minimize the risk of microbial keratitis. Regardless of the underlying mechanisms, compliant daily disposable wear eliminates contact lens care systems as a variable.

Another important consideration is that no contact lens cases are needed with daily disposable lens wear. According the American Optometric Association Contact Lens and Cornea Section, patients should replace contact lens cases at minimum every three months. It's been widely reported that cases serve as a common source for microbial contamination, which can then be transferred to the contact lenses. Patients wearing daily disposable contact lenses do not need to worry about a contact lens case as a variable.

Hypersensitivity

Patients who have seasonal allergies can have significant difficulties with wearing contact lenses comfortably during allergy season. The inflammatory response of the ocular tissues to allergens for such individuals promotes uncomfortable contact lens wear. Daily disposable contact lenses are a logical first line option to help patients wear contact lenses comfortably during allergy season.

The ocular tissues impacted by allergies tend to produce more inflammatory by-products. Unfortunately, this often results in contact lens deposits (Figure 2), which can trigger the development of giant papillary conjunctivitis (GPC) (Figure 3). This condition makes it difficult to wear contact lenses and may lead to contact lens intolerance. This variable is less of an issue for those patients replacing their contact lenses on a daily basis because deposit buildup remains minimal.

In addition to benefits for environmental allergy sufferers, there are also benefits in using daily replacement contact lenses for patients who may have sensitivities to preservatives in contact lens care systems. Daily disposable wear allows patients to avoid these potential sources of irritation that can lead to uncomfortable contact lens wear.

Compliance

Replacing contact lenses as directed is, unfortunately, poorly complied with among patients who wear frequent replacement contact lenses. Bailey (2006) has shown that there are different compliance rates associated with different replacement schedules. Two-week replacement contact lens wearers demonstrated the poorest compliance, with only 48 percent of patients wearing this modality as directed. Monthly replacement contact lens wearers showed better compliance rates, with 66 percent of patients reporting compliance with the recommended replacement schedule. Daily disposable contact lens wearers demonstrated the highest rate of compliance, with 94 percent of patients in this study complying with the daily replacement schedule.

Compliance is an important factor to consider when selecting replacement schedules for patients. When patients replace their contact lenses on the proper schedule, they will need contact lenses more frequently and thus receive more regular eye care.

Daily Disposable Options

As I've discussed, daily disposable contact lenses offer many advantages. Their convenience, benefits for allergy sufferers and the higher rates of compliance associated with this modality of contact lens wear make it a viable option for many patients. We will next review the different types of daily disposable contact lenses available and highlight their differences.

With many daily disposables available, it's important to appreciate the differences among the various brands. Although no one brand will satisfy all patients, an appreciation of those available will allow you to fit most individuals with this modality when appropriate.

1·Day Acuvue and 1·Day Acuvue Moist Vistakon produces these two daily disposable lenses in etafilcon A material (58 percent water content). Both lenses are available in two base curve radii: 8.5mm and 9.0mm. They're available in a wide range of powers from +6.00D to –6.00D in 0.25D steps and from –6.50D to –12.00D in 0.50D steps.

The 1·Day Acuvue Moist lens differs from the original 1·Day Acuvue by incorporating the company's Lacreon technology into the contact lens in an attempt to address end-of-day dryness issues. Lacreon technology embeds the wetting agent polyvinyl pyrrolidone (PVP) into the contact lens, producing a surface that is more hydrophilic and resulting in improved comfort, according to Vistakon.

Focus Dailies with AquaRelease The Focus Dailies (CIBA Vision) line is the most extensive line of daily disposable contact lenses. They're available in sphere and toric designs. Focus Dailies Progressives is a multifocal design option for the presbyopic population. All of these contact lenses contain AquaRelease, a polyvinyl alcohol (PVA) that is slowly released from the lens into the tear film throughout the day in an effort to increase patient comfort.

Freshlook One-Day Colors are daily replacement contact lenses that offer patients the option to cosmetically change their eye color. They're available in four colors: blue, green, gray and pure hazel.

The line of daily disposable contact lenses from CIBA are all composed of nelfilcon A (69 percent water content). They're all available in one base curve radius, 8.6mm, and offer many options to satisfy the visual needs of a wide array of patients.

SofLens One Day Disposable The Soflens One Day Disposable (Bausch & Lomb) is manufactured in hilafilcon A (70 percent water). This contact lens is available in one base curve radius of 8.6mm. It's produced in a wide range of powers including +6.50D to –6.50D in 0.25D steps and from –7.00D to –9.00D in 0.50D steps. The SofLens One Day Disposable also features a visibility tint.

Proclear 1 Day and ClearSight 1 Day are CooperVision's two daily disposable lens options. Proclear 1 Day replacement lenses are manufactured in omafilcon A (60 percent water content) and contain phosphorylcholine, which has been shown to attract and surround itself with water. A double-masked, randomized daily wear study demonstrated that this material can provide patients with additional comfort.

ClearSight 1 Day is manufactured in ocufilcon B (52 percent water content). It's available in one base curve radius, 8.7mm. Powers range from –10.00D to +6.00D (0.50D steps >–6.00D and >+5.00D).

Practice Benefits and Patient Presentation

In addition to the many patient benefits that are evident with daily disposable contact lenses, they offer significant benefits to your practice as well. Assuming that patients purchase a one-year supply of contact lenses after seeing their eyecare practitioner, it's clear that dispensing daily disposables is more profitable than dispensing frequent replacement contact lenses. Daily disposables command a higher materials fee, and these patients are in general more compliant with their replacement schedule. This means that a daily disposable lens wearer generates more revenue than a frequent replacement lens wearer when the patient receives a comprehensive examination and then purchases contact lenses.

As mentioned previously, it's evident that daily disposable contact lens wearers are more compliant with their replacement schedule than are wearers of all other modalities. If they're more compliant, they will need to purchase their contact lenses more regularly. This means more regular visits for eye health examinations and to purchase contact lenses. This quickly results in increased revenues over time, as the two patients in Table 1 demonstrate. Over a six-year period, the difference in revenues generated between these two patients is $2,000. These fees are for this example only and will vary in different regions across the country and even in different practices, but this example does clearly demonstrate that, from a financial standpoint, fitting daily disposables can be significantly more profitable than fitting frequent replacement contact lenses.

Figure 2. Frequent replacement contact lens showing significant deposits.

Other revenue streams are also associated with seeing patients more often. It provides increased opportunities to offer other optical goods such as glasses and sunglasses. In the March 2006 issue, Mark Ritson, PhD, looked at the profitability of contact lens wearers in optometric practice and found that contact lens wearers were significantly more profitable than spectacle- only wearers. The primary reasons for this result were that contact lens patients were seen more frequently and they required other optical goods. Taking Ritson's research into consideration, it's clear that fitting daily disposables makes financial sense to a practice.

A major obstacle that practitioners encounter when presenting this option to patients relates to cost concerns. Namely that the cost — or perceived cost — is significantly more than that of frequent replacement contact lenses. There are many factors that you need to consider when presenting the cost of daily disposable contact lenses to patients.

There are costs associated with frequent replacement contact lenses that aren't associated with daily disposables. A major consideration for frequent replacement contact lenses is the cost of the care systems.

Another factor to consider is that the manufacturer mail-in rebates usually have a higher value for a one-year supply purchase of daily disposable lenses than for a one-year supply of two-week or monthly replacement modalities.

The cost of lens care systems combined with the rebates available significantly reduces the cost difference between daily disposables and frequent replacement contact lenses. This knowledge will create a comfortable forum for discussing costs with your patients concerning this modality of wear.

Figure 3. Giant papillary conjunctivitis evident in a patient wearing frequent replacement contact lenses.

Conclusion

Daily disposables provide a viable option for contact lens wearers because of their convenience, benefits for allergy sufferers and high rate of compliance. Many options are available for practitioners to maximize their likelihood of success. This modality of lens wear presents a profitable option for eyecare practitioners. You must still remember that success in a contact lens practice means listening to your patients and individualizing contact lens wearing regimens. Daily disposables can help in this mission by providing many patients with comfortable, convenient contact lens wear. CLS

To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #147.