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Conventional Lenses Are Not Dead

BY STEVEN GOLDBERG, OD

It was my first day seeing patients in the practice I had recently joined. One patient entered the examination room wearing her one-year-old conventional (non-disposable) CooperClear (CooperVision) contact lenses. "They still make those?" I thought to myself. She was perfectly content and wanted to get a new pair. "You don't want disposable lenses?" I asked.

I quickly learned that perhaps a quarter of the contact lens patients in this practice were similar to this patient — happily wearing what I considered to be ancient-technology lenses. I half-expected music in the office to come streaming from an eight-track player.

When I graduated optometry school some 23 years ago, such contact lenses were all the rage, together with GP rigid lenses, which were new at that time. Two-week disposable lenses were a distant dream. But today? Who doesn't wear disposable lenses?

Unexpected Findings

My initial inclination was to bring all of these patients into the 21st century by refitting them with newer, more frequent replacement lenses. Yet, slit lamp examinations have shown little in the way of keratitis or corneal neovascularization. Naturally, there's the occasional contact lens overwear patient who does exhibit these problems, but the vast majority seemed to be in quite good physiological condition.

Compare this to some disposable lens patients. If yours are like mine, many are wearing their two-week lenses for four weeks or longer, and corneal neovascularization is not uncommon. I emphasize to every single patient the importance of replacing the lenses as prescribed and avoiding contact lens overwear, I let them know they run the risk of having blood vessels grow where they don't belong, but I know my impassioned warnings are often falling on deaf ears.

Older Can Sometimes Be Better

In a perfect world, I would fit every soft lens patient with high-Dk silicone hydrogel lenses, and patients would wear them on a daily wear basis and replace them as instructed. In fact, this is the approach I take for new wearers. My current favorites are Biofinity (CooperVision) and Acuvue Oasys (Vistakon) lenses.

But now when I see previous patients who have been wearing conventional contact lenses for years and are asymptomatic and keratitis-free, I'm comfortable having them stay with this modality. I've even switched a few patients who were disposable lens abusers to conventional lenses (they weren't amenable to upgrading to silicone hydrogels).

Nationally, few patients are fit with conventional lenses. According to a Contact Lens Spectrum Reader Profile Survey reported in "Contact Lenses 2006" (January 2007 issue), only 3 percent of lens fits/refits involved such lenses.

Conventional replacement contact lenses are lower-Dk and are considered older technology, but these lenses can still have a place in your contact lens armamentarium. They are more deposit-resistant than newer-generation lenses and seem less prone to produce corneal staining, infiltrates or corneal ulcers compared to low-Dk disposable lenses.

My preference is to fit my patients with the newest silicone hydrogels, but for patients unwilling to upgrade, I've found that conventional contact lenses are largely safe and effective. CLS

Dr. Goldberg is in private practice in St. Louis, MO. The optometrist and freelance writer can be reached at smgoldberg2000@hotmail.com.