Contact Lens Practice Pearls

My Contact Lens Resolution

By Gregory J. Nixon, OD, FAAO

As we turn the calendar at the start of a new year, the tradition of making resolutions is upon us. I'm generally not one to make New Year's resolutions, certainly not as they relate to how I practice. However, this year, I think I will make an exception.

As I'm in the midst of my 15th year of practice, I've grown increasingly skeptical of some patients' ability to maintain compliance with lens replacement schedules and lens care regimens. For that reason, I vow to offer more patients the option of daily disposable lenses. While I have always thought that daily disposables are a great option for patients, I've found them increasingly effective in addressing lens replacement noncompliance. Additionally, recent advances in lens designs and power availability within this category make them better choices for even more patients.

Daily Disposable Benefits

While the virtues of this modality may seem obvious, their benefits have become more important in recent years.

When they were first introduced, a single-use lens was a great option for allergy patients, chronic depositors, or those who had solution sensitivity. My recent experience has found additional patients to add to this list: those who are noncompliant with lens replacement.

I've always prided myself on the level of patient education in my practice and the impact it has had on creating a loyal, compliant patient base. We have been fortunate to add many new patients to our practice recently. However, as we inherit these new patients, we also inherit the bad lens habits that they bring with them.

The most common offense is extending replacement schedules of both two-week and monthly lenses. While I am disappointed in this behavior, I am even more disappointed to discover that these patients were often instructed by their previous practitioner to “wear them until they hurt.” Such advice and ensuing behavior puts patients at risk for lens deposits leading to GPC, surface dryness leading to lens discomfort, and lens contamination leading to ocular infection.

Unfortunately, despite extensive amounts of patient education, the only thing that is often effective in changing the habits of noncompliant patients is for them to experience one of these adverse events. Therefore, I recommend being proactive and refitting these patients into a daily disposable modality that fosters built-in lens replacement compliance.

Current Daily Options

The expansion of parameter availability and increase in sophisticated materials make today's daily disposable lenses better options for more patients. There is an aspheric contact lens (Bausch + Lomb's Soflens Daily Disposable), contact lenses for improved comfort and wetting (CooperVision's Proclear 1 Day, Ciba Vision's [Ciba] Dailies AquaComfort Plus and Vistakon's 1-Day Acuvue Moist), and a silicone hydrogel lens (Vistakon's 1-Day Acuvue TruEye). There are even two daily disposable toric lenses (Ciba's Focus Dailies Toric and CooperVision's ClearSight 1 Day Toric).

Grow the Modality, Increase Lens Wearers

One of the most overlooked benefits of daily disposables is their convenience and availability for part-time wear. I think that there are many spectacle wearers who would love the opportunity to wear contact lenses on occasion for sports or exercise and for certain business or social functions. In this new year, I also vow to offer daily disposables to these patients as well to allow even more people to enjoy the benefits of contact lenses. Because the United States significantly lags behind most of the world in daily disposable prescribing, perhaps my fellow U.S. practitioners should also consider this resolution. CLS

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Dr. Nixon is an associate professor of clinical optometry and the director of Extern Programs at The Ohio University College of Optometry. He is also in a group private practice in Westerville, Ohio. He is on the Allergan Academic Advisory Board and the B+L Advisory Board. You can reach him at gnixon@optometry.osu.edu.