Contact Lens Practice Pearls

Newer Uses for Silicone Hydrogel Contact Lenses

BY JESSICA H. MATHEW, OD, PHD, FAAO

With the introduction of “breathable” silicone hydrogel contact lens materials, healthier options in lens wear have evolved over the last decade. Although initially advocated for extended (overnight) wear, this material type made its way into daily wear lenses and more recently has been implemented into daily disposable contact lenses.

In the past, stock silicone hydrogel contact lens options were not available for certain populations of patients whose parameters fall outside of the normal range. But with the expansion of silicone hydrogel materials across all contact lens modalities, we have a large repertoire of healthy, breathable options in stock lenses for both normal daily wear and for special clinical circumstances.

Post-Refractive Corneas

Johnson & Johnson Vision Care, Inc. (JJVCI) offers the flattest base curves among stock silicone hydrogel options with its 1-Day Acuvue TruEye lens (9.0mm base curve) and its Acuvue Oasys lens (8.8mm base curve). These lens curvatures are ideal for patients who have undergone refractive surgery and now have significantly flat corneas. The frequent replacement and high oxygen permeability of these lenses are also advantageous and necessary in maintaining the health of post-surgical corneas.

High Refractive Error

In late 2013, CooperVision launched Biofinity XR, an extended range of its silicone hydrogel Biofinity lens. The new parameters include sphere powers of +8.50D to +15.00D and from –12.50D to –20.00D in 0.50D steps. In addition to the extended spherical range, CooperVision will soon launch an extended Biofinity Toric range.

Therapeutic Bandage Lenses

Therapeutic bandage lenses are used for certain acute and chronic ocular conditions such as corneal abrasion, recurrent corneal erosion, filamentary keratitis, post-surgical conditions, and even for ocular drug delivery. Lenses that have U.S. Food and Drug Administration (FDA) clearance for therapeutic use include Acuvue Oasys, Air Optix Night & Day Aqua (Alcon), and PureVision (Bausch + Lomb).

Although FDA-cleared silicone hydrogel therapeutic bandage contact lenses are nothing new, the packaging and presentation of these lenses are. In the case of Acuvue Oasys, a specific bandage lens is available for which the packaging on the lens states “bandage.” Other brands simply offer a plano power lens for use in therapeutic situations. Keep in mind that to receive an insurance reimbursement for prescribing a bandage lens, you must use lenses that have been specifically purchased for this purpose. In other words, while you can use a low-power lens from your existing trial set, it would be better to buy plano or “bandage” lenses ahead of time.

Better Care for More Patients

Although silicone hydrogel materials have been around for more than a decade, newer advances now give us a wider range of uses clinically, allowing us to provide the best care possible for our specialty patients. With the extension in stock parameters of this material, we can now offer a healthier option to patients who could not benefit from it before.

Of course, let’s not forget that there are many great options in custom soft contact lenses that can be manufactured in a silicone hydrogel material for these patients as well. CLS

Dr. Mathew is a research assistant professor at the University of Houston College of Optometry. She manages patients who have severe corneal distortions and require specialty contact lenses, and she is also involved in basic science and clinical trial research with The Texas Eye Research and Technology Center and The Ocular Surface Institute. She has received research funding from Allergan, CooperVision, Clearlab, Essilor, Shire, Tearlab, Menicon, and Vistakon. You can reach her at jmathew@optometry.uh.edu.