It’s likely that eyecare professionals (ECPs) rely on just a few well-used reference materials during the course of their everyday contact lens (CL) practice. This may be anything from a lens-specific fitting guide to patient-centric information on safe wear and care of CLs. Beyond those few familiar pieces, what else is available? This article recognizes that a plethora of information exists about the fitting and use of CLs. However, many remain sparsely used. We’ve done a lot of research for you and have grouped it by broad subject area (such as resource materials) and included any relevant links. Inclusion in this article does not reflect an endorsement of one resource over another. The objective of this piece is to serve as a reference to highlight the multitude of information that is available for ECPs to help them in their CL practice.

METHOD AND SCOPE

Method For this article, a search was conducted across professional organizations, CL manufacturers, and other related sources to find resources that support the category of CLs, patient education, and the fitting of basic soft and GP contact lenses. The article covers spherical, toric, and multifocal lens designs along with soft lenses designed specifically for myopia control.

Scope To be suitable for inclusion, each resource had to be freely available, without the need for paid access, an account, or membership of a specific organization. Materials that fell outside of the scope of this article include product-specific fitting guides and direct-to-patient materials, unless they were judged to be of use by practitioners in-office when educating patients. Resources for specialty lens fitting will be covered in an issue of Contact Lens Spectrum (CLS) later this year.

Earlier in 2019, CLS (and its weekly email newsletter, Contact Lenses Today) publicly invited organizations and manufacturers to share their own materials. Where this did not occur, the research conducted for this article attempted to fill in the gaps. Note: It should be recognized that it would be almost impossible to find and include every available relevant piece of resource material. Omissions are possible, and readers are invited to contact CLS if there are further materials that they wish to share.

PATIENT COMMUNICATION

Patient communication for new and existing wearers is key to driving CL success in practice. The simple action of introducing the option of CLs to patients more frequently will result in more CL fits¹ and will likely lead to an increase in business. Existing CL wearers returning for their annual review benefit from clear and open discussion to elicit any issues or sub-optimal performance that might eventually lead to dropout.²

Links for the resources mentioned in this section are summarized in Table 1. The American Optometric Association (AOA) has a number of useful resources within the Contact Lens & Cornea Section of its website. Among these are comprehensive pieces on discussing CL options with patients and tips on how to engage patients to improve their CL experience (Figure 1). Bausch + Lomb (B+L) has produced some video examples of communication, specifically with astigmatic and presbyopic patients. And, CooperVision has provided several pieces of information on practice-building with CLs, which includes establishing key performance indicators (KPIs), tips on marketing, patient retention, and ECP case studies. CooperVision also has available an overview to which patients can be directed to learn more about CLs. Johnson & Johnson (J&J) Vision provides some written information about talking to potential new wearers, among other useful topics in the resource section of its site.

Other sources of background information on CLs that are written for patients can be found at the Association of Contact Lens Manufacturers (ACLM), the Association of Optometrists (AOP), and the British Contact Lens Association (BCLA). In addition, comparisons of soft and GP lenses are available at the Canadian Association of Optometrists (CAO) website. Patients interested in GP lenses can be directed to the GP Contact Lenses site (which is put together by the GP Lens Institute [GPLI] and the Contact Lens Manufacturers Association [CLMA]), where they will find a wide range of information.

PATIENT EDUCATION

Application and Removal A number of organizations and manufacturers have resources to help with teaching new wearers the techniques for applying and removing CLs. The focus on this area is important, with handling difficulties cited as one of the primary reasons for ceasing CL wear in the first three months of use.^3,4 All too often, patients find it challenging to retain much of the information that they are given during the teaching appointment in the office. Being able to hand out printed reminders or provide video links of the techniques that patients need to learn can provide valuable support to new wearers in their early days of wear (Table 2). Video examples of soft lens application and removal have been produced by Alcon and J&J Vision, with written examples available from the American Academy of Ophthalmology, the AOP, B+L, CooperVision, the CAO, and Clearlab. Application and removal of GPs, including video examples, are provided by Art Optical and the GPLI.

Wear and Care Encouraging compliant habits with CL wear is known to reduce the risk of complications such as microbial keratitis and corneal infiltrative events.^5-9 Luckily, many risk factors—such as poor hand hygiene, sleeping in lenses, irregular CL case replacement, and water exposure—are modifiable risks. Therefore, the role of both initial and ongoing patient education should be placed as a central focus for maintaining safe CL wear. It can be very useful for practitioners to be able to provide information to patients while they are at their appointment as well as for their reference at home (Table 2).

Among other patient information on its site, Alcon has produced a useful list of do’s and don’ts for safe CL wear, along with advice on how to care for CLs. A number of professional, academic, or government organizations also have written information for patients in this area, including All About Vision, the American Academy of Ophthalmology, the AOA, the CAO, the Centers for Disease Control and Prevention (CDC), and the National Eye Institute. The AOP provides information on both soft and GP lenses on its website. The Centre for Ocular Research & Education (CORE) has downloadable patient handouts to promote correct cleaning regimens and safe wear, and the Association of Optometric Contact Lens Educators (AOCLE) has information available in English (Figure 1), French, and Spanish. Videos on safe CL wear are available from the U.S. Food & Drug Administration (FDA), and the AOP.

While specialty lens fitting will be discussed in another article, the GPLI website provides a wide variety of ECP-supporting materials and education related to all aspects of GP lenses. Information on caring for GP lenses is available for download, along with staff training videos.

Additionally, given the increasing interest in myopia control, it is not surprising that there are many materials available designed specifically for wear of CLs by young people. Safe CL wear in children is promoted in an issue on kids and CLs available in Contact Lens Update (produced by CORE). The FDA also provides some basic information and safe wear tips for parents to understand more about kids and CLs. Similar advice is available on the CAO site, and more information for parental background reading is also on Myopia Profile, which is an information resource developed by Drs. Paul and Kate Gifford. The AOA provides a good overview for ECPs about prescribing CLs to adolescents (some of which is industry sponsored). The J&J consumer website also has information for both kids and parents to read.

Given the different routes by which they are available, and the concerns over safe use, it is not surprising that cosmetic CLs have some dedicated resources as well. For example, the FDA has information for patients in written and video formats, and CORE has produced a handout to educate patients.

INFORMATION FOR PRACTITIONERS

General Information A number of sources offer general information on CLs written for ECPs (Table 3). CooperVision has a clinical resources section that contains articles on silicone hydrogel CLs, digital eye fatigue, soft multifocal contact lenses, and myopia control. The Contact Lens & Cornea section of the AOA site has several resources for ECPs on subjects ranging from lens care and different modality options to CL disposal. Information is also available on toric lenses from SynergEyes and on multifocal lenses from the AOA, B+L, and CLS.

Myopia Management The growing interest in this area of clinical practice has resulted in a variety of materials becoming available on this topic (Table 3). This ranges from the open-access peer-review white papers from the International Myopia Institute (IMI) to information for parents and patients on their options. Summaries of the IMI papers, along with a quick-start guide to implementing the clinical management guidelines in practice, are available in Contact Lens Update (Figure 1). Of course, there is a plethora of information available in various eyecare journals that contain data and advice to help ECPs better understand the clinical practice of myopia management. In addition to numerous articles on myopia, CLS also produced two useful supplements on myopia control.

The Brien Holden Vision Institute (BHVI) has freely available background information for ECPs, along with guidelines and a myopia calculator, both accessible via a one-time login. Myopia Profile is a site dedicated to providing clinically relevant content for ECPs on the subject of myopia management, with regularly updated content, blogs, and a resources section. This resource also links to My Kids Vision, which provides information for parents about myopia, its risks, and the options available for management. Written directly for the parent audience, this resource could be useful to recommend to patients who desire to learn and research more about the subject on their own time.

No soft lens is currently cleared by the FDA for myopia control in the United States. However, ECPs can still access information about the subject for their own and their patients’ education from manufacturers who have lenses specifically designed for this that are currently available elsewhere in the world.

Tools and Calculators Naturally, manufacturers have fitting guides available for their own lenses, many of which are freely available online, but because they are product specific, they are considered out of scope for this article. However, it is necessary to mention the tools and calculators available to ECPs. It is important to acknowledge that many of these are also product specific, but given that more than one manufacturer offers these resources, and accepting that it is important for ECPs to be aware of such support, some examples of these tools have been included. The general aim of such tools is to support ECPs in achieving successful fits, especially with toric and multifocal lens designs, to help minimize chair time, and to enable trained support staff to order trial lenses (Table 3).

CooperVision has an online conversion calculator for back vertex distance, along with a tool (online and app versions available) that suggests trial lenses for both toric and multifocal lenses based on the patients’ spectacle prescription. An initial trial lens power can also be calculated for multifocals made by Visioneering Technologies, and SpecialEyes has a number of fitting tools and calculators available. For GP lenses, the GPLI is a good source of fitting tools, calculators, and troubleshooting for ECPs.

Clinical Techniques and Contact Lens Complications The Clinical Contact Lens Management Guide (produced by CORE) has a section specifically designed to help students and recent graduates with biomicroscope techniques. Each technique is demonstrated in a video, and examples are provided of different CL complications and how best to view them with the biomicroscope. Produced specifically to demonstrate diagnostic and therapeutic techniques related to dry eye disease, a series of videos is available on the Tear Film & Ocular Surface Society Dry Eye WorkShop II (TFOS DEWS II) site; several of those videos are also relevant to the management of contact lens wearers (Table 3).

Differential diagnosis along with management options are also available for ECPs in the Clinical Contact Lens Management Guide. A search function enables conditions to be searched by name or by presenting signs and symptoms. High-resolution photographs that depict a number of anterior eye structures and complications related to CL wear are available in the clinical resources section of the B+L site. And, AOCLE has a library that contains a number of CL-related pathologies and their management.

Lens Availability Updated annually, all CLs (soft, GP, scleral, and custom) and solutions that are available in Canada can be accessed via Contact Lens Compendium, a searchable database from CORE. CLS produces the annual Contact Lenses & Solutions Summary (CLASS). And, the GPLI has a searchable database of GP lenses. AOCLE has produced a pocket guide of lenses, but the most recent version available on the website is from 2014.

CONCLUSION

Beyond individual lens-specific fit guides, a search of educational, professional, and manufacturing groups reveals a plethora of information related to basic CL use. ECPs have free access to background information on a wide range of clinically important topics, which, in the case of myopia management, continue to be updated regularly. Increasingly, online tips, tools, and calculators are becoming available to help with efficient chair time and to drive fit success in practice.

Many of the available educational materials can also benefit patients and relate to initial application and removal training as well as to the overall safe wear of CLs. These resources are particularly useful for ECPs and their staff to help patients become confident and safe CL wearers, thereby promoting healthy CL wear for years to come. CLS

REFERENCES

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2. Nichols JJ, Willcox MD, Bron AJ, et al. The TFOS International Workshop on Contact Lens Discomfort: Executive Summary. Invest Ophthalmol Vis Sci. 2013 Oct 18;54:TFOS7-TFOS13.
3. Sulley A, Young G, Hunt C, McCready S, Targett MT, Craven R. Retention Rates in New Contact Lens Wearers. Eye Contact Lens. 2018 Sep;44 Suppl 1;S273-S282.
4. Sulley A, Young G, Hunt C. Factors in the success of new contact lens wearers. Contact Lens Anterior Eye. 2017 Feb;40:15-24.
5. Dart JK, Radford CF, Minassian D, Verma S, Stapleton F. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology. 2008 Oct;115:1647-1654, 1654.e1-3.
6. Stapleton F, Keay L, Edwards K, et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008 Oct;115:1655-1662.
7. Chalmers RL, Wagner H, Mitchell GL, et al. Age and other risk factors for corneal infiltrative and inflammatory events in young soft contact lens wearers from the Contact Lens Assessment in Youth (CLAY) study. Invest Ophthalmol Vis Sci. 2011 Aug;52:6690-6696.
8. Chalmers RL, Keay L, McNally J, Kern J. Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates. Optom Vis Sci. 2012 Mar;89:316-325.
9. Szczotka-Flynn L, Chalmers R. Incidence and epidemiologic associations of corneal infiltrates with silicone hydrogel contact lenses. Eye Contact Lens. 2013 Jan;39:49-52.