Each month, Contact Lens Spectrum broadcasts a livestream series called “CLS Live!” during which host Jason Jedlicka, OD, sits down with leaders in the world of contact lenses to pinpoint key trends, critical insights, and intelligent takeaways. Dr. Jedlicka is a clinical associate professor at Indiana University School of Optometry and chief of the school’s Cornea and Contact Lens Service.

During each episode, Dr. Jedlicka and his monthly guest(s) discuss new and future products, the latest research, and worldwide trends in prescribing—and even bring viewers up to date live from the floor of CLS conferences such as the Global Specialty Lens Symposium.

>> Each CLS Live! episode airs on CLS’ Facebook and LinkedIn pages plus the CLS YouTube channel.

This episode, which originally aired on June 14, is part of a past-present-future look at the industry, this time focusing on the recent history and immediate future of soft contact lenses. In this livestream, Dr. Jedlicka spoke with Lyndon Jones, PhD, DSc, director of the Centre for Ocular Research and Education (CORE) at the University of Waterloo. Dr. Jones has also recently been made a fellow of the Royal Society of Canada, making him only the second optometrist ever to be granted this distinction.

Q: Jason Jedlicka, OD: In the last episode, we talked about the history of soft lenses, deposits, and how disposability has almost eliminated them. But we didn’t talk about a lot of other aspects of disposability.

In my opinion, one of the negatives with disposability is that we have less parameters to work with than we did when lenses lasted a lot longer. You still can order custom lenses that have those parameters, but you don’t have the replacement basis. Do you think that disposability and the simplification of available parameters has led to an issue with dropouts from bad fits, or do you think that disposable lenses really are one-size-fits-all?

A: Dr. Jones: Companies have done a great job in terms of trying to optimize the lens fit for the vast majority of patients in our practice. There’s a good reason for that. Obviously, it makes it simpler to fit, and certainly the number of SKUs you end up having to make and store in your practice is fewer as well.

But, interestingly, when we looked at the Tear Film & Ocular Surface Society Contact Lens Discomfort workshop reports…and the factors of a contact lens material and design that linked to comfort, one of the very few things that popped out was actually lens fit. Now, you look at all those other things that you think would drive comfort—like modulus, oxygen transport, edge profile—none of those really have huge amounts of evidence to show that they’re, in fact, linked to comfort. But lens fit does. So, it is important that we optimize lens fit.

If a lens doesn’t look like it’s completely covering the cornea, don’t say, “It’s going to be alright.” Of course, that has great implications for one of the other things I think we are becoming more aware of now, and that’s contact lens substitution.

I think there are many practitioners, certainly many patients, and even some regulators, who feel that lens A is pretty much the same as lens B, and why shouldn’t patients have whatever choice that they want? [They think that] if you want to go online and order a different lens, so long as it looks like it’s the same prescription—it should fit, that should be OK.

A recent paper looked at why contact lens substitution can produce issues, and we were able to show quite conclusively that there’s a good reason why you need to involve the practitioner if you’re going to try a new lens. You can’t just go on the internet, order what you want, and think it’s going to work.

Q: Dr. Jedlicka: Let’s speak about dropouts. We’ve talked about disposability being a great improvement for our patients. Why are we still having dropouts? Is it going back to the fit? Or what other issues are there?

A: Dr. Jones: Certainly, if we look at all the dropout work that’s been done, dropout rates remain consistent and average about 25%. So, 1 in 4 patients drop out within a three- to five-year time frame.

What is interesting is the main reasons patients drop out from lenses, depending on whether they’re a longer-term or existing wearer compared with a new wearer. And if you look at an existing wearer, the main reason is the one we always think about, which is dryness and discomfort toward the end of the day, versus a new wearer whose main reasons for dropping out, particularly in the first three to six months, [are] handling and vision. That, I think, is a real lesson for us with new patients to ensure that we follow up to make sure the patient is getting on well.

I think we say “Well, they did OK in the practice, we’re going to send them home.” In their own environment, patients don’t necessarily get on with that handling so well, and when they’re in their own environment, maybe their vision is not as good as it should be. So, you or your staff members [should] follow up quickly, within a couple days, to see how they’re doing, maybe do a remote consultation.

There is another thing that we’re not very good at. Often at a progress check, we’ll ask a patient, “How many hours are you wearing your lenses for?” What we don’t ask is the killer follow-up question: “How many hours are they comfortable for?”

We’re not really interested in total wear time, we’re much more interested in comfortable wear time. So, if there is two hours or more difference between total and comfortable wear time, we need to step in and do something. Maybe that’s a change in material, change in care system, [or] a change in frequency of replacement.

We are also not very good at offering patients something new when they come into the practice. We’ll say “How are you getting on with your lens?” “Fine” is not good enough; patients should do better than “fine.” And if they’re only fine, why not offer them something new?

I tend to find that patients don’t know how comfortable their lenses can be until they have something to compare it with. We know that across a lifetime of wear, we shouldn’t expect that the lens we fit a patient with today will still be the same one that will suit their lifestyle or their ocular surface over the next five to 10 years. So, offering them the next greatest thing when they come into the practice is great because patients do get a comparison, [and] because it makes them want to keep coming back in to see you.

Q: Dr. Jedlicka: I want to look to the future a little bit. Look to 10 years down the road here—are there materials in development? I don’t mean the fancy high-tech stuff. I’m talking about the stuff that most practitioners will prescribe someday. What’s the future for regular soft lenses?

A: Dr. Jones: The great thing is that companies are still constantly innovating. I mentioned already the biology of the eye. One of the things we know is that, over the course of the day, for the vast majority of people, there is this drop off in comfort. Now, is that something that’s happening to the lens, or is that something that’s happening to the biology of your eye?

Probably the biggest innovation is trying to produce contact lens materials that look more like the palpebral conjunctiva and the cornea. If you could produce lens materials that look like that and there is as minimal interaction as possible between the surface of the eye, the under surface of a lid, and that lens material you put in, and it really is truly “biomimetic,” so it looks like the cornea and conjunctiva, I think we’re going to stand a better chance. CLS

CATCH CLS LIVE! Watch this livestream’s full interview—and catch past and future episodes in the series via the online version of Contact Lens Spectrum at clspectrum.com or our Facebook or LinkedIn pages. Additionally, you can subscribe to Contact Lens Spectrum’s YouTube channel (bit.ly/clsyoutube22 ) to view this and other past interviews and to receive notifications for upcoming ones.