Daily disposable contact lenses, once reserved as problem-solvers, are now excellent options to enhance the contact lens wear experience. As manufacturing processes have improved in efficiency and as parameter offerings have expanded, daily disposables can provide many advantages over reusable contact lenses for both patients and practitioners. They offer the ultimate convenience compared to other modalities as well as superior comfort and ocular health support.

INCREASED PRESCRIBING PATTERNS

Daily disposable soft contact lenses were first introduced in the mid-1990s.¹ Because of the many advantages they offer, prescribing rates have significantly increased with time.

According to the annual International Contact Lens Prescribing report of 2021, daily disposables are prescribed to an average of 49% of patients in the United States.² Ten years ago, only 19% of patients were prescribed daily disposables in the United States.³ Internationally, an average of 49% of patients are prescribed daily disposables; Australia leads with the highest percentage of 69%² (Table 1).

Manufacturers continue to invest heavily to increase the production efficiency, parameter availability, and material technology of daily disposable contact lenses. Currently, practitioners have the flexibility to select from a multitude of spherical, toric, and multifocal daily disposable lenses with various materials, water content, wetting technologies, and power ranges.⁴ In the last few years, new technology has continued to emerge from contact lens manufacturers.

NEW OFFERINGS

In late 2021, a new multifocal daily disposable entered the market. This lens offers three add powers of low (+0.75D to +1.25D), medium (+1.50D to +1.75D), and high (+2.00D to +2.50D). The lenses are manufactured in a silicone hydrogel material and have UVA and UVB blocking technology.

One of the most significant new advancements is the U.S. Food and Drug Administration (FDA) approval of a daily disposable contact lens that slows myopia progression. These lenses allow practitioners to ensure best practices for young children who have progressive myopia. The lenses were found to slow the rate of progression effectively and safely in children 8 to 12 years old.⁵

ADVANTAGES OF DAILY DISPOSABLES

Convenience In a fast-paced world, convenience is king as evidenced by consumer expectations of quick two-day shipping, meals delivered to the doorstep, and grocery items picked up curbside. Daily disposable contact lenses are among the most convenient modalities of contact lens wear. The minimal maintenance they require may be one of the most appealing features for patients.⁶

With reusable contact lenses, patients must adopt a cleaning regimen that may require multiple steps, such as rinsing, rubbing, and placing in a storage case. Conversely, daily disposable lenses can simply be thrown away after use. In addition to allowing more free time by removing the cleaning step, patients will also save time by skipping the need to visit the contact lens solution aisle.

In addition to convenience, contact lenses should meet the demands of current lifestyles. Patients’ needs may range from requiring many hours of comfortable wear while viewing digital devices to working in the elements outdoors. Daily disposable lenses may provide better end-of-day comfort and fewer symptoms of dryness when compared to reusable lenses made with the same material and design.⁷ This holds true regardless of whether the patient uses a multipurpose or hydrogen peroxide cleaning solution.

Daily disposables can also help decrease ocular allergy symptoms compared to reusable contact lenses, likely by reducing the eyes’ exposure to allergens.⁶

Elimination of Multipurpose Solution Use Not only is the use of a multipurpose solution (MPS) with reusable lenses an inconvenience, but the contents of multipurpose cleaners can disturb the homeostasis of the ocular surface in the absence of other risk factors.⁸ MPSs are designed to disinfect lenses while minimizing ocular surface disturbance; however, the antimicrobial preservatives commonly used in MPSs can result in corneal cytotoxicity.

Cytotoxicity can occur secondary to excess MPS entering the eye from the contact lens or from slow release of preservatives within the contact lens over time.⁸ For example, one commonly used preservative, myristamidopropyl dimethylamine (MAPD), can be readily absorbed into silicone hydrogel matrices due to its hydrophobic nature.^9-11 Another commonly used preservative, polyhexamethylene biguanide (PHMB), readily absorbs in FDA group IV contact lenses.¹⁰ After a brief wear time, these preservatives will be released from the contact lens matrix and be absorbed into the tear film or corneal tissue.^10-12

MPSs also contain surfactants, chelating agents, and wetting agents.¹³ The preservatives and other chemicals in MPSs may weaken the corneal epithelial tight junctions, which can result in corneal vulnerability to bacteria or other harmful toxins and result in corneal subepithelial infiltrates.^7,14,15

Other potential complications secondary to MPS use include increased corneal staining and inflammatory sequelae of the ocular surface.^16-18 Along with inflammatory responses, some patients may experience a type IV cell-mediated allergic response to the preservatives or other agents in the solution.¹⁴

For reusable contact lenses, hydrogen peroxide systems are a better option for patients due to the lack of preservatives. Hydrogen peroxide is biocidal for harmful organic substances through oxidative reactions. The hydrogen peroxide is subsequently neutralized by a catalyst agent, either in the lens case or one added to the case.¹³

The preservative-free nature of hydrogen peroxide systems results in minimal corneal staining and corneal infiltrative events.^7,18,19 In addition, hydrogen peroxide systems decrease the likelihood of reusing solution and may increase compliance with a one-step versus two-step system.¹³

Hydrogen peroxide systems may offer an advantage over MPSs; however, applying a fresh lens to the eye every day will decrease the risk of improper cleaning or handling of lenses and overall result in comfortable and safe wear.

COVID Concerns Benefits of daily disposables to patients are further highlighted with community health concerns regarding COVID. There were many fallacies spread regarding the dangers of wearing contact lenses at the height of the pandemic; however, to my knowledge, no evidence exists to support that contact lens wear is unsafe or increases the risk for the wearer to contract COVID.

It is reasonable to expect that it may be advantageous to wear daily disposable contact lenses versus spectacles. Consider part-time spectacle wearers. It is likely that the part-time wearer will handle their frames frequently without handwashing. Even for full-time wearers, frames may be frequently touched or adjusted while on the face. SARS-CoV-2 can be viable and contagious on hard plastic surfaces for up to several days.²⁰

Specifically, for daily disposable lenses, it may be advantageous to have patients focus solely on proper handwashing, as opposed to additional care requirements for rinsing, rubbing, and properly storing lenses.²⁰ Additionally, daily disposables typically result in fewer complications and less discomfort; therefore, patients will likely minimize their exposure in public settings by requiring less additional office visits.^21,22

Contact Lens Discomfort A common statement that eyecare practitioners may hear from patients is, “I have tried contact lenses, but they do not work for me.” Dissatisfaction and subsequent discontinuation of contact lenses is most frequently related to comfort, regardless of age.²³ In a study evaluating reasons for discontinuation of contact lens wear, 24.4% of the subjects polled discontinued wear due to discomfort, while 19.9% discontinued secondary to concerns of dryness²³ (Table 2).

Daily disposables may offer a solution to contact lens dropouts, possessing multiple benefits when compared to reusable contact lenses. In general, when compared to conventional daily contact lens wearers, daily disposable wearers will likely experience less subjective vision disturbance, redness, foreign body sensation, and overall, fewer complications.²¹ Evidence suggests that refitting unsatisfied patients from reusable wear to daily disposable wear may improve wearing experiences due to decreased exposure to allergens, deposits, biocidal agents in MPSs, and other contaminants from the environment.¹

For patients who suffer with allergies, daily disposables eliminate the need for solutions that may result in allergenic responses. In addition, allergens or toxins from the environment will be discarded at the end of the day versus the likelihood of reintroducing the allergenic agents with reusable wear.²⁴ In one study investigating contact lens wear in allergy sufferers, 67% of the subjects reported improved comfort with daily disposable lenses and some subjects were able to reduce or stop taking anti-allergy medications.²⁵

For patients who suffer with contact lens-related dry eye, daily disposable contact lenses have been found to help decrease tear osmolarity compared to reusable contact lens wear.²⁶ The decrease in osmolarity may be secondary to better compliance and lack of contact lens solution use.¹⁶ In addition, daily disposable lenses are less likely to accumulate deposits on the contact lens surface compared to reusable lenses.²⁷ Deposits often lead to discomfort, dryness, and reduced acuity.^21,24,28

Better Vision Aside from comfort and ocular health, one of the most significant advantages to daily disposable wear may be superior vision compared to conventional contact lens wear.²⁴ As daily disposable lenses tend to accumulate fewer deposits, wearers will likely experience improved subjective visual acuity.²⁸ This may be especially advantageous for multifocal and toric contact lens wearers.

Improved Compliance For reusable contact lens wearers, remembering when to replace lenses may be a challenge.²³ In addition, each day that patients apply, remove, clean, and store their lenses, 53 steps are involved to properly handle and care for reusable contact lenses.¹⁸ Considering the cumbersome nature of adding 53 steps to the patient’s day, there is an increased risk for poor contact lens care compliance with reusable lenses.^23,29,30

In contrast, daily disposables require 26 steps for proper care and handling, a more reasonable ask for patients dealing with the demands of everyday life.¹⁸ By simplifying contact lens care, patients are more likely to have improved compliance, resulting in a decreased risk for microbial contamination.^21,29

POTENTIAL DISADVANTAGES

While daily disposable contact lenses offer many benefits to patients and eyecare practitioners, there may also be disadvantages to consider. Possible disadvantages include increased waste, higher cost for the patient, and parameter constraints.

On an annual basis, a full-time daily disposable contact lens wearer generates 1.06kg of waste compared to 0.83kg produced by reusable-monthly replacement wearers.³¹ Most of the waste generated by daily disposable wearers consists of blister packs. The reusable-monthly wearers waste contribution includes MPS bottles and packaging, as well as blister packs.

Although daily disposable lens wearers produce 27% more waste than reusable wearers, 100% of the waste can be recycled. Only 81% of waste generated by reusable wearers can be recycled, secondary to unrecyclable pieces of some solution bottles. By using household collecting recycling programs or partnership teams, wearers of daily disposable lenses can be assured that, although throwing a lens away every day may appear wasteful, there is better opportunity to recycle materials through the daily versus reusable modality.³¹

The higher cost of contact lens purchase may also be a concern for patients. A hidden variable for potential daily disposable wearers to consider is the cost associated with MPSs. Depending on the MPS, label recommendations for rinsing and rubbing vary widely. The recommended time for rinsing the contact lenses may range from five to 20 seconds.

When considering the volume of solution needed for rinsing and storing lenses, patients could be using upwards of 20.47mL of solution per day or 7,471.55mL per year if using the solution properly per package insert directions.³² This quantity of solution results in purchasing $150 worth of MPSs per year.³² Other cost savings to consider for daily disposable contact lens wearers are the higher rebates that are available compared to the much lower rebate offerings for reusable lenses.

While the apparent disadvantages of daily disposable lenses may not hold true, one true disadvantage to a select number of patients is parameter availability. This includes those who have high levels of ametropia or astigmatism, those who have oblique cylindrical requirements, and presbyopic patients who have astigmatism.

SIHY VERSUS HYDROGEL

As previously discussed, daily disposable contact lenses are a healthier option compared to reusable lenses. With a daily replacement modality, are there additional health benefits to prescribing silicone hydrogel (SiHy) materials? SiHy contact lens materials were developed to improve oxygen diffusion and prevent hypoxia-related corneal events secondary to overnight wear.³³

According to the International Contact Lens Prescribing Report, daily disposable SiHy lenses were prescribed three times more often than hydrogel daily disposable lenses in the United States². When eyecare professionals were polled on prescribing SiHy versus hydrogel contact lenses, 91% agreed that “silicone hydrogel 1 day lenses provide better long term eye health for my patients than hydrogel 1 day lenses,” and 90% agreed that “silicone hydrogel 1 day lenses provide a better wearing experience for my patients than hydrogel 1 day lenses.”³³

In addition to the increased popularity of SiHy daily disposable lenses, there is a significant increase in the number of peer-reviewed papers publishing information on SiHy materials and the daily disposable modality.³⁴ In studies investigating hydrogel versus SiHy daily replacement lenses, hydrogel contact lenses have shown equivalence in ocular health outcomes. Hydrogels were found to provide a sufficient oxygen supply to prevent corneal hypoxia, corneal vascularization, and hyperemia of the limbus and bulbar conjunctiva in the open eye.^23,33

Although equivalence may exist in an open-eye environment, SiHy lenses are a better option if patients habitually sleep in lenses.

In a survey conducted by Dumbleton et al, subjects were polled on their habits regarding sleeping while wearing daily disposable contact lenses. Seventy-five percent of subjects reported napping while 28% reported sleeping overnight in their lenses in the preceding month.²³ With only one hour of closed-eye wear, hydrogel contact lenses can cause significantly greater corneal swelling than SiHy lenses.³⁵ In addition, hydrogel contact lens wearers could suffer from corneal hypoxia with patterns of over-wear and thicker contact lens designs.²³

Both hydrogel and SiHy lenses are healthy options for daily disposable contact lens wear. For patients who frequently sleep in lenses, SiHy daily disposables are likely a better option.

PRACTICE MANAGEMENT PEARLS

1. New Contact Lens Wearers and Daily Disposables Patients who are new to contact lenses are great candidates for daily disposables. If patients ask about reusable lenses, they can be educated on the benefit of fresh lenses every day, fewer worries about torn or lost lenses, and the superior comfort of wear. In addition, help patients understand that, like cell phones and other technology, contact lens offerings continue to evolve and daily disposable wear will offer the best visual and health experience.
2. Benefits of Daily Disposables to Part-Time Wearers Prescribing daily disposable contact lenses for part-time wear offers convenience and decreases the risk of case contaminants causing complications. The longer a contact lens remains in a contact lens case, the less effective the contact lens solution’s disinfecting properties may be.³⁶ Decreased MPS efficacy can occur from uptake of the preservatives by the contact lens.³⁶With time, bacteria and other harmful agents can begin to grow on and within the contact lens, resulting in increased risk for complications, such as inflammation and microbial keratitis. Patients need to clean and disinfect lenses thoroughly before applying them. Explain to patients the convenience of using a fresh lens and throwing it away at the end of its use. In addition, once the seal of an MPS bottle is broken, depending on room temperature, the solution may lose efficacy against certain bacterial strains in as little as six to seven weeks.³⁷ Lastly, it may be more cost-effective for patients to purchase a 30- or 60-day supply of solution rather than purchasing it every few months, as well as an annual supply of monthly contact lenses.
3. Traveling? No Problem If a patient is a frequent traveler, daily disposables are much more convenient compared to reusable lenses. Educate patients that they will simply need to bring a few strips of daily disposables depending on length of travel. Daily disposable wearers do not have the added burden of finding contact lens solution packaging that satisfies Transportation Security Administration size requirements or worry about losing a contact lens while away from home.
4. Safety of Daily Disposables for Children Daily disposable contact lenses should be the preferred modality for children, as they have the lowest rate of complications.²⁴ When educating parents on the benefits of daily disposables, it may be helpful to discuss all the steps necessary to properly care for a reusable lens. In addition, parents will likely appreciate that they do not have the added responsibility to track when their child’s lenses need to be replaced or if they’re cleaning lenses correctly.
5. Current Unhappy Reusable Wearers If you have patients who experience dryness, fluctuating vision, discomfort, or allergy flares with reusable lenses, allow them to try daily disposable lenses for a week. Of course, the benefits can be discussed, but it may be more impactful for patients to experience the improvement in comfort and clarity. It is important to pay attention to patients who suffer in silence by asking the right questions, such as “What would you change about your current contact lenses?” and “Do you notice a difference in the comfort of your contact lenses on day one versus day 30 of wear?”
6. Happy Staff, Happy Patients If you have team members who wear reusable lenses, fitting them with daily disposable lenses will create genuine advocates for the modality. If patients are questioning their decision, it is likely that a happy daily disposable technician or patient care coordinator could sway them in the right direction.

THE FUTURE OF DAILY DISPOSABLE LENSES

The future of contact lens capabilities can be grouped into disease detection, disease management, and optical enhancements, as reviewed by the Contact Lens Evidence-based Academic Reports (CLEAR).³⁸ A contact lens recently acquired FDA approval for monitoring intraocular pressure (IOP) in patients who have glaucoma. This technology could drastically improve management of patients who have glaucoma by keeping track of IOP fluctuations versus our limited in-office samples of IOP measurements.³⁸

Drug delivery contact lens systems will hopefully be commercially available soon in the United States. A new daily disposable lens containing ketotifen, a histamine antagonist, has recently gained approval and is available in Japan and Canada; it also has FDA approval, but is not commercially available in the United States yet.³⁹

In addition, augmented reality technology is evolving from large headsets to micro displays packaged in 0.41mm of a contact lens.³⁸ A prototype is currently under development that could provide aid to patients with low vision and enhance vision at distances surpassing the eyes’ ability to see.²⁴ Other innovations could include contact lenses that instantaneously adjust to accommodate presbyopia and lenses with embedded therapeutics to treat the ocular surface for dry eye, microbial keratitis, and glaucoma.³⁸

As lifestyles, hobbies, and career requirements continue to evolve over time, so too should the technology that helps people see the world. Compared to reusable contact lenses, daily replacement modalities better align with modern-day needs: the desire for convenience, comfortable wear sustained through long days, and, overall, an enhanced contact lens wear experience. CLS

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