I, Dr. Brujic, saw a 22-year-old male, a new patient to the practice, for an eye exam. He played for a university football team and was running low on contact lenses. Anterior segment health was unremarkable. There was a small flame-shaped hemorrhage in the inferior arcade of the right eye.

His general health was unremarkable. He reported that two weeks ago he had a complete physical and everything was normal and healthy, and that the doctor also did a complete blood cell count and all levels were well within the normal range. His blood pressure at the visit was 115/75.

The patient was wearing a daily disposable silicone hydrogel contact lens with a power of OD –1.00D, OS –1.00D. The patient reported good vision and no problems with comfort. All patients are asked to rank their comfort with their lenses at the beginning of the day and at the end of the day on a scale from 0 to 10, with 0 being least comfortable and 10 being most comfortable. At the beginning of the day, his comfort was a 10. At the end of the day, the patient reported the comfort as a 4.

The patient had an over-refraction over his contact lenses of –0.25D OD and –0.25D OS. We discussed options regarding more advanced technologies and refit the patient with a new option. His initial experience was that the lenses felt very similar to his previous lenses, but he could tell that the vision was better.

We wanted to follow up with the patient in about six weeks to ensure that the retinal hemorrhage had resolved. We deduced that the hemorrhage was likely due to trauma from football. The practice ordered the patient one box of lenses that contained 90 lenses (45 pairs), which provided him with enough lenses to get him by until the scheduled follow-up. We followed up with the contact lenses at that time as well.

The Next Visit

The patient came for an appointment six weeks later and the retinal hemorrhage had completely resolved. The technician who was working with the patient stopped me in the hall. “Dr. B, the patient loves the lenses you fit him with!” she shared. “He notices a big difference in the comfort and vision of the lenses and rated the comfort a 10 out of 10 at the end of the day with these new lenses.”

I walked in to see the patient and discussed the resolution of the hemorrhage. Additionally, we discussed the lenses and he continued to praise them and how good they felt. He specifically told me that “the new contact lenses feel like they fit [his] eyes better.”

The Verdict

Some corporate entities wish for laws to be changed so that patients can switch contact lenses when ordering. They feel that all lenses in a given category are “the same.”

This is just one example of a patient who was wearing a premium daily disposable silicone hydrogel lens and was fit with another option and felt a substantial improvement. We have all had patients for whom even subtle changes in lens design or material alters the wearing experience significantly.

If the new normal is that all soft contact lenses are the same, then we don’t want to be normal. CLS