EYECARE PRACTITIONERS currently have an abundance of contact lens options for patients in both soft and specialty designs. More and more patients are recognizing orthokeratology as a unique contact lens option for themselves or their children. In addition, there is a global movement to shift patients from planned replacement lenses to daily disposable lenses due to their numerous benefits.

So, when faced with a patient who is a candidate for both of these excellent options, how does the practitioner decide which is the better option? Let’s look at a few scenarios.

PATIENT #1:

• 36-year-old male
• Spends 10-plus hours per day on his computer
• Current monthly disposable silicone hydrogel contact lens wearer
• Wears his contacts for about 14 hours each day
• Reports dryness around 2 p.m. every day that is temporarily relieved with rewetting drops
• Compliant with monthly replacement and uses an appropriate multipurpose solution
• Refraction: OD –2.00DS                   OS –2.25DS

Switching this patient from a monthly disposable to a daily disposable contact lens—either hydrogel or silicone hydrogel—may provide him with longer, more comfortable wear each day. The reason for this is multifactorial but is likely due to the reduced exposure to deposits, allergens, and disinfectants when wearing a daily disposable contact lens (Hickson-Curran et al, 2014).

PATIENT #2:

• 7-year-old female
• Very athletic—plays soccer, does gymnastics, and is a swimmer
• Has never worn correction
• Two highly myopic parents who are concerned about their daughter’s myopia progression
• Refraction: OD –2.50 –1.25 x 180
                     OS –2.00 –1.00 x 170

Because of her young age and level of myopia, it is imperative to start myopia control immediately. Her mild astigmatism limits soft contact lens options to either a monthly or quarterly replacement design—neither of which are optimal choices for a young, inexperienced contact lens wearer. Thus, orthokeratology is top choice for this patient. The advantages include this being a proven form of myopia control and freedom from daytime contact lens wear, which is especially beneficial because of her age and athleticism (Hiraoka 2022).

PATIENT #3:

• 22-year-old female
• Recently started wearing glasses full time due to vision worsening over the last two years
• Not interested in contact lenses or wearing spectacles
• Wants a laser in situ keratomileusis (LASIK) consult
• Refraction: OD –0.75DS
                     OS –1.00DS

This patient appears to be a good candidate for both daily disposable lenses and orthokeratology. However, since she is not interested in traditional contact lenses, she may be intrigued by the idea of orthokeratology. Adult-onset myopia manifests after the age of 18, usually results in low to moderate myopia, and appears to be associated with prolonged near work and close working distances (Bullimore et al, 2006). Due to the late onset, it is nearly impossible to predict when her myopia will stop progressing. Thus, LASIK would not be a wise decision at this time. Orthokeratology will provide her with the freedom from spectacles for which she is longing and will also serve as a strategy to slow her myopia progression.

PATIENT #4:

• 17-year-old male
• Enjoys wearing glasses
• Only wants to wear contact lenses on occasion for acting
• Refraction: OD –5.00 –1.25 x 090
                     OS –4.50 –2.00 x 080

Daily disposable contact lenses are a cost-effective option for patients who only want to wear contact lenses occasionally. Essentially, the patient pays for what they wear instead of wasting wear time on a planned replacement lens. Thankfully, there are several soft toric daily disposable lens options for patients who have astigmatism.

Currently, not only can most patients wear contact lenses, but they have several options that can be tailored to their needs. The only issue: which one do you choose? CLS

REFERENCES

1. Hickson-Curran S, Spyridon M, Hunt C, Young G. The use of daily disposable lenses in problematic reusable contact lens wearers. Cont Lens Anterior Eye. 2014 Aug;37:285-291.
2. Hiraoka T. Myopia Control With Orthokeratology: A Review. Eye Contact Lens. 2022 Mar 1;48:100-104.
3. Bullimore MA, Reuter KS, Jones LA, Mitchell GL, Zoz J, Rah MJ. The Study of Progression of Adult Nearsightedness (SPAN): design and baseline characteristics. Optom Vis Sci. 2006 Aug;83:594.