A New Way to See the World
A New Way to See the World
Learn how a new daily disposable lens – Biotrue ONEday – mimics the natural properties of the eye, providing comfortable vision throughout the day.
Harue J. Marsden, OD, MS, FAAO: Today, we’re discussing the material, technology and design behind a revolutionary new contact lens: the Biotrue® ONEday daily disposable contact lens (Bausch + Lomb). Let’s begin by talking about how you decide which lens material to prescribe for your patients. What influences your decision?
David I. Geffen, OD, FAAO: Vision is most important, followed closely by comfort that’s sustained throughout the day. When I’m confident a specific material will deliver excellent vision and comfort, that’s the material I’ll prescribe.
Dr. Marsden: Do you ask patients certain questions to uncover any comfort issues they may be having?
Dr. Geffen: I always ask patients if their lenses are as comfortable at 3 o’clock in the afternoon or at dinnertime as they were in the morning. If they say their lenses feel dry or gritty, or if they say they start feeling their lenses in the afternoon, then I know I should change the material or the care system.
Kerry A. Giedd, OD, MS, FAAO: I usually assume patients have some end-of-day comfort issues, and I look to new technologies and materials to improve the lens-wearing experience. Knowing a patient’s history is important, but choosing a lens often involves making a judgment based on my knowledge of the best product available.
Dr. Marsden: Dr. Jedlicka, what performance features are you looking for in contact lens materials?
Jason Jedlicka, OD, FAAO: If we can bring patients good comfort in a lens that’s easy to handle and provides enough oxygen for ocular health and gives optimal vision throughout the day, that’s the ultimate goal.
Dr. Marsden: Silicone hydrogel lenses have been the lenses of first choice in many practices. Let’s discuss your clinical experience with this category of material.
Contact Lens Material Advancements
Alan P. Saks, DipOptom(SA), MCOptom(UK), FAAO(USA), FCLS(NZ): About 14 years ago, I converted most of my patients to daily disposable lenses whenever possible. I found this modality solved many problems. Red eyes seemed to disappear, and problems related to solution interactions and lens case hygiene were eliminated. When silicone hydrogel lenses became available, I prescribed quite a lot of them, expecting they would reduce the risk of complications, such as microbial keratitis. Instead, I found some patients experienced discomfort and corneal infiltrative events, so I went back to prescribing non-silicone lens materials, when indicated. My lens of first choice is one that has good lubricity, good wettability, minimal deposit build-up, and delivers stable vision and comfort in extreme conditions.
Dr. Giedd: The daily disposable contact lens segment of my practice has grown so much in the last 2 years that silicone hydrogel is no longer my number one choice of lens material. Even for frequent replacement, I don’t feel current silicone hydrogel lenses are as advantageous as we once expected they would be.
Dr. Marsden: What if silicone hydrogel were the only material available to us? How would that affect clinical practice?
Dr. Saks: I believe we’d continue to see patients leave contact lens wear, some because of silicone intolerance and others because of lipid deposits and contaminated lenses with wetting problems, leading to discomfort.
Gina Wesley, OD, MS, FAAO: I believe it’s important that we always have a variety of options available for our patients. No one lens material or modality will solve all of their problems. Are there benefits to having silicone hydrogel lenses? Yes. But there are benefits to having hydrogel materials, as well. With several options, we can ensure our patients are happy, safe and healthy in their contact lenses.
Dr. Marsden: In addition to corneal infiltrative events, have you seen an increased incidence of any other complications in patients who wear silicone hydrogel lenses?
Dr. Geffen: I’m seeing more cases of giant papillary conjunctivitis (GPC) in patients wearing silicone hydrogel lenses than in those wearing hydrogel lenses. I suspect we’re not hearing about these cases or reading about them in the literature because they can be treated successfully.
“The comfort of the HyperGel material has far surpassed my expectations, so I fit most of my patients who wear spherical lenses in Biotrue ONEday contact lenses.
— David I. Geffen, OD, FAAO”
Dr. Marsden: Generally, do you feel a contact lens with high oxygen transmissibility is a safer lens?
Dr. Wesley: Ten years ago, many practitioners thought silicone hydrogel contact lenses were the be-all and end-all because of their high oxygen transmissibility. We’ve since come to realize that we need a certain level of oxygen to maintain a healthy cornea, but the question remains as to what level of oxygen that may be.
Dr. Saks: I prescribed quite a few high water content hydrogels when I practiced at high altitude in a very dry climate in South Africa. From that experience, I learned that perhaps 100 Dk isn’t necessary for a daily wear lens, as long as we’re delivering sufficient oxygen to prevent hypoxic complications, while providing good comfort and vision. I’ve observed this anecdotally, and I believe supporting evidence is starting to build.
Dr. Wesley: There are advantages to having more oxygen flow for some patients, such as those in extended wear, but each patient has such a mix of confounding factors affecting their eyes when they wear contact lenses that I’ve found oxygen isn’t the only answer for them. Do we still need silicone hydrogels? Yes, I believe we do, but we’re realizing that we need other materials and new innovations to address the various needs of our patients.
Dr. Geffen: Members of the Brien Holden Vision Institute published a fascinating study that compared a daily wear hydrogel lens with a daily wear silicone hydrogel lens and a 2-week silicone hydrogel lens.1 The study showed that although some clinical signs may differ between those lenses, the comfort of silicone hydrogel material was no better than that of hydrogel. These results proved to me that current silicone hydrogel materials aren’t the be-all and end-all for comfort and dryness, which is what I’ve found in my practice. We prescribe a significant number of hydrogel lenses, even in our frequent replacement lenses, because of comfort issues or intolerance to silicone hydrogel material. Yes, we do have oxygen concerns for some of our patients, but silicone hydrogel lenses aren’t the answer across the board. We need to look at what’s best for the patient.
Dr. Marsden: One of the newest innovations in contact lenses is the daily disposable Biotrue® ONEday lens manufactured with HyperGelTM (nesofilcon A), a novel hydrogel material.
Bioinspired, Biocompatible Lenses
Dr. Marsden: Biotrue® ONEday lenses are said to be bioinspired and biocompatible. What do you look for in a bioinspired or biocompatible contact lens?
Dr. Geffen: I’m looking for something that will mimic the properties of the natural cornea while correcting vision. I want to correct spherical aberrations with good optics, but I also want a lens with the wettability of a normal, healthy cornea.
Dr. Saks: My primary definition of biocompatibility would be something that doesn’t cause an inflammatory response in the eye. We want to avoid any signs of bioincompatibility, such as infiltrates, inflammatory lid reactions, contact lens-induced papillary conjunctivitis, redness and pathological staining.
Dr. Jedlicka: I also want a lens that resists dehydration. We know that when a lens dehydrates, the shape and the optics change.2 The optics in a new contact lens may be great, but if the lens dehydrates, vision may become blurry. A lens that maintains hydration should also be a better-fitting lens, which supports stable vision and comfort throughout the day.
Dr. Saks: We want something that mimics the characteristics of the tear film. We can correct higher-order aberrations with good optics, but we can’t correct aberrations caused by an unstable tear film. We want to mimic all of the eye’s characteristics from the anterior lipid layer through the cornea to provide a lens that has great optics and hydration properties.
|CAN A LENS MATERIAL KEEP EYES MOIST?
Dryness is a common complaint among contact lens wearers, one that affects their enjoyment of wearing contact lenses and often shortens their wear time. In addition to discomfort, contact lens dryness can impact the ocular surface and quality of vision. Thus, one goal of manufacturers is to create a lens material that is consistently more moist.
Nesofilcon A, a high-moisture next-generation material, was designed to work like the eye, matching the cornea’s water content (78%) and mimicking the tear film’s lipid layer to retain moisture. To test its dehydration resistance properties, researchers measured Biotrue ONEday side by side with etafilcon A (1-day Acuvue Moist [Johnson & Johnson Vision Care]; 58%) and narafilcon B (1-day Acuvue TruEye [Johnson & Johnson Vision Care]; 48%). In a low-humidity controlled environment,* researchers found that nesofilcon A had a significantly lower water loss at just 1.5%, compared to 5.5% for etafilcon A and 8.5% for narafilcon B over a 4-hour test period.1
Corneal staining measured after 4 hours wearing nesofilcon A lenses in a dry environment demonstrated no corneal desiccation staining patterns in any patients. This is particularly noteworthy because previous studies had found higher levels of dessication in patients with historical high water content lenses.2,3
* The average indoor temperature was 72°F with a relative humidity of 30% at the time of the experiment.
1. Schafer J, et al. Comparing On Eye Dehydration and Corneal Staining of Three Daily Disposable Contact Lenses in a Low Humidity Environment. Presented durig the 2012 meeting of the British Contact Lens Association. Birmingham, England.
2. Zantos SG, Orsborn GN, Walter HC, Knoll HA. Studies on corneal staining with thin hydrogel contact lenses. Journal of the BCLA 1986;9:61-64.
3. Orsborn GN, Zantos SG. Corneal desiccation staining with thin high water content contact lenses. CLAO J 1988;14(2):81-85.
Dr. Marsden: How do you describe the properties of Biotrue® ONEday lenses to your patients?
Dr. Geffen: I explain that they mimic some of the properties of the natural tear film, that their water content matches that of the cornea,3 and they have advanced optics for outstanding vision, all of which combine to enhance end-of-day comfort.
Dr. Marsden: Previously, we discussed how lens dehydration affects end-of-day comfort. Does lens dehydration cause any other symptoms throughout the day?
Dr. Wesley: By midday or lunchtime, many of our patients are starting to notice blurry, fluctuating vision, and may become more aware of some visual discomfort, which worsens during the day. These symptoms can be caused by lens dehydration.
Dr. Marsden: Let’s discuss how you determine if the daily disposable modality is right for a patient and why you recommend Biotrue ONEday lenses.
When Only a Daily Disposable Will Do
Dr. Marsden: What questions do you ask to determine if the best lens choice for a patient is a daily disposable?
Dr. Wesley: It’s important to ask patients how they’re going to wear their contact lenses. Obviously, if someone wants to sleep in his lenses, I won’t prescribe a daily disposable. I think candid conversations and direct questions lead me to the best recommendation. When a patient says he’s looking for a better experience with contact lenses — and it often comes down to improving the patient’s lens-wearing experience — I immediately think of a daily disposable. That’s my go-to lens. It’s healthy, safe, and the most convenient modality I can prescribe.
|PREVENTING DROPOUTS, IMPROVING SATISFACTION
Dr. Marsden: We know the number of new patients starting contact lens wear is about the same as the number leaving contact lens wear.1 If you have a patient who was previously unsuccessful wearing contact lenses, do you proactively discuss their reasons for dropping out and the new technologies that are available?
Dr. Wesley: It’s important to have a dialogue with your patients about what’s new, how it’s different and what it can deliver for them. I’m always encouraging my patients to try contact lenses again. We really have a great opportunity to help our patients have a better wearing experience.
Dr. Marsden: Do you talk to your patients about the biomimetic component of Biotrue ONEday lenses? If so, how do they respond?
Dr. Geffen: I tell my patients that we have a new material that mimics many of the properties of the natural eye, and that this improves their vision and comfort and will allow them to wear contact lenses with greater satisfaction. Patients are excited that we can offer them this new technology.
1. Rumpakis J. New data on contact lens dropouts: an international perspective. Review of Optometry January 2010.
“… daily disposable lenses are becoming the standard in my practice. Every patient whose prescription is available in a daily disposable lens is offered that modality and encouraged to try it.
— Kerry A. Giedd, OD, MS, FAAO”
Dr. Saks: I agree that starting a dialogue is important. My first question is, “Why do you want contact lenses?” I’ve found very few patients actually want to sleep in their lenses. Mostly, they want convenience. If someone is keen on extended wear, we’ll talk about it, but more often than not, when I tell patients they can eliminate lens care hassles with daily disposable lenses, that’s what they choose.
Dr. Marsden: Dr. Saks, you’ve practiced in some areas with challenging environmental conditions. How do patients’ needs differ, depending on their environment?
Dr. Saks: I have an office in the city and another in the suburbs. I’ve found that patients in the city want lenses they can wear in an office for 8 hours and then at home for another 6 or 7 hours as they surf the Internet, watch TV, play on their electronic tablets or look at their cell phones. In the suburban office, more people want their contact lenses to perform well for outdoor recreation, such as kitesurfing and other extreme activities, which New Zealanders are fairly keen on.
Regardless of the environment — even at high altitudes and in an extremely dry climate, which I experienced when practicing in South Africa — I need contact lenses that will perform well. I can’t tell patients they can’t wear their lenses more than 8 hours a day. They demand at least 16 hours of great vision and comfort — every day.
Dr. Marsden: Dr. Giedd, in your experience, what patients are best suited to daily disposable lenses?
Dr. Giedd: Five years ago, I was more likely to view daily disposables as a niche product for children and teens, heavy depositors, allergy sufferers, part-time wearers, and in my practice, for people who participate in water sports and need to dispose of lenses immediately after use in those settings. Those are still great applications for daily disposable lenses, but with new materials and options across the entire daily disposable category, daily disposable lenses are becoming the standard in my practice. Every patient whose prescription is available in a daily disposable is offered that modality and encouraged to try it. When patients are unsure, we give them diagnostic lenses to test-drive on their own. (See “Preventing Dropouts, Improving Satisfaction” on page 7.)
Dr. Marsden: What sort of feedback do patients usually give you after their test-drive?
Dr. Giedd: Most often, they fall in love with the daily disposable modality and can’t imagine going back to reusable lenses. It’s a great practice-builder and a way to improve patient satisfaction and loyalty to my practice.
Dr. Marsden: It’s obvious this panel has embraced the daily disposable modality. Let’s discuss the properties of the Biotrue® ONEday lens that make it your lens of choice.
New Daily Disposable of Choice
Dr. Geffen: The comfort of the HyperGel material has far surpassed my expectations, so I fit most of my patients who wear spherical lenses in Biotrue ONEday contact lenses. Nine out of 10 of my patients who I have refit from other lenses come back and say, “I don’t care what they cost. I want these lenses, because I’ve never worn anything as comfortable as this product in my life.” I’ve been blown away by the comfort as well as the excellent vision that this lens provides.
Dr. Giedd: Practicing in Florida, I recommend using a lens that protects against UV radiation. I also like a lens that will perform well all day. I want a lens that provides good vision and maintains its hydration for great comfort. I don’t want a product that becomes uncomfortable after a certain number of wear hours under the guise of enforcing compliance. My loyalty is to my patients, so I’ll try any product that I think has merit. I want the whole package and it appears that Biotrue® ONEday may deliver all of that.
“If we can bring patients good comfort in a lens that’s easy to handle, provides enough oxygen for ocular health and gives optimal vision througout the day, that’s the ultimate goal.
— Jason Jedlicka, OD, FAAO”
“I think we can consider Biotrue ONEday lenses a breakthrough. They address the problems of traditional hydrogels. I think they’re going to make a big difference in the contact lens world.
— Alan P. Saks, DipOptom(SA), MCOptom(UK), FAAO(USA), FCLS(NZ)”
Dr. Marsden: Biotrue ONEday has some unique moisture-retention properties. Have you found this benefits visual performance and comfort?
Dr. Geffen: Yes. If we don’t provide adequate vision, patients won’t wear a lens. If we don’t provide good comfort, they won’t wear a lens. Biotrue ONEday delivers both.
Dr. Saks: Dr. Geffen, have you used this lens to solve problems with dryness symptoms?
Dr. Geffen: Most of my patients have found Biotrue ONEday to be an extremely comfortable lens, and it’s been an effective problem-solver even for some very challenging patients. For example, patients who use antihistamines to alleviate allergy symptoms often experience dryness symptoms with contact lens wear. I’ve found these patients can continue wearing the Biotrue ONEday lens comfortably. As another example, a local cornea specialist referred to me a patient with significant superficial punctate keratitis. After being fitted with Biotrue ONEday lenses, I observed no corneal staining, and the patient was ecstatic, telling me, “My vision has never been this good, and I don’t have any more dryness.” This lens solved long-term dryness symptoms for her and gave her excellent vision, as well. Since then, she has sent us five new patients. Biotrue ONEday lenses were successful in both normal and challenging patients.
Dr. Marsden: Dr. Jedlicka, in your experience, how does the Biotrue ONEday lens compare with other daily disposable lenses?
Dr. Jedlicka: In the past, if I felt a patient might benefit from a daily disposable, there always seemed to be a counter-reason not to prescribe one. Patients sometimes found the early generations of these daily disposable lenses difficult to handle or optically inferior to other contact lens options. Biotrue ONEday removes those objections. Now, with Biotrue ONEday, I can say, “Why not a daily disposable?” without reservation.
Dr. Marsden: Dr. Wesley, do your patients ever have problems handling daily disposables?
Dr. Wesley: I don’t have to worry about handling issues with the Biotrue ONEday lens. In fact, I fit many young children in my practice. I used to teach my 7- and 8-year olds with a different lens and then put them into daily disposables once they learned how to handle and apply the conventional lenses. Now, I can skip that step and put patients directly in the Biotrue ONEday lenses because they’re so easy to handle.
Dr. Marsden: You’ve all had success with Biotrue ONEday lenses. Have there been any surprises when fitting this lens?
Dr. Jedlicka: My patients’ reactions have surprised me. I’ve never had the experience of fitting a new lens and having so many patients come back and tell me it’s the best lens they’ve ever worn. That sometimes happens with new lenses but not to the extent I’ve seen with Biotrue ONEday.
Dr. Marsden: Let’s discuss how poorly performing contact lenses coupled with lifestyle demands can exacerbate visual symptoms.
Signs of the Times: Blurry, Fluctuating Vision
Dr. Marsden: Have you found that your patients have greater visual demands because of the technology they use?
Dr. Giedd: Most definitely. Smart phones, electronic tablets and similar devices have changed patients’ needs, and they’ve also raised their expectations for vision. Patients expect to easily read text on their phones and other devices, even though the text is roughly the equivalent of a 3-point font. That’s something I always consider when I’m discussing lens designs and new technology.
|LENSES THAT RETAIN THEIR SHAPE AND OPTICS
As a contact lens loses water, its shape can change, and any change in the lens’ shape may impact its optical performance. If a lens material loses less water, it may do a better job of retaining its shape and optics. This means that contact lens wearers may experience clear, comfortable vision over long wear times.
Simply adding more water to lenses isn’t the answer; some historical lenses with higher water content actually dehydrated more than their lower water content counterparts.1 With 78% water content (just like the cornea) and an oxygen transmissibility of 42, a new contact lens material called nesofilcon A was designed to behave like the eye itself, mimicking the eye’s natural lipid layer to stay hydrated and providing consistently clear optics over time.
In two studies comparing the consistency of optical performance and lens shape in four different lens materials, nesofilcon A performed the best.
Figure 1. Time elapsed (180 sec) U.S. Air Force target images of nesofilcon A (A), etafilcon A (B), narafilcon B (C) and nelfilcon A (D).
Lee and colleagues2 compared lenses made of nesofilcon A (Biotrue® ONEday; 78% water), etafilcon A (1-day Acuvue Moist [Johnson & Johnson Vision Care]; 58% water), narafilcon B (1-day Acuvue TruEye [Johnson & Johnson Vision Care]); 48% water) and nelfilcon A (Dailies Aqua Comfort Plus [Alcon]; 69% water). They fit 20 -3.00 D lenses of each type on a 7.8 mm polymethylmethacrylate model cornea designed to view a US Air Force Target and send the retinal image plane of the target to a CCD camera. As the lenses dehydrated, images were captured every 10 seconds up to a total of 180 seconds (Figure 1).
Figure 2. These images of lenses, taken every 4 minutes from 0 to 20 minutes, show how lens materials change shape as they dehydrate in extreme dehydration conditions. Nesofilcon A (A) retains its shape better than the other materials, etafilcon A (B), narafilcon B (C) and nelfilcon A (D).
A one-way ANOVA showed a statistically significant difference (p<0.001) between nesofilcon A compared to nelfilcon A, narafilcon B and etafilcon A, where the overall mean predicted logMAR scores were -0.009, 0.116, 0.136 and 0.182.
For the time zero images, there was a statistically significant difference between nesofilcon A and nelfilcon A (p<0.03) with mean predicted logMAR scores of -0.11 and -0.05, respectively.
For images taken at 10 seconds (a period of time shorter than typical blink rates associated with reading or computer use), there was a statistically significant difference between nesofilcon A compared to nelfilcon A and etafilcon A (p<0.001) with mean predicted logMAR scores of -0.10, -0.02, -0.03, respectively.
Cox and Lee3 evaluated the same four lens materials for how they retained their shape as they dehydrated. The lenses were dehydrated simultaneously in a controlled environment for 20 minutes with researchers taking photos every 2 minutes (Figure 2).
The study demonstrated that the nesofilcon A lens material showed the least shape change among daily disposable lenses tested.
1. Morgan PB, Efron N. In vivo dehydration of silicone hydrogel contact lenses. Eye Contact Lens 2003;29(3):173-176.
2. Lee RH, Kingston A, Richardson G. Evaluation of contact lens image stability and predicted logMAR image resolution as lenses dehydrate. Invest Ophthalmol Vis Sci 2012;53:E-abstract 6110.
3. Cox IG, Lee RH. Understanding lens shape dynamics during off-eye dehydration of contact lens materials with varying water content. Invest Ophthalmol Vis Sci 2012; 53: E-abstract: 6104.
Dr. Jedlicka: We also know that when people work on computers for hours, they’re not blinking as frequently, so their eyes and lenses are more vulnerable to dehydration.
Dr. Marsden: Do your patients comment about blurred vision or tired eyes?
Dr. Giedd: Absolutely. I suspect all of us deal with that complaint on a regular basis. Most of my patients spend many hours a day working on computers. They recognize that it takes a toll on their eyes, especially on their contact lenses, but they still want good comfort and good vision. They need their 10, 12, 14 hours of screen time, and they need products that will meet that visual demand.
Dr. Marsden: Dr. Geffen, what questions do you ask that help you pinpoint the cause for complaints of blurry, fluctuating vision?
Dr. Geffen: One key question is: “In the midafternoon, do your eyes start to feel tired or heavy?” Many patients have complaints in the midafternoon, because they’ve spent 6 hours staring at a screen. Even on their lunch breaks, they’re playing on the Internet, shopping and managing their personal e-mails — so they’re spending all day at one point of focus. A contact lens that has advanced optics and is dehydration-resistant can help resolve these complaints.
Dr. Marsden: Dr. Jedlicka, are there any other questions you ask to uncover symptoms or complaints that might prompt you to prescribe daily disposables?
Dr. Jedlicka: When a patient complains about blurry vision, our first thought may be that his prescription has changed, but blurry vision may be related to the condition of the lens surface, to dehydration or possibly to lenses that are a week past their replacement date. It’s important to ask the patient when he experiences blurred vision. If his vision doesn’t get blurry until his lenses are 5 days old, it makes sense to switch him to a lens that never has to be 5 days old.
Dr. Marsden: Should we be looking at end-of-day comfort and vision as two separate entities as we approach patient care and lens selection?
Dr. Wesley: It’s difficult to separate the two. Some patients will say, “I think my vision is blurry at the end of the day, but I’m constantly thinking about my lenses because they feel dry on my eyes.” So, we don’t know if dry lenses are affecting their vision or if they’re truly bothered by their vision and that’s why they’re aware of their lenses on their eyes. I hope to be able to resolve whatever might be causing one or both of those issues with Biotrue® ONEday contact lenses.
“I start my contact lens examinations by telling patients that, as their eye doctor, I feel I have a responsibility to let them know what’s different and new in contact lens technology.
— Gina Wesley, OD, MS, FAAO”
How Patients Respond to Biotrue ONEday Lenses
Dr. Marsden: What do your patients say when they first apply Biotrue ONEday lenses?
Dr. Geffen: Their initial reaction is, “Wow! This feels good.”
Dr. Marsden: What about comfort throughout the day?
Dr. Giedd: My patients are definitely noticing longer comfortable wearing times and better visual performance throughout the day. Overall, they’re less aware of their eyes and their vision, and that’s a positive thing. I always tell patients, “Life is too busy to think about seeing.” When you can get through the day and not have to think about your contact lenses, that’s a huge measure of success.
Dr. Geffen: What Dr. Giedd said is absolutely true. The best comment I can hear from a patient is, “I haven’t thought about my eyes all week.” That reaction proves to me that Biotrue ONEday lenses truly mimic the natural properties of the eye.
Dr. Marsden: Is the fit of Biotrue ONEday different from that of other lenses? Does it look any different to you as compared with other soft lenses?
Dr. Jedlicka: No. I think it’s a well-fitting lens. I don’t see decentration as an issue, though this is an issue with some other lens designs. The Biotrue ONEday lens is a well-designed and easy-to-wear lens.
Made Specifically for Daily Disposables
Dr. Marsden: What are your thoughts on the older-generation materials that are being used for daily disposables lenses?
Dr. Geffen: With HyperGel, we have a new material that combines some of the benefits of silicone hydrogel with some of the benefits of hydrogel to create a lens that provides great comfort as well as great optics.
Dr. Marsden: How does HyperGel material differ from other hydrogel materials?
Dr. Wesley: HyperGel matches the natural corneal water content, and it supports oxygen transmission needs for daily wear through the lens.
Dr. Marsden: Do you feel HyperGel material is novel and different? What does it add to your daily disposable lens portfolio?
Dr. Geffen: Biotrue ONEday isn’t an old-style hydrogel lens. HyperGel is a breakthrough material that’s different from anything we’ve had before.
Dr. Saks: HyperGel brings us many of the properties we’ve been asking for. It’s a high water lens that mimics the lipid layer of the tear film; it wets well and doesn’t dehydrate throughout the day;4 it has great optics and UV protection.
Dr. Marsden: How does HyperGel material relate to the FDA categories? Do those classifications influence your lens choices?
Dr. Giedd: Quite honestly, I don’t reference those classifications any more. It’s difficult to define the lenses of today in those terms, because so many factors go into lens performance and patient satisfaction. A lens made from HyperGel isn’t an old-school hydrogel lens. It’s a novel material and new technology.
Dr. Marsden: Is it beneficial to use a contact lens material that was developed specifically for daily disposable contact lenses and isn’t being used in other fitting modalities?
Dr. Saks: The fact that the HyperGel material in the Biotrue® ONEday lens exists only in a daily disposable modality is a critical point.
Dr. Wesley: When a manufacturer has invested in the research and development needed to produce a new material specifically for a daily disposable lens rather than repackaging an old material in a new box, I feel more confident it will perform well in this modality.
Lifting Barriers to Practice Growth
Dr. Marsden: We know practitioners in the United States have been slow to adopt the daily disposable modality compared with practitioners in other countries. How do you explain your success with this modality?
Dr. Giedd: Success with daily disposables starts with recognizing their value. As contact lens practitioners, we often judge what we think our patients can afford, but compared to what people spend in other areas of their lives, daily disposables are an affordable, worthwhile investment. When I tell patients that for about a dollar per day, they can wear fresh lenses every day and eliminate all of the lens care hassles, they understand the value. I think practitioners have been slow to promote daily disposables because, at face value, the cost appears greater than for conventional lenses.
Dr. Jedlicka: We need to get beyond the cost barrier. I think we’re driven to get as much as we can for as little as we can spend, even if that means getting something inferior. We need to move beyond cost and focus on value.
Dr. Marsden: Dr. Saks, how do you talk to patients to get beyond the perception of higher cost?
Dr. Saks: If patients are concerned about costs, I tell them to add up the annual cost of their lenses plus the cost of care solutions, which they often forget to include. Then I have them factor in the convenience they gain. Suddenly, the equation shifts positively to the daily disposables.
Dr. Marsden: Dr. Wesley, how do you demonstrate the value of Biotrue ONEday lenses for your patients?
Dr. Wesley: In my practice, we have a contact lens pricing sheet that my staff completes as I’m fitting each patient. On it, we compare the cost of the patient’s habitual lenses with Biotrue ONEday lenses. We factor in all of the pricing variables, add in care solution costs for the habitual lenses, and then calculate a price per day or price per lens. Patients take that information with them, along with Biotrue ONEday lenses to try, so they can make an educated decision while experiencing the lenses.
|BIOINSPIRED PRODUCTS: WHAT PATIENTS WANT
Dr. Marsden: How have your patients responded to bioinspired products in the contact lens market?
Dr. Giedd: Bausch + Lomb’s first bioinspired product, Biotrue MultiPurpose Solution, introduced an intriguing concept to our patients. I was truly amazed by how they embraced the concept of looking to nature for inspiration. Bioinspired products really deliver what patients want, not only in eye care but in the bigger picture as they look for more holistic treatments that are inspired by nature. I think Biotrue MultiPurpose Solution really paved the way for this new way of thinking and for the introduction of Biotrue ONEday contact lenses.
Dr. Jedlicka: People are becoming more aware of their relationship with nature. It’s important for them to know we have products that are designed to be compatible with our bodies.
Dr. Geffen: When I tell patients we now have a contact lens that is bioinspired and mimics the properties of their natural eyes, they get excited. They can really relate to that. They recognize that I’m concerned about their general health and well being, which is very important to them.
Dr. Giedd: In our practice, we eliminate the risk in the sense that our patients don’t have to worry about the cost of trying a new lens. If patients are wearing reuseable lenses, I offer the Biotrue ONEday lens as an alternative. I apply it at
the end of the examination, so I can check the fit and get initial feedback from patients. Even if the overall expectation is that patients will stay with their habitual lenses, I want to give them the opportunity to try something new. In my office, that doesn’t necessarily change the cost of the visit, and it doesn’t add any significant time to my interaction. Patients are really happy when they can try a new product without worrying about committing to it or the cost of it. When you eliminate that risk and let patients experience it for 5 or 10 days, usually they’re hooked fairly quickly.
Dr. Saks: I rarely need to discuss costs, especially when I put a lens on the eye, and the patient says, “Wow! That feels great.” That’s what sells a lens.
|SIMPLIFICATION AIDS COMPLIANCE
|Dr. Marsden: Do you have concerns about patients who overwear their daily disposable lenses or sleep in them?
Dr. Saks: According to some studies, and I’ve observed this in my own practice, patients who wear daily disposable lenses are among the most compliant contact lens wearers.1,2 By prescribing daily disposable lenses, we can reduce the number of required lens care steps to just three: 1) keep your hands clean; 2) avoid sleeping in your lenses; and 3) change your lenses every day. With daily disposables, we can focus all of our energy on maintaining compliance in these three key areas, not a list of tasks that involve 20 different steps and a chemistry set. Daily disposable lenses simplify lens wear.
Dr. Wesley: I agree that patients who wear daily disposable lenses are my most compliant patients. Conversely, I’ve found many patients who are wearing reusable lenses are overwearing their lenses, although not necessarily deliberately. We have some data telling us that it’s difficult for patients to remember when they should replace their lenses.3 Suddenly, 2 weeks is 3 weeks, and 4 weeks is 6 weeks. A daily schedule is easy to remember.
1. Nichols JJ. Annual Report: Contact Lenses 2011. Contact Lens Spectrum January 2012.
2. Dumbleton K, Woods C, Jones L, Fonn D, Sarwer DB. Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in the United States. Eye Contact Lens 2009;35:164-171.
3. Dumbleton K, Richter D, Woods C, Jones L, Fonn D. Compliance with contact lens replacement in Canada and the United States. Optom Vis Sci 2010;87:131-139.
Dr. Wesley: We also have to remember that patients don’t always express their concerns or symptoms. For that reason, I start my contact lens examinations by telling patients that, as their eye doctor, I feel I have a responsibility to let them know what’s different and new in contact lens technology. Then I discuss the new products or advances that I believe could enhance their experience. I hope my comments will prompt the patient to mention things he wouldn’t have recognized or verbalized, because he’s assumed that accepting certain compromises is just life in contact lenses. This dialogue opens up a tremendous opportunity to improve a patient’s experience. Driving patient satisfaction improves their loyalty, their success, and the internal organic growth of your practice through referrals.
Dr. Geffen: Give your patients the chance to test-drive this lens, as I do. Put it on the eye. When patients return at the end of a week, they’re going to say, “Give me the year’s supply, because this is the most comfortable lens, with the best vision of any product I’ve ever tried.” And that’s what I’m routinely finding in my practice. My patients just love it.
Dr. Marsden: Dr. Geffen, how do you talk to your patients about buying an annual supply of contact lenses?
Dr. Geffen: For any lens type that we fit in our practice, we assume the patient will purchase an annual supply at the time of the visit. Anyone who doesn’t want to do that will talk to the staff, but our staff is very good at showing patients what the rebates will do for them. More than 90 percent of our patients purchase an annual supply of contact lenses.
Dr. Marsden: Dr. Saks, you communicate with practitioners around the world. With the introduction of Biotrue® ONEday lenses, do you sense there will be a move toward daily disposables in the United States?
Dr. Saks: In Australia, New Zealand and the Asia Pacific area, market penetration for daily disposable lenses is approximately 30 percent, and in some other parts of the world, Scandinavia, for example, it’s in the 40-60 percent range.5 Biotrue ONEday lenses offer a wonderful opportunity for growth. My American colleagues are definitely starting to show a greater interest in the daily disposable modality. We just have to get the message out about the numerous benefits.
Changing the Game
Dr. Marsden: With its bioinspired properties, great comfort and visual performance throughout the day, ease of handling and the convenience of being a daily disposable lens, do you feel the Biotrue ONEday will be a game-changer in the daily disposable market?
Dr. Geffen: I believe the Biotrue ONEday lens is a game-changer in contact lens wear — period — not just the daily disposable market. It’s going to change how practitioners fit contact lenses. Once practitioners start to prescribe Biotrue® ONEday lenses, I believe they’ll be switching their patients from monthly and 2-week lenses, not only growing the daily disposable market but also growing their own practices. When I reviewed my files, I found that patients who wear 2-week lenses return to my office every 18.5 months, and patients who wear monthly lenses return every 13 to 13.5 months, while patients who wear daily disposables return every 12 to 12.5 months. To me, these statistics confirm that daily disposable lenses are healthier for my patients and more profitable for my practice.
|“When a manufacturer has invested in the research and development needed to produce a new material specifically for a daily disposable lens … I feel more confident it will perform well in this modality.
— Gina Wesley, OD, MS, FAAO”
Dr. Jedlicka: When silicone hydrogel lenses were introduced and we saw their potential, most of us were eager to be at the forefront and adopt that technology. We all wanted the extra oxygen permeability that silicone hydrogel lenses delivered, but we still wanted many of the positive attributes of our hydrogel materials. Biotrue ONEday lenses combine the properties of both, so that we have more oxygen than we ever expect from a non-silicone hydrogel lens, with all the positive attributes of hydrogels, as well.
Dr. Saks: I think we can consider Biotrue ONEday lenses a breakthrough. They address the disadvantages of traditional hydrogels and silicone hydrogels. I think they’re going to make a big difference in the contact lens world.
1. Diec J, Lazon de la Jara P, Willcox M, Holden BA. The clinical performance of lenses disposed of daily can vary considerably. Eye Contact Lens 2012;38(5):313-318.
2. Lee RH, Kingston AC, Richardson G. Evaluation of Contact Lens Image
Stability and Predicted logMAR Image Resolution as Lenses Dehydrate. Poster presented at: Annual Meeting of the Association for Research in Vision and Ophthalmology; May, 10, 2012; Ft. Lauderdale, FL.
3. Bergmanson J. Clinical Ocular Anatomy and Physiology, 14th ed. Texas Eye Research and Technology Center, University of Houston College of Optometry, Houston, Texas. 2007.
4. Schafer J, et al. Comparing On Eye Dehydration and Corneal Staining of Three Daily Disposable Contact Lenses in a Low Humidity Environment. Presented durig the 2012 meeting of the British Contact Lens Association. Birmingham, England.
5. Morgan PB, Woods CA, Tranoudis, IG, et al. International Contact Lens Prescribing in 2011. Contact Lens Spectrum, January 2012.
Contact Lens Spectrum, Issue: March 2013