Article Date: 9/1/2013

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Daily Disposables

Targeted Daily Disposable Prescribing

The following strategies can help you provide the benefits of daily disposable lenses to more patients.

By Gregory J. Nixon, OD, FAAO

Dr. Nixon is a professor of clinical optometry and director of extern programs at The Ohio State University College of Optometry. He is also in a group private practice in Westerville, Ohio. He is on the Allergan Academic Advisory Board, the B+L Advisory Board, the Alcon Glaucoma Advisory Board, and the Alcon Speakers Bureau. You can reach him at gnixon@optometry.osu.edu.

Daily disposable contact lens wear is often thought of as the safest, healthiest, and most convenient contact lens option. Recent industry data shows that daily disposables comprise 39.5 percent of global contact lens sales (Nichols, 2013). While this represents an approximate 2 percent increase from 2011, it is reasonable to ask why daily disposable lenses don’t represent a majority of contact lens sales if they are indeed the best contact lens option.

Further, despite the United States trending upward in daily disposable fitting from 14 percent to 17 percent of fits in 2011 and 2012, respectively (Nichols, 2013), the United States continues to lag behind worldwide trends. International prescribing of daily disposables averaged 21 percent and 26 percent, respectively, in the same time frame, with countries such as Denmark and Taiwan having the majority of their lens fits in the daily disposable modality (Morgan et al, 2013). So, while it appears that daily disposable fitting is gaining momentum, there is still a tremendous opportunity for more robust growth within this contact lens category.

This begs the question, what strategies can be employed to maximize daily disposable lens prescribing? How can we increase the number of people who can enjoy the benefits of this modality? The answer to both of these questions lies in identifying and targeting some of the key patient demographics for which this modality is most suited.

The Benefits of Daily Disposable Lenses

Before identifying our target demographics, it seems worthwhile to review the virtues of daily disposable lenses. Without the need of any clinical data, we know that the convenience provided by daily disposability continues to be a hallmark feature of this treatment option. Avoiding the hassles of cleaning, disinfection, and storage of reusable contact lenses has great appeal, especially in light of our increasingly hectic contemporary lifestyles.

Over the years, clinical research has provided evidence of other intriguing health benefits of daily disposables as well. The likelihood of having a corneal infiltrative event is 12.5 times greater when wearing reusable lenses compared to when wearing daily disposables (Chalmers et al, 2012). When adverse events do occur with daily disposables, it appears that they are milder in presentation. The rate of developing a moderate-to-severe keratitis is approximately half that of the rate with traditional daily wear lenses (Stapleton and Carnt, 2012).

One possible contributor to generating fewer complications in ocular health lies in the fact that daily disposable lens wearers demonstrate high rates of compliance with recommended replacement schedules. When compared to two-week and monthly replacement wearers, daily disposable lens wearers exhibited the highest rates of compliance in two separate studies (Dumbleton et al, 2009; Yeung et al, 2010). These studies seem to indicate that the daily disposable modality fosters built-in lens replacement compliance because the results were nearly the same even though one factored in practitioner recommendation and the other didn’t.

New Contact Lens Wearers

Daily disposables were once thought of as a niche product for certain wearers. But considering their many benefits, there is no reason not to offer them as a top recommendation for most new contact lens patients. First-time lens wearers need active prescribing recommendations from their practitioner regarding what type of lens is best for them. Contact lens neophytes have no history of having to clean, disinfect, or reuse lenses, so starting in this modality can begin a lifetime of single-use lens wear.

In particular, children starting in contact lens wear are excellent daily disposable lens candidates. Because concern about hygiene and care compliance may be heightened with certain segments of this age group, many parents specifically ask for daily disposable lenses to help ensure a safe and healthy wearing experience for their kids. Plus, multiple lens designs are now available with ultraviolet (UV) protection, which is also a valuable feature for pediatric contact lens fitting. Previous concerns about being able to fit only limited spherical prescriptions in daily disposable lenses have been alleviated with expanded parameters that can correct a wide range of spherical, astigmatic, and presbyopic refractive errors (Table 1).

For daily disposables to become the lens of choice for new contact lens wearers, practitioners need to overcome their reluctance to recommend this alternative due to suspected patient apprehension over costs. First, as more daily disposable lens options have become available, the cost disparity has decreased. Nonetheless, it is still common for patients to have concerns over costs associated with eye care and eyewear. However, most are also savvy, contemporary consumers who are able to comprehend the concept of “cost versus value.” The matter is not simply about how much they are willing to spend, but whether there is adequate value for the products and services that they purchase. Once they enjoy the benefits of trial lenses, they are often motivated to invest in the daily disposable category even if the annual supply cost is marginally higher than for two-week or monthly replacement lenses. Once the savings from the lack of care solutions and the occasional industry rebates are factored in, the difference in the cost of an annual supply of daily disposable lenses can be as little as 30 cents a day. When viewed in these terms, patients often consider this a nominal expense for the value of obtaining clear, comfortable vision with the convenience of daily disposability.

Part-Time Lens Wearers

When daily disposable lenses first entered the market in the mid 1990s, they were often thought of as a niche product for part-time lens wearers. This population remains a promising group to target; a high percentage of current daily disposable prescriptions are for part-time wear. Patients may be part-time lens wearers for a number of reasons. Many are happy spectacle wearers who may simply desire contact lens wear only for certain social or athletic activities. This can range from wearing them for a weekly sports match to wearing them once a year while on vacation.

Whatever the reason, spectacle wearers need to be made aware that they can enjoy the benefits of contact lens wear without having to commit to an arduous, ongoing care and replacement regimen. One strategy to expose spectacle wearers to the benefits of wearing daily disposable lenses on a part-time basis is for a practitioner or trained staff member to apply diagnostic daily disposables to patients during the frame selection for a new eyewear purchase. This not only helps them view their appearance while trying on spectacle frames, but it exposes them to contact lens wear in a low-pressure situation. If the lenses are worn only for the frame selection process, they can simply be removed and discarded. But if this impromptu contact lens trial provokes patient interest in pursuing a contact lens purchase, it is easy to then progress into checking the fit and the health response of the eye, application and removal training, and educating the patient about the wear and care of the lenses for an at-home trial.

TABLE 1
Some Common Daily Disposable Lens Parameters
Spherical Lenses
Manufacturer	Lens	BaseCurve(s)	Parameters
Alcon	Focus Dailies	8.6mm	+6.00D to –10.00D
	Dailies AquaComfort Plus	8.7mm	+6.00D to –10.00D
	Dailies Total1	8.5mm	–0.50D to –10.00D
Bausch + Lomb	SofLens Daily Disposable	8.6mm	+6.50D to –9.00D
	Biotrue Oneday	8.6mm	–0.25D to –9.00D
CooperVision	Proclear 1 Day	8.7mm	+8.00D to –12.00D
	ClearSight 1 Day	8.7mm	+6.00D to –10.00D
Safigel	Safigel 1 Day	8.4mm, 8.6mm	+4.00D to –10.00D
Vistakon	1-Day Acuvue	8.5mm & 9.0mm	+6.00D to –12.00D
	1-Day Acuvue Moist	8.5mm & 9.0mm	+6.00D to –12.00D
	1-Day Acuvue TruEye	8.5mm & 9.0mm	+6.00D to –12.00D
Astigmatic Lenses
Alcon	Focus Dailies Toric	8.6mm	Sphere: +4.00D to –8.00D
			Cylinder: –0.75D & –1.50D
			Axis: 20º, 70º, 90º, 110º, 160º, 180º
Bausch + Lomb	SofLens Daily Disposable Toricfor Astigmatism	8.6mm	Sphere: plano to –9.00D
			Cylinder: –0.75D, –1.25D, –1.75D
			Axis: 20º, 90º, 160º, 180º
CooperVision	ClearSight 1 Day toric	8.7mm	Sphere: plano to –7.00D
			Cylinder: –0.75D & –1.25D
			Axis: 20º, 90º, 160º, 180º
Vistakon	1-Day Acuvue Moist for Astigmatism	8.5mm	Sphere: plano to –9.00D
			Cylinder: –0.75D, –1.25D, –1.75D, –2.25D*
			Axis: 10º, 20º, 60º, 70º, 80º, 90º, 100º, 110º, 120º, 160º, 170º, 180º *Only 20º, 90º, 160º, 180º in –2.25D cylinder
			Sphere: +0.25D to +4.00D
			Cylinder: –0.75D, –1.25D, –1.75D
			Axis: 20º, 70º, 90º, 110º, 160º, 180º
Presbyopic Lenses
Alcon	Focus Dailies Progressives	8.6mm	Sphere: +5.00D to –6.00D
			Single progressive add effective to +3.00D
CooperVision	Proclear 1 Day Multifocal	8.7mm	Sphere: +6.00D to –10.00D
		Single progressive add effective to +2.50D

Another often overlooked group of patients that may benefit from part-time wear are previous full-time contact lens dropouts. Some of these patients may have given up on contact lens wear due to significant lens comfort issues that dramatically reduced their wearing time and their ability to wear their contact lenses comfortably all day. Many of these patients might still enjoy wearing contact lenses for a few hours of episodic wear. Other contact lens dropouts may not have obtained the visual clarity or stability that they needed to perform critical vision-related work tasks. Many of these patients still have the opportunity to wear lenses in less critical vision situations such as going out to dinner or exercising. We must not forget to educate these patients that contact lenses are not an all-or-nothing proposition and can be used effectively in many individual circumstances.

TABLE 2
Some Common Daily Disposable Advanced Lens Features
Manufacturer	Lens	Advanced Features
Alcon	Focus Dailies	Moisture agents polyvinyl alcohol (PVA) & polyethylene glycol (PEG) released onto lens surface by blink activation
	Dailies AquaComfort Plus	1. PVA and PEG as above
		2. Hydroxypropyl methylcellulose (HPMC) in blister pack to provide added comfort on application
	Dailies Total1	Water gradient technology with silicone hydrogel core and 80-percent water near surface for increased wettability and lubricity
Bausch + Lomb	SofLens Daily Disposable & SofLens Daily Disposable Toric for Astigmatism	1. Poloxamine in blister pack to provide wettable, comfortable lens surface
		2. Aspheric optics
	Biotrue Oneday	1. HyperGel material of 78 percent water with surfactant to mimic lipid layer of the tears
		2. Aspheric optics
		3. UV protection
CooperVision	Proclear 1 Day & Proclear 1 Day Multifocal	1. Phosphorylcholine (PC) molecules maintain hydration and attract water to the lens surface
		2. Aspheric optics
	Clearsight 1 Day	UV protection
Safigel	Safigel 1 Day	1. Hyaluronate-Gel Technology attracts water
		2. Aspheric optics
		3. UV protection
Vistakon	1-Day Acuvue & 1-Day Acuvue Moist	1. UV protection
		2. Inversion indicator
	1-Day Acuvue Moist & 1-Day Acuvue Moist for Astigmatism	1. UV protection
		2. Lacreon Technology embeds a moisture agent into the lens matrix to provide moisture and reduce surface friction
	1-Day Acuvue TruEye	1. UV protection
		2. Inversion indicator
		3. Silicone hydrogel material

Ocular Allergies and Solution Toxicity

Contact lens patients often have significant challenges with ocular allergies. Deposits that build up on the surface of the lenses can act as a binding site for environmental allergens, prolonging their exposure to the ocular surface. This increases the magnitude of the allergic response. While we have seen tremendous growth in anti-allergy ocular pharmaceuticals to manage these symptoms, the absolute best defense against environmental allergies is elimination of the antigens.

Starting each day with a fresh, new contact lens prevents patients from re-exposing themselves to antigens that collect on the lens surface and, in the case of reusable lenses, have survived the lens cleaning process. Daily disposability also eliminates the need for contact lens care solutions, which can in themselves induce allergies as well as contribute to solution-induced corneal staining and corneal infiltrative events.

Reusable Lens Wearers

Existing two-week and monthly replacement wearers can also be ideal for refitting into daily disposables. These patients don’t necessarily need to be dissatisfied with their current lenses or present with complaints of dry eye, allergies, or deposits as mentioned above. Admittedly, it can sometimes be risky to change the lens of a satisfied patient who has no complaints. There are certain circumstances in which it is wise to take the approach, “If it ain’t broke, don’t fix it,” but I often aspire to the adage, “You can make a happy patient happier.” Many longstanding reusable lens wearers may not even know that this type of alternative is even available. I have been making a habit of asking my existing wearers, “Did you know that your prescription is now available in a daily disposable lens?”

The best way to demonstrate the benefits of daily disposables is to use your diagnostic lenses to refit reusable lens wearers in the office on the day of their examination and give them at least a seven- to 10-day trial pack to try at home and work. In this brief period of time, they often respond positively to having a fresh lens each day without the necessary cleaning and disinfection steps required for their previous lenses.

Advanced Lens Features

It seems like the main goal in the contact lens industry today is to create a contact lens wearing experience that provides all-day comfort. This is in direct response to the prevailing evidence that contact lens discomfort remains the foremost complaint among lens wearers and is a perennial cause of contact lens dropout (Richdale et al, 2007; Rumpakis, 2010).

Many manufacturers are now applying advanced lens features to their daily disposable contact lenses. Most of these features address the comfort issue by adding wetting agents to the lens material itself, such as the Lacreon Technology used in manufacturing the 1-Day Acuvue Moist (Vistakon) lens, the phosphorylcholine incorporated into the Proclear 1 Day (CooperVision) lens, and the sodium hyaluronate in Safigel 1 Day (Safigel). Another method involves putting additional wetting agents in the blister pack, such as hydroxypropyl methylcellulose (HPMC) in Alcon’s Dailies AquaComfort Plus lenses and poloxamine in Bausch + Lomb’s SofLens Daily Disposable lenses.

Further, entirely new daily disposable lens materials have been developed to address the all-day comfort issue. Vistakon formulated the first daily disposable in a silicone hydrogel material in its 1-Day Acuvue TruEye lens. Alcon has introduced its latest lens material technology in a new daily disposable lens, Dailies Total1—the first lens of its kind to introduce a water gradient technology. Other advanced features incorporated into daily disposable contact lenses include the HyperGel material (a high-water-content material) used by B+L in its SofLens Daily Disposable lenses and UV protection, which has been incorporated into many daily disposable lens designs. Table 2 provides a partial list of daily disposable advanced lens features.

Fulfill the Potential

Even with the current rise in use of daily disposables, they are still highly underutilized for the value that they provide. Lack of awareness among the general public about their availability and affordability is a key factor. As a profession, we need to make sure that daily disposable contact lenses are not our best kept secret. Take advantage of all the benefits that these lenses can provide by recommending them to all of your patients who meet the target demographics discussed in this article. They will become some of the most satisfied patients in your practice. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #214.

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Contact Lens Spectrum, Volume: 28 , Issue: September 2013, page(s): 18 - 23

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