Daily Disposable Lens Designed for Comfort
Lancaster, C. Steven OD
A new soft lens may offer success for contact lens dropouts.
Daily disposable contact lenses are an increasingly attractive option for patients. Wearers of these lenses don't have to worry about buying (or the efficacy of) solutions or about replacement schedules. The newer offerings also address a previous complaint of daily disposable lens wearers - all-day comfort.
The new 1?Day Acuvue Moist (Vistakon) was designed to combat previous end-of-day comfort and dryness issues. Here we'll look at the technology and talk to practitioners who have been dispensing the lens since its launch in July 2006. They'll also discuss why they're excited about the future of daily disposables.
Designing for Moisture
Cristina M. Schnider, OD, MSc, MBA, FAAO, Director, Medical Affairs, Vistakon, said that Vistakon's Hydraclear technology taught them several things that were important about creating a comfortable lens. Lubricity, flexibility and moisture are the three things that we optimized with our Hydraclear technology, Dr. Schnider said. With that technology, all the components of the lens are combined at the beginning of the process. The technology starts with the very genesis of the material to create physical flexibility, smoothness, lubricity and moisture retention.
The Lacreon process Vistakon uses to create 1?Day Acuvue Moist is different because the wetting agent is added at the end of the process, after the lens is polymerized. 1?Day Acuvue Moist incorporates a high molecular weight polymer that is hydrophilic, binding water molecules in the lens matrix. This polymer is not present in 1?Day Acuvue.
We start with the etafilcon lens and add the moisture, Dr. Schnider said. By using the wetting agent, we've been able to change the nature of the lens. The process is really as important as the ingredients.
Vistakon designed 1?Day Acuvue Moist to simulate the mucin layer of the natural tears, to reduce friction and lysozyme absorption and to enhance moisture retention. The lens has a 58 percent water content.
1?Day Acuvue Moist has a visibility tint and provides ultraviolet radiation blocking. UV blocking averages 97 percent in the UVB range of 280nm to 315nm and 82 percent in the UVA range of 316nm to 380nm.
Potential Daily Wear Patients
Daily disposables, best-sellers in Japan and Europe, haven't been as popular in the United States. Addressing comfort problems and stressing the health benefits of daily disposable lens wear can encourage more patients to wear them.
Bradford Ripps, OD, who is in private practice in Lake Hopatcong, NJ, is a strong proponent of single-use lenses, especially for patients younger than 18. You can solve 80 percent of contact lens problems that occur by using a one-day lens, Dr. Ripps said. These patients are by far the most compliant. There's no confusion about what needs to be done. It's so convenient.
Since they came out, we prescribe a daily use lens for any patient under 18, Dr. Ripps said. He cites ease of compliance, UV blocking and health benefits. He added that if a patient's first introduction to contact lenses is with a single-use lens, it's difficult for them to switch to a planned replacement lens and lose the convenience of a daily disposable.
Robert Breeden, OD, also agrees that single-use lenses are a good choice for young patients. In his Eatontown, NJ, practice many student athletes choose them because of UV blocking. It's also convenient for them to have an extra supply of lenses on-hand for games.
We explain to students and parents the convenience and safety, Dr. Breeden said. The parents appreciate that.
People who travel often during the year, for business or for pleasure, are also prime candidates for daily disposables, Dr. Breeden said. Especially keeping in mind new airline restrictions on liquids, daily disposable travelers don't have to worry about trying to get solution bottles through security.
Many patients when offered the convenience really opt for it, Dr. Breeden said.
Mark Weintraub, OD, who practices in Santa Monica, Calif., concurs. Daily disposables are my lens of choice for all patients who have little or no cylindrical correction, he said. I find that patients wearing one-day lenses experience fewer problems with allergies and infections. Compliance with cleaning and disinfection regimens, which is a more pervasive problem than we like to admit, becomes a non-issue.
He began prescribing 1?Day Acuvue Moist last summer, and was part of the 1?Day launch in 1995. He cites moistness as one advantage of the new lens.
In the absence of dry eye symptoms, I've continued to fit patients under 30 years of age with the regular 1?Day (Acuvue) lens. I generally fit patients over 30 years of age with 1?Day Acuvue Moist because they're more likely to have dry eye symptoms and be able to appreciate a difference, Dr. Weintraub said. I wear 1?Day Acuvue Moist as well.
Dr. Breeden said that with discomfort being the No. 1 reason for patients dropping out of lens wear, 1?Day Acuvue Moist has been successful with many of these patients because the lenses stay wet on the eye, reducing irritation. His practice also has had success fitting the lens on allergy patients who suffer in the fall with hay fever.
Universally, dropouts will describe contact lens problems as dry, Dr. Schnider said. That's what makes the moist, cool, soothing feeling relevant to existing wearers. Even just touching a new lens that's moist, there's the anticipation that you believe it's going to be comfortable.
Daily Disposable Discussions
I thoroughly educate my patients on visual health and hygiene. After recently seeing a referred case of Acanthamoeba keratitis in a teen from tap water rinsing and contact lens abuse, I'm more convinced that daily disposables are the healthiest option for most patients.
At the Atlantic Eye Institute, I provide patients with the opportunity to experience this new technology whenever I fit a spherical disposable soft contact lens. I fit one eye with a two-week disposable and the other with a 1?Day Acuvue Moist. I give them an extra two-week disposable diagnostic lens for the other eye and a small supply of diagnostic 1?Day Acuvue Moist lenses for both eyes. Upon follow-up, most patients elect to purchase the 1?Day Acuvue Moist after experiencing the benefits of this lens. Many patients purchase supplies of both lenses.
Health is a big part of the approach, Dr. Breeden said. Nothing replaces putting a new clean, sterile lens on the eye. It's the healthiest option.
Throughout the course of a contact lens exam, Dr. Ripps asks questions about lens wear, hobbies, etc. He asks if the patient's eyes feel dry at the end of the day. Simple questions such as, Do you take your lenses out as soon as you get home from work? offer clues to comfort. These are obvious patients to inform about 1?Day Acuvue Moist.
At the end of the exam, if the patient is doing fine with his current lenses, Dr. Ripps asks if he'd like to hear about new technology that will make his eyes feel better and less dry throughout the day.
I put a pair on them in the office and instantly they feel the difference, Dr. Ripps said. In a small percentage of the population for whom it made no difference, they still wanted the new technology.
I generally tell my patients, 'It's not magic, it's not the miracle cure for contact lens-related dry eyes, but I personally can wear these lenses an hour or two longer than other lenses before experiencing dry eye symptoms,' Dr. Weintraub said. He added that the feedback from his patients has been consistent with his personal experience.
Patients also are savvier than ever. They're interested in new technology, and that your practice is offering the latest in contact lenses.
For years contact lens technology had languished. But just as computers have ramped up, contact lenses have increased dramatically in the past four years, Dr. Breeden said. Offer the new technology aggressively.
Dr. Breeden's approach is to tell patients that he believes this technology is better. With existing contact lens wearers, he fits them with the new lens and tells patients that if they disagree, they can return to their former lenses. They know I'm not trying to take away their lenses. I'm trying to offer them something better, he said.
When the question of the cost of daily disposables arises, Dr. Ripps points out that contact lenses are really the cheapest medical devices. Single-use lenses at 70 cents to $1 a day are incredibly inexpensive, he said. He usually dispenses a six-month supply, although rarely patients will ask for a smaller supply.
These patients don't have to buy solutions or lens cases, or worry about sterile lens cases or solutions, Dr. Breeden said. I usually dispense a six-month supply. We do offer tier pricing for our lenses.
Positive Patient Response
Since he began dispensing 1?Day Acuvue Moist, Dr. Ripps said the response has been positive. I ask patients if the lens has made a difference. More than 90 percent were very happy. I had three patients who decided to go back to 1?Day Acuvue.
Dr. Ripps did have a few patients who said they felt their vision wasn't as sharp, but he's found few have had that experience. Patients he's fit have also commented about comfort upon initial dispensing. Initial comfort is dramatically better, he said.
Dr. Breeden had similar results. We're getting good wettability at the end of the day, but we're also finding it enhances initial comfort. Patients say the lenses feel wet, fresh and moist.
Also reporting an increase in comfort to Dr. Breeden are allergy patients who have moderate symptoms. These patients experienced reduced irritation and were able to wear their lenses longer during the autumn allergy season. With daily disposable lenses, allergy sufferers don't experience the allergen build-up associated with planned replacement lenses.
I personally have found a dramatic increase in comfort level at the end of the day when wearing the 1?Day Acuvue Moist. My wearing time has been increased and my dry eye symptoms have significantly decreased since I switched to this lens.
Dr. Ripps points out that sometimes eyecare practitioners are concerned with a patient's ability or willingness to pay for daily disposable lenses, so they never mention the option to the patient. People can afford what they see value in, Dr. Ripps said. It's our job to provide the patient what's best for them.
For many patients, what's best increasingly may be single-use lenses. With initial and all-day comfort - along with the health benefits of putting in a new lens each day - daily disposable lenses may soon find increased success with patients everywhere.
Dr. Lancaster joined the Atlantic Eye Institute in Jacksonville, Fla., in 1999. He has served as a clinical investigator in contact lenses and drug research studies and has lectured nationally and internationally on contact lenses and ocular disease.