Deciding on a Lens of Choice
HIGHLIGHTS FROM A ROUNDTABLE DISCUSSION
Deciding on a Lens of Choice
Find out what kitchen sponges and bagged salad have to do with contact lens preferences among these clinicians.
Richard Wallingford, OD: Soft contact lenses dominate the U.S. market today, and all of you report that 90% to 95% of your contact lens patients are wearing soft lenses. So let's talk about your lens of first choice. What is your preferred modality?
Andrew J. Emch, OD, MS: The daily disposable is my lens of first choice. I like the health benefits it provides. I like the convenience it provides, and I think patients appreciate those benefits, too.
Wilson W. Movic, OD, FAAO: We are big promoters of daily disposable contact lenses in my practice. They are healthy, they are convenient, and patients love them. When patients use daily disposables, they are applying a clean, fresh lens every day. In addition, I have found patients often do not clean their reusable lenses properly or replace their lens cases as often as they should. Those compliance issues become nonissues when you prescribe daily lens replacement.
Timothy R. Poling, OD, FAAO: My contact lens of choice is a daily disposable, as well. That is what I usually offer first. I live and practice near the Appalachian Trail and the Blue Ridge Parkway, where outdoor activities, such as hiking and horseback riding, are popular. It is also an area where allergies are prevalent, so my challenge is to keep my patients' eyes as healthy and comfortable as possible. Even if patients do not wear daily disposable lenses full time, I still offer them for part-time wear for camping or traveling.
Jeffrey J. Walline, OD, PhD, FAAO: I am a huge fan of daily disposables, so they are the first lenses I choose for all of my patients. If a patient decides not to wear daily disposables, then I prescribe silicone hydrogel lenses.
James R. Dugué, OD: I like daily disposables — I prefer them for my younger patients — but my lenses of choice are 2-week silicone hydrogels. I like the breathability and the end-of-day comfort the silicone hydrogel material offers. In addition, I fit a lot of multifocal and toric lenses, and everything I need is available in the silicone hydro-gel material.
Dr. Poling: I present daily disposable lenses first and then silicone hydrogels — typically 2-week replacement — although I still encourage patients to consider daily disposables for part-time wear. I believe we must have options that will optimize our patients' visual experiences and comfort for different aspects of their lives.
Dr. Wallingford: In your opinion, what are the clinical benefits of silicone hydrogel lenses? Are there certain types of patients for whom you prefer to prescribe silicone hydrogels?
Dr. Movic: The number one benefit, in my opinion, is that silicone hydrogel material allows more oxygen to reach the eye. Patients experience this as a whiter eye. There is less hypoxia, less neovascularization and less protein deposition. With less protein on the lens, the tear layer is smoother, and this translates to improved comfort. In addition, the water content is lower, so there is less dehydration and less dryness, which also enhances comfort.
“We are big promoters of daily disposable lenses in my practice. They are healthy, they are convenient, and patients love them. When patients use daily disposables, they're applying a clean, fresh lens every day.”
— Wilson W. Movic, OD, FAAO
CHOOSING A REPLACEMENT SCHEDULE
Dr. Wallingford: What determines which replacement schedule you prescribe?
Dr. Dugué: For 99% of my patients, I prescribe 2-week lenses. I believe people who “stretch” their lenses will stretch a 2-week lens to 3 weeks and a 1-month lens to 6 weeks. I would rather they wear a 2-week lens for 3 weeks than a 1-month lens for 6 weeks. To discourage patients from stretching their lenses, I use the analogy of a kitchen sponge and what it looks like after a couple of weeks of use. I tell patients, “That contact lens is like your old kitchen sponge. You need to throw it away and get out a new one, because it just gets gross after a while.”
Dr. Emch: I recommend the more frequent replacement schedule first. That is usually a daily disposable lens. If a daily disposable is not available, or if a patient does not want to wear a daily disposable, I will prescribe the 2-week modality. I like the idea of great lens performance, and to me, more frequent lens replacement translates to better performance.
Dr. Dugué: I look at the whole clinical picture. Definitely, if I am prescribing for a younger patient or someone with allergies, I am likely to prescribe a single-use lens. Then it comes down to parameters. If the only lens available for a patient's prescription is a monthly lens, then that is what I prescribe. Otherwise, I will choose a 2-week lens most of the time.
||“I recommend the more frequent replacement schedule first. That's usually a daily disposable lens. …I like the idea of great lens performance, and to me, more frequent lens replacement translates to better performance.”
— Andrew J. Emch, OD, MS
Dr. Movic: I start with daily disposable lenses. If the patient's parameters are available, that is what I prescribe. It is a natural routine. I take out a 90-pack and say to the patient, “This is going to sound silly,” — and it does, because often patients are not aware this is available — “but you take a lens out of the package and put it on your eye, and at the end of the day, you throw it away. Tomorrow, you start with a new, clean lens. There are no solutions, and, therefore, no solution sensitivities to worry about.”
In my opinion, the daily disposable lens is the healthiest option, even when compared with a 2-week or 1-month silicone hydrogel lens. Patients apply a clean lens every day, so you do not have dirty-case problems or solution noncompliance problems.
Then I say to patients, “The reason you're going to buy this lens is the same reason you buy bagged salad. That's because it's easy. We can all cut up lettuce and carrots. It only takes a minute to do that, but it's just so easy to tear open a bag, shake out the vegetables and start eating.” And they say, “Yeah, I buy bagged salad,” and they try daily disposables and like them.
Dr. Walline: We found parents like daily disposables, too. We performed a study1 where we fit kids for free with daily disposable or 2-week disposable lenses, and 92% of the parents chose the daily disposable, of course. We also told them how much the cost difference is and then asked what they would choose if they had to pay for the lenses. More than 60% of the parents said they would prefer the daily disposables for their children. Despite the fact that 8% to 10% of the market share is daily disposable, I think 60% of patients want them. So, as eyecare professionals, I think we are putting too much emphasis on cost and not enough on eye health and convenience, which patients really want to pay for. (See “Addressing Cost Concerns.”) From that perspective, daily disposable is the first option.
Dr. Poling: Parents want what is best for their kids, and from a compliance standpoint, I think they understand the benefits of not having to deal with solutions and lens cases.
Addressing Cost Concerns
Dr. Walline: I think we should be presenting daily disposable contact lenses as an option for every patient and avoid second-guessing their ability or desire to pay for them. We should never assume our patients cannott afford something. Patients do not have to have iPhones, as opposed to regular cell phones, but they want them because they like the convenience, they like the comfort, and it is really important to them. We should present our patients with options or make a recommendation, and that recommendation should be what we think is best. As for the cost, I think if patients used solutions the way they are supposed to use them, daily disposable lenses would be cost effective.
Dr. Emch: I work in a university clinic with student clinicians who tend to be particularly frugal, which may influence what they recommend for patients. To help them and patients understand costs, I put together a slide presentation based on myself, using the volume of solution required for 2-week lenses according to the manufacturer's directions. By extrapolating that out for a year, I calculated how much it would cost to wear 2-week lenses, including the solution, as compared to the cost of daily disposables. Then I divided that by 365 to arrive at a daily cost. Often, that is the number that resonates with patients. They say, “I spend $3.50 on my coffee at Starbucks every morning. So you're telling me wearing daily disposable contact lenses every day will cost me less than that? And I will have good health, good vision all day, and the convenience of taking those lenses out at the end of the day and throwing them away?” When you present options in such a way that patients understand how they will affect their pocketbooks on a daily basis, they can relate better.
WHO BENEFITS FROM 1-DAY LENSES?
Dr. Wallingford: Besides kids, are there other patients who do well with a daily replacement schedule?
Dr. Poling: Allergies are a significant issue in my area. Even though many patients cannot wear their lenses for as many hours as usual during the allergy season, they still want to make it through at least the working hours. So a daily disposable is the lens of choice.
Dr. Dugué: Single-use lenses are the way to go for the weekend warrior, the person who wants to wear contact lenses to play tennis or basketball, for example. People who travel a great deal are good candidates for daily disposables, and I also steer noncompliant patients toward daily disposable lenses.
Dr. Wallingford: How do you describe the benefits of daily disposables to patients?
Dr. Movic: Health is the first benefit I mention because I think that's what patients want to hear from me. I explain it's a clean lens every day. It's a smooth surface, and it's a comfortable lens. In addition, because it's a clean lens, we can make sure their vision is clear. And finally, there is convenience. So I discuss four benefits: health, comfort, vision and convenience.
“As eyecare practitioners, I think we are putting too much emphasis on cost and not enough on eye health and convenience, which patients really want to pay for. From that perspective, daily disposable is the first option.”
— Jeffrey J. Walline, OD, PhD, FAAO
Dr. Emch: As a contact lens wearer myself, I like knowing the fresh, new lens I am putting on my eye is not in any way limited or affected by wear that took place the day before. That is certainly one of the clinical benefits, as well as a benefit that patients appreciate. If patients do not fully appreciate the vision, comfort and health factors, which we all strive for when prescribing contact lenses, the convenience often seals the deal.
Dr. Poling: I try to use terminology that patients will understand, so I will talk about less redness. I say the lenses will feel fresh every day, and patients will have more flexibility with their daily routines. In addition to health, freshness and flexibility, another benefit is fewer unscheduled visits, particularly during allergy season, which is a benefit for the practice, as well.
Dr. Dugué: Another benefit of daily disposables from the patient's and the clinician's perspective is that patients do not have to worry about trying to “save” a damaged lens and make it last 2 full weeks. Someone wearing 1-day lenses will be less likely to risk complications by trying to wear a lens he should not be wearing.
Dr. Poling: Even when patients are wearing a different type lens, I still suggest they get a supply of daily disposables to use for travel or other activities. Sometimes, after they have experienced the benefits of daily disposables, they come back and tell me how much they liked the convenience, and that is the hook for them. Often, just getting them to experience the lenses makes the difference.
Dr. Walline: I frequently work with kids, and bedtime routine — well, routine in general — is really important for kids, so I think making that routine a short one is the absolute best thing. I really like daily disposables from that perspective. I also think patients sleep in daily disposable lenses less often, just because they do not have to go through the hassle of cleaning.
POLLING THE PANEL
Dr. Wallingford: For what percentage of new patients do you prescribe daily disposables?
Dr. Movic: Among spherical lens patients, we could be hitting 50% to 60%.
Dr. Walline: About 80% or more of new patients who are kids — most of my patients are kids — are wearing daily disposables. Among the adult population, about 30% to 40% wear daily disposables.
Dr. Emch: Even though the daily disposable is my number one recommendation, I estimate about 30% to 40% of adults in my practice are wearing them. I agree that when patients experience a daily disposable contact lens, they often want to convert to that modality. One of the doctors at Ohio State talks about daily disposables being addictive, because once you try them, if you have been using other lens modalities, that convenience changes your world.
Dr. Dugué: About 90% of my younger patients are wearing daily disposables. Among adults, that number drops to about 10%. I expect my daily business will increase significantly, however, when Johnson & Johnson introduces its silicone hydrogel daily disposable lens. Acuvue Oasys Brand Contact Lenses are wonderful — my wife calls them her “Wow!” lenses. Having a daily disposable lens in that material is what I have been waiting for. It will bring me closer to my ideal, which is prescribing silicone hydro-gels for all of my patients.
1. Walline JJ, Jones LA, Chitkara M, Coffey B, Jackson JM, Manny RE, et al. The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study design and baseline data. Optom Vis Sci. 2006;83:37-45.
||Richard Wallingford, OD
Dr. Wallingford is Director of Professional Affairs for Vistakon, Division of Johnson & Johnson Vision Care, Inc.
||James R. Dugué, OD
Dr. Dugué is a private practitioner specializing in contact lenses in Mission Viejo, Calif. He has received research funds from Vistakon, Division of Johnson & Johnson Vision Care, Inc., and Visioncare Research, Ltd.
||Andrew J. Emch, OD, MS
Dr. Emch is a clinical assistant professor at The Ohio State University College of Optometry, where he also serves as a research optometrist in the Contact Lens and Tear Film Laboratory. He is a consultant or advisor to Ciba Vision and Vistakon, Division of Johnson & Johnson Vision Care, Inc. He is a member of the advisory panel for Vistakon, Division of Johnson & Johnson Vision Care, Inc.
||Wilson W. Movic, OD, FAAO
Dr. Movic is a principal partner at Eyecare Associates, a private practice in Bloomington, III. He is a consultant or advisor for, a member of an advisory panel of, and has received research funds from: Alcon, Bausch + Lomb, Ciba Vision, CooperVision and Vistakon, Division of Johnson & Johnson Vision Care, Inc.
||Timothy R. Poling, OD, FAAO|
Dr. Poling is the owner of Botetourt Eyecare, LLC, in Salem, Va., a private practice with an emphasis on research. He is a consultant or advisor for and has received research funds from Vistakon, Division of Johnson & Johnson Vision Care, Inc.
||Jeffrey J. Walline, OD, PhD, FAAO
Dr. Walline is an assistant professor at The Ohio State University College of Optometry, Where he conducts studies of pediatric contact lens wear. He is a consultant or advisor for and has received research funds from Paragon Vision Sciences and Vistakon, Division of Johnson & Johnson Vision Care, Inc.
Contact Lens Spectrum, Issue: July 2010