Modality vs. Material: Resolving A Long-standing Dilemma
HIGHLIGHTS FROM A ROUNDTABLE DISCUSSION
Modality vs. Material: Resolving A Long-standing Dilemma
Panelists have a candid discussion about 1-Day Acuvue Brand TruEye Contact Lenses, the first silicone hydrogel daily disposable lenses.
Dr. Wallingford: All of our panelists are clinical investigators of Johnson & Johnson Vision Care's newest contact lens, 1-Day Acuvue Brand TruEye Contact Lenses. Please describe your experiences with this new lens and your clinical impressions after using it in your practices.
Dr. Emch: At my site, we were fitting first-time contact lens wearers, so our patients were not able to give subjective impressions about how this lens compares to a lens they used previously. Clinically, I have been reasonably impressed with its on-eye performance. The lenses move adequately. They center well, and coverage is not an issue.
Dr. Walline: What I like about the lens is that there is very little movement but adequate movement, which I think is part of the reason for the comfort my patients describe. The vision has been outstanding, better than 20/15 in almost all patients. I observed wetting problems on less than 10% of the eyes and deposits on less than 20% of the lenses, and none of those patients was symptomatic. I cannot think of any issues I have had with the lens in terms of physiology or patient-reported problems.
Dr. Poling: 1-Day Acuvue TruEye Brand lenses met my expectations. The fitting characteristics are typical of Vistakon lenses. Centration is good, and there is just enough movement to make the lenses comfortable.
Dr. Dugué: In my practice, we studied 20 existing contact lens wearers. At least 7 of the 20 patients mentioned their vision was clearer than with their habitual lenses. Visual acuity for most patients was 20/15. Response to end-of-day comfort was exceptional. Several patients mentioned that. One of my patients commented, “This is the healthiest my eyes have been in years.”
Dr. Movic: This lens does have good optics. One patient was reading a couple of letters on the 20/10 line.
Dr. Dugué: Several patients also mentioned how easy it was to handle the lens.
Dr. Walline: In our clinic, we are fitting only new contact lens wearers, so they have no basis for comparison to other contact lenses, but I found it interesting that none of them complained about handling the lens. With other daily disposable lenses, I have found some new wearers cannot handle them well, especially initially.
PATIENTS WEIGH IN
Dr. Walline: Most of my patients reported absolutely no discomfort. In fact, most of them were surprised at how comfortable the lenses are, and they had no visual complaints. These first-time wearers really like TruEye lenses.
Dr. Poling: Comfort was outstanding, particularly end-of-day comfort. Many patients said they liked the idea of putting on a “fresh” lens. I heard that word frequently. Vision was excellent, as I expected it would be.
“1-Day Acuvue TruEye Brand lenses met my expectations. The fitting characteristics are typical of Vistakon lenses. Centration is good, and there is just enough movement to make the lenses comfortable.”
— Timothy R. Poling, OD, FAA0
Another word I heard frequently was “flexibility.” Some of my patients are swimmers, and they like being able to remove their lenses and apply a fresh pair. Also, if patients have to replace a torn lens, they do not feel they are throwing their money away just because a lens was torn. Overall, it was a very good experience for my patients. I did have some daily disposable wearers in the study, and they indicated the handling was definitely better with these lenses compared with their usual daily disposables.
Dr. Emch: Several patients commented on the visual clarity, and these are people who are not making comparisons to contact lenses they have worn in the past. They are comparing the clarity to what they experience with their eyeglasses. Some patients said, “I never expected the vision would be this clear.” That clarity may have to do with the optics of the lenses, or it may have to do with the lack of a frame or better peripheral vision and fusion. In addition, comfort has been very good. Handling has been quite good, which is nice when you are teaching someone application and removal for the first time.
“Visual acuity for most patients was 20/15. Response to end-of-day comfort was exceptional. Several patients mentioned that. One of my patients commented, ‘This is the healthiest my eyes have been in years.’”
— James R. Dugué, OD
Dr. Poling: One of my patients is a man with dryness issues whom I have seen for several years. His habitual lenses are daily disposables, but he just tolerates them. During the study, he commented he really enjoyed wearing 1-Day Acuvue TruEye lenses throughout the day and into the evening. With his habitual lenses, he was just making it through the work day. With these new lenses, instead of switching to eyeglasses at 6:00 p.m., he was wearing his lenses until 10:00 p.m. 1-Day Acuvue TruEye lenses extended his end-of-day comfort.
Dr. Movic: One of my patients, an engineer, has tried many different lenses over the years. After participating in the study, he said he likes the 1-Day Acuvue TruEye lenses and wants to switch to them when they become available. Another patient, whose habitual lenses are daily disposables, said the TruEye lenses were definitely more comfortable than the lenses she has been wearing. She also is ready to switch.
Dr. Emch: My success stories involve high school athletes who had never been able to play sports without wearing a hefty pair of goggles or prescription eyeglasses. One patient in particular, a 6-diopter myope, noticed a substantial improvement in his tennis game because he was not hampered by eyeglasses slipping down or fogging up. He had better peripheral vision and felt freer overall.
In fact, we saw improved confidence and self-esteem among most of the patients in our study. These patients were accustomed to wearing eyeglasses and, all of a sudden, they were wearing contact lenses, which prompted positive responses from their peers and family members and also affected how they felt about themselves.
Dr. Dugué: All 20 of our study patients were successful with 1-Day Acuvue TruEye lenses. Several patients increased their wearing times from 12 hours to 16 hours.
One patient who stands out is a woman who came in toward the end of recruiting. She was 28 years old and about a 5-diopter myope. She had quite a bit of staining, tarsal roughness and conjunctival injection. She was so anxious to do the study that I pulled out the grading scales and very carefully examined her. Although she was not the ideal study subject, she did qualify. I put her in the lens, and she loved it. By the third month, she had much less staining, no injection and fewer tarsal anomalies. Everything looked better than it had at day one. She wore the lenses comfortably for 16 hours a day, with only slight dryness after 12 hours. She said she has never been more comfortable wearing contact lenses.
Dr. Wallingford: For which patients are you most likely to prescribe 1-Day Acuvue TruEye lenses?
Dr. Walline: To be perfectly honest, probably everybody, but in particular, athletes and kids who are concerned about their appearance.
Dr. Poling: I will target any patients who are active in sports and outdoor activities.
Dr. Emch: Overwhelmingly, I will prescribe them for kids. I think parents want their kids to be more concerned with being kids than whether or not their contact lenses are healthy for them.
Certainly, allergy patients and folks who tend to accumulate debris on their contact lenses over the course of a day would be good candidates. Also, people who are currently wearing other daily disposable contact lenses may be interested in adopting the latest advance in contact lenses.
WHAT PATIENTS WILL WANT TO KNOW
Dr. Wallingford: When 1-Day Acuvue TruEye Brand lenses become available, what will you tell patients about them?
Dr. Poling: It is important to question patients to find out what they are not getting from their current lenses. This gives you an opportunity to discuss a new lens. I regularly ask patients if there is anything they would change about their current contact lenses. If I think 1-Day Acuvue TruEye lenses will benefit them — for example, with dryness — I might say, “My expectation is that you might get a few more hours of wear.” I would not guarantee it, but I would say, “This is the latest material in the best modality, so it is likely you will have a better, more comfortable experience throughout the day.”
Dr. Dugué: Patients — at least where I live — want the newest iPod, the newest computers and the latest cars. So I will say this is the latest technology, and it is the most breathable daily disposable lens on the market. I will tell patients this is the lens I have been waiting for, and it is from Johnson & Johnson Vision Care.
Dr. Walline: I am fortunate to travel all over the world and talk to people about fitting kids with contact lenses. A question that always comes up is: Should I fit them in daily disposables or silicone hydrogels? Until now, I have not had a great answer.
I will tell patients that we have lenses that allow a substantial amount of oxygen to reach the eye, and we have lenses that you can throw away every day, but until now, we did not have those two things together in one lens. Now, we have a brand new lens that combines those features, the 1-Day Acuvue Brand TruEye contact lens. It is convenient, it is comfortable, it is healthy, and you will see great with it.
||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