Article Date: 6/1/2013

The Shifting Prescribing Paradigm

The Shifting Prescribing Paradigm

Learn why so many practitioners now choose daily disposables as their go-to lenses.

images Dr. Nichols is the Kevin Mc-Daid Vision Source Professor at the University of Houston College of Optometry as well as the editor-in-chief of Contact Lens Spectrum and editor of the weekly e-mail newsletter Contact Lenses Today. He has received research funding or lecture honoraria from Alcon Laboratories Inc., Bausch + Lomb and Vistakon.

By Jason J. Nichols, OD, MPH, PhD

Daily disposable contact lenses have come a long way since their introduction in the 1990s, owing to advances in material composition and manufacturing processes. These lenses are recognized by patients and eyecare professionals not only for their convenience but also because they’re a healthy option. The rising appreciation of this modality is evidenced by increasing prescribing frequency worldwide, even in the United States, where practitioners have been slow to embrace this modality. In this article, I discuss the reasons why daily disposable contact lenses are challenging other modalities for the top prescribing spot in many practices.

New-lens Comfort Every Day

Despite many years of research and implementation of various clinical management approaches and algorithms, dryness and discomfort with contact lens wear persist. In one study, 79 percent of lens wearers reported ocular discomfort and 77 percent reported varying degrees of dryness.1 Non-lens wearers also reported significant increases in late-day ocular discomfort, visual changes, soreness and irritation.1 What’s more, symptoms of ocular discomfort and dryness are the primary reasons why patients become dissatisfied and stop wearing their lenses.2 Overall comfort and end-of-day comfort remain elusive goals.

Daily disposable contact lenses provide a fresh, clean surface each day, and a clean lens surface can be expected to enhance comfort. When compared with conventional and frequent replacement lenses (e.g., 2-week, monthly), daily disposables displayed less surface deposition and better overall lens-wearing satisfaction.3

Cost Effective for Part-time Wear

The cost of daily disposable contact lenses has been considered a primary barrier to prescribing this modality. In fact, a 2011 Quick Poll4 by Contact Lenses Today showed that cost is the number one reason (58 percent) why eyecare practitioners don’t prescribe daily disposables [Oct. 23, 2011]. A recent study found that daily disposables can, indeed, be cost-effective for part-time wearers.

Efron and colleagues examined the cost-per-wear of daily, 2-week and monthly replacement lenses.5 They estimated the annual cost of professional fees, care solutions and lenses and divided that sum by the number of times the lenses are worn per year. They assumed patients were fully compliant with their wearing schedules and lens care and that they would make the most cost-effective purchases of lenses and care solutions. The study showed that the cost-per-wear of daily disposable spherical lenses is lower than for reusable spherical lenses when worn from 1 to 4 days per week. At 5 days of lens wear per week, the cost-per-wear is virtually the same for all three spherical lens replacement frequencies, and at 6 or 7 days of lens wear per week, the cost-per-wear of daily disposables is higher.

Although some lens wearers and practitioners may perceive daily disposable lenses as more costly, this study found that part-time wearers may receive the additional benefit of a less expensive modality with improved convenience. A 2012 Quick Poll4 by Contact Lenses Today showed that 76 percent of respondents believe daily disposable contact lenses are more convenient than 2-week and monthly replacement lenses [Nov. 11, 2012].

Improved Compliance, Fewer Complications

Eye health is of utmost importance to all of us, which is yet another reason to consider prescribing daily disposable lenses. In a 2010 Quick Poll4 by Contact Lenses Today, 89 percent of respondents believed the daily disposable modality is associated with a general reduction in contact lens-associated complications [Dec. 19, 2010]. Thus, the daily disposable modality may play an important role in promoting ocular health with contact lens wear, and there may be several reasons for this.

In a recent Web-based survey, contact lens wearers reported low compliance in hand-washing, lens-wearing times, rubbing and rinsing lenses, topping off solutions and lens case cleaning.7 None of the respondents wearing planned replacement or daily wear soft lenses or GP lenses reported total compliance; however, 8.9 percent of U.S. daily disposable lens wearers reported full compliance in all behaviors.

Addressing Allergy Symptoms

Ocular allergy symptoms can be especially challenging for contact lens wearers, because allergens and irritants can accumulate on lens surfaces. Replacing lenses daily can help improve comfort for allergy prone patients.3

A study by Solomon and colleagues found that patients wearing daily disposable lenses had decreased lens deposits and fewer associated tarsal abnormalities than those wearing 2-week replacement lenses.3 Another study compared comfort and slit-lamp findings for contact lens patients with ocular allergy symptoms. In this crossover study, patients wore daily disposable lenses for 1 month and new pairs of their habitual lenses (mostly 2-week and monthly replacement modalities) for 1 month during allergy season.6 When comparing comfort, 67 percent of the patients reported better comfort with the daily disposable lenses than with their habitual lenses; 18 percent reported improved comfort with a new pair of their habitual lenses. Slit-lamp findings of bulbar redness, corneal staining, palpebral redness and lid roughness were improved with the daily disposable lenses compared with new habitual lenses.6 Some study participants reported they were able to reduce or discontinue use of their allergy medications while wearing daily disposable lenses.6

In another study, researchers found that practitioners were more compliant in prescribing the manufacturer’s recommended replacement schedule for daily disposable lenses than for 2-week replacement lenses.8 Similarly, patients were more likely to adhere to the recommended replacement schedule for daily disposable lenses than for 2-week replacement lenses. In other studies that compared patients wearing daily disposables with those wearing conventional daily lenses or frequent replacement lenses, those in the daily disposable groups had lower complication rates.3,9

Although one study10 found an increased risk of microbial keratitis with some daily disposable lenses — a somewhat perplexing finding — a more recent study found daily disposable wear to be highly protective against symptomatic corneal infiltrative events.11 Although daily disposable lens wear still requires proper hand-washing and compliance with daily replacement, this modality has eliminated the need for cleaning, disinfecting and storing lenses. Perhaps the removal of these steps has helped to improve compliance.

A Good Fit for Kids

Children can be successful contact lens wearers,12-14 and they report significantly higher satisfaction with their quality of vision when wearing contact lenses as opposed to eyeglasses during sports participation.15 Similarly, children who wear contact lenses report significantly higher self-perception of their physical appearance and social acceptance than those of the same age who wear eyeglasses.16

Studies specifically examining daily disposable lenses and children found high success rates.12-14 The children in these studies demonstrated good vision, good ocular health with no significant complications, and excellent lens-handling skills. Most of the children and their parents reported high levels of satisfaction with contact lens wear. The majority of wearers preferred contact lenses over spectacles for vision, comfort and their appearance.12 In addition, having a back-up supply of daily disposable lenses is helpful for children, who may lose or damage their lenses more often than adults.14

Because daily disposable lenses don’t require cleaning and disinfecting, they may be of particular benefit to children.14 While careful hand-washing and diligent attention to prescribed wearing times and follow-up visits remain important responsibilities for children and parents, daily disposable lenses may provide a convenient and consistently clean option.

Prescribing Rates on the Rise

According to an international survey, daily disposable lenses, while not as widely prescribed as 1- and 4-week replacement lenses, have gained popularity in the countries surveyed (Australia, Canada, Japan, The Netherlands, Norway, the United Kingdom, and the United States).17 Although they are especially popular in Japan, Norway and the United Kingdom, this survey found a significant increase in the prescribing rate for daily disposable lenses in the lesser prescribing countries (Australia, Canada, The Netherlands and the United States), especially in the last 3 years of the survey (2006 to 2008). Also of note in this survey, daily disposable lenses were worn more often by men, part-time wearers and patients who were slightly younger than those wearing reusable soft lenses.

Newly released data from 40 countries during the period 2007 to 2011 show daily disposable lenses are gaining in popularity and now represent nearly 25 percent of the soft lenses prescribed in these countries.18 According to this study, daily disposables are most frequently prescribed in Japan and parts of Northern Europe. According to these researchers, cost appears to be the most significant factor in prescribing daily disposable lenses, and they found a relationship between a country’s gross domestic product (basically, a measure of average wealth of individuals in a nation) and frequency of daily disposable fittings. In general, the countries with a higher income were associated with more daily disposable fittings. One notable exception was the U.S. market. Although the United States was among the top five countries for gross domestic product, it ranked 29th out of 40 countries for proportion of daily disposable fittings.18 Despite this puzzling finding, optimism for the growth of daily disposable lenses remains high in North America.

More recent data for the United States indicate that for the past few years, daily disposable lenses have enjoyed the highest yearly percentage growth rates of almost all categories.19 Data from the Contact Lens Spectrum Annual Report 2012 show that when compared with other modalities, such as 2-week replacement or quarterly replacement lenses, the daily disposable category showed substantial gains in 2012 compared to 2011. Daily disposables were used in about 17 percent of fits and refits for 2012, up from 14 percent in 2011 and 11 percent in 2009. Data from GfK Retail and Technology showed the daily disposable category grew by nearly 19 percent in the United States between January and September 2012 when compared with the same time period in 2011.19

Trend information for daily disposables for 2013 also appears positive. Data from a Contact Lens Spectrum survey regarding anticipated use for the coming year reveals that 64 percent of respondents expect to prescribe silicone hydrogel daily disposables, and 52 percent expect to prescribe hydrogel daily disposable lenses more frequently in 2013.19

When comparing data from 2011 and 2012 for Europe, Japan and the United States, daily disposables exhibited the highest growth rates in the U.S. market.19

Finally, a 2012 Quick Poll4 by Contact Lenses Today showed that 44 percent of respondents believe daily disposables will dominate the contact lens market in the next few years [Oct. 28, 2012]. These trends suggest that practitioners and patients are realizing the benefits of the daily disposable modality.

Understandable Trend

Daily disposable contact lenses are available with an extensive array of vision-correcting capabilities in numerous lens materials and a wide range of parameters. The prescribing rates for daily disposables are trending upward, and the benefits of daily disposables make that an easy trend to understand. CLS

References

1. Begley CG, Chalmers RL, Mitchell GL, et al. Characterization of ocular surface symptoms from optometric practices in North America. Cornea 2001;20:610-618.

2. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea 2007;26:168-174.

3. Solomon OD, Freeman MI, Boshnick EL, et al. A 3-year prospective study of the clinical performance of daily disposable contact lenses compared with frequent replacement and conventional daily wear contact lenses. CLAO J 1996;22:250-257.

4. Contact Lenses Today. http://www.cltoday.com/archive.asp

5. Efron N, Efron SE, Morgan PB, Morgan SL. A ‘cost-per-wear’ model based on contact lens replacement frequency. Clin Exp Optom 2010;93:253-260.

6. Hayes VY, Schnider CM, Veys J. An evaluation of 1-day disposable contact lens wear in a population of allergy sufferers. Cont Lens Anterior Eye 2003;26:85-93.

7. Morgan PG, Efron N, Toshida H, Nichols JJ. An international analysis of contact lens compliance. Cont Lens Anterior Eye 2011;34:223-228.

8. 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.

9. Suchecki JK, Ehlers WH, Donshik PC. A comparison of contact lens-related complications in various daily wear modalities. CLAO J 2000;26:204-213.

9. Suchecki JK, Ehlers WH, Donshik PC. A comparison of contact lens-related complications in various daily wear modalities. CLAO J 2000;26:204-213.

10. Dart JK, Radford CF, Minassian D, Verma S, Stapleton F. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology 2008;115(10):1647-1654.

11. Chalmers RL, Keay L, McNally J, Kern J. Multicenter casecontrol study of the role of lens materials and care products on the development of corneal infiltrates. Optom Vis Sci 2012;89(3):316-325.

12. Li L, Moody K, Tan DT, Yew KC, Ming PY, Long QB. Contact lenses in pediatrics study in Singapore. Eye Contact Lens 2009;35:188-195.

13. Walline JJ, Jones LA, Rah MJ et al; CLIP Study Group. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci 2007;84:896-902.

14. Walline JJ, Long S, Zadnik K. Daily disposable contact lens wear in myopic children. Optom Vis Sci 2004;81:255-259.

15. Rah MJ, Walline JJ, Jones-Jordan LA, et al. Vision specific quality of life of pediatric contact lens wearers. Optom Vis Sci 2010;87:560-566.

16. Walline JJ, Jones LA, Sinnott L, et al; ACHIEVE Study Group. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci 2009;86:222-232.

17. Efron N, Morgan PB, Helland M, et al. Daily disposable contact lens prescribing around the world. Cont Lens Anterior Eye 2010;33:225-227.

18. Efron N, Morgan PB, Woods CA; The International Contact Lens Prescribing Survey Consortium. An international survey of daily disposable contact lens prescribing. Clin Exp Optom 2013;96:58-64.

19. Nichols JJ. Contact Lenses 2012. Contact Lens Spectrum 2013;28(1):24-26, 28, 29, 52.



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