SiHy EXTENDED WEAR LENSES
Discover the Truth About the Wearing Habits of Patients
Knowing their behaviors will help you prescribe the best modality.
Dr. Eiden: In the following roundtable discussion, a panel of experts will review the myths, misperceptions and the medical evidence surrounding the safety of silicone hydrogel (SiHy) extended wear, or continuous wear, contact lenses. We'll uncover the truth about the relative risk of complications, such as microbial keratitis (MK). We'll put the data into a clinical and practical perspective, and make recommendations on how to select appropriate SiHy lens materials and designs and how to manage patients who want to wear their lenses overnight. First, we'll discuss the importance of becoming familiar with the lifestyle of your patients in order to prescribe the best contact lens modality.
DETERMINING PATIENT BEHAVIORS
Dr. Eiden: You're all familiar with the statistics regarding lens-wearing habits. Research consistently shows that about 50% of patients want to wear contact lenses overnight. Currently, almost 20% regularly wear their lenses overnight, and two-thirds admit to accidentally falling asleep or napping while wearing their contact lenses. What does this mean for your practice?
Dr. Sorrenson: I always ask my patients, "Do you ever fall asleep in your contact lenses?" and "Do you ever take a nap in them?" If they're sleeping in their lenses, I try to switch them into SiHys, because I want their corneas to get the most oxygen possible.
Dr. Eiden: Do you encounter patients who tell you what you want to hear? How do you get to the truth about the behaviors of your patients when it comes to wearing their contact lenses?
Dr. Davis: To get truthful answers, you have to develop a good rapport with your patients and communicate in a positive tone. For starters, remain nonconfrontational, and don't take it personally if they haven't adhered to your prescribed guidelines.
Next, frame your questions to get specific answers. Instead of saying, "How are you doing with your lenses?" try, "On a scale of 1 to 10, how would you rate your contact lenses?" "How can we make them a 10?" and "If you could change one thing about your contact lenses, what would it be?" Instead of asking, "Do you ever sleep in your lenses?" consider, "How often do you sleep or nap in your contact lenses?"
Dr. Hom: Additionally, I consider the patient's lifestyle. For example, if the patient is a mother of an infant, I may recommend continuous wear lenses — especially if she has a high prescription — so she can wake several times a night or fall asleep in a chair without a problem.
Dr. Eiden: Do some clinical observations lead you to believe patients aren't wearing their contact lenses as prescribed, even if they don't admit it?
Dr. Davis: I question patients while I look through the slit lamp. I may get suspicious if I see signs of hypoxia, such as epithelial microcysts, limbal conjunctival injection or excessive neovascularization at the corneal limbus (Figure 1). These signs are more common with low-Dk lenses. Also, you may notice patients aren't wearing their lenses as prescribed when they physically struggle to remove their lenses. After removal, they may rub their eyes or mention their eyes feel more sensitive. I explain that oxygen deprivation is likely the cause, and I recommend higher Dk/t continuous-wear lenses.
Figure 1. Signs of hypoxia, such as neovascularization at the corneal limbus, are more common with low-Dk contact lenses.
WHO'S BEEN SLEEPING IN THEIR LENSES?
Dr. Eiden: How do you get to the truth about the wearing habits of teenagers and college-age kids?
Dr. Goldberg: There's no question that they frequently fall asleep studying or watching TV. To choose a modality, I look at their activities, and I try to develop a rapport so patients don't feel intimidated. I might say, "What time do you usually get to bed at night?" A patient may tell me, "Eleven or 12 o'clock, after I've played some Wii for an hour." I know the lifestyle, and I know the patient is better off with the extra safety of continuous wear lenses. CLS
S. Barry Eiden, OD, FAAO, (moderator) is president and medical director of North Suburban Vision Consultants, Ltd., a private group practice specializing in primary eye care, complex contact lens management, treatment of eye diseases and refractive surgery. He's cofounder and president of EyeVis Eye and Vision Research Institute. He's an assistant clinical professor at the University of Illinois at Chicago Medical Center in the department of ophthalmology, Cornea and Contact Lens Service, and an adjunct faculty member of the Illinois, Salus, and UMSL Colleges of Optometry. Dr. Eiden has served as a consultant to Alcon, CIBA Vision and Synergeyes. He has received research funding from Alcon, Coopervision, EyeVis, Hydrogel and Synergeyes. He has been a member of advisory panels for CIBA Vision, Coopervision, Special Eyes and Synergeyes.
Jennifer E. Davis, OD, practices in Waynesboro, Va., and has been in private practice for 8 years. She was selected as Virginia's Young Optometrist of the Year in 2007. She's an adjunct assistant clinical professor at Pacific University College of Optometry and a visiting assistant professor of ophthalmology at the University of Virginia. Dr. Davis is a member of the Alcon speaker's alliance and the CIBA Vision speaker's bureau.
Fred Goldberg, OD, FAAO, is the founder of McLean Eyecare Center, a group practice in McLean, Va. He's served as a clinical faculty member at the Pennsylvania College of Optometry. He's lectured on pediatric contact practice and written articles on practice record keeping. He's the immediate past president of the Virginia Optometric Association and is the 2009 Virginia Optometrist of the Year. Dr. Goldberg has consulted for CIBA Vision.
Milton M. Hom, OD, FAAO (DipCL), practices in Azuza, Calif. He's a Diplomate in Cornea and Contact Lenses and has written more than 150 articles in various publications. He serves on several editorial boards and has published more than 25 abstracts and peer-reviewed studies. He's the author of Mosby's Ocular Drug Consult and Manual of Contact Lens Prescribing and Fitting, Third Edition. Dr. Hom has received research funding from Alcon, Allergan, AMO, Bausch & Lomb, CIBA Vision and Inspire.
Laurie Sorrenson, OD, FAAO, is part of a group private practice in Austin, Texas, and is 4th year Practice Management Coursemaster at the University of Houston College of Optometry. She's spoken extensively on therapeutic management of LASIK, glaucoma, dry eyes, keratoconus, topography, contact lenses, anterior segment pathology and oral medications. Dr. Sorrenson has been an advisor to CIBA Vision and Crystal Practice Management.
Loretta Szczotka-Flynn, OD, MS, FAAO (DipCL), is associate professor at Case Western Reserve University, Department of Ophthalmology & Visual Sciences, and director of the Contact Lens Service at the University Hospitals Case Medical Center in Cleveland. She's a Diplomate in the Cornea and Contact Lens Section of the American Academy of Optometry and Diplomate award chair for the section. She has received research funding from Alcon, CIBA Vision, Coopervision and Vistakon.