DAILY DISPOSABLE LENSES
One-Day Lenses—Past, Present, and Future
Fifteen years after one-day lenses hit the world stage, renewed interest in ocular health, part-time wear, and pediatric fitting is shining a spotlight on the modality.
By Colleen M. Riley, OD, MS, FAAO
Dr. Riley is vice president of Professional Development for Vistakon.
This year marks the 15th anniversary of the introduction of 1-Day Acuvue (Vistakon) contact lenses, the first one-day lenses. Today, every large contact lens manufacturer offers one-day lenses, proof of the commitment that all of us have to the ocular health, performance, and comfort benefits of a fresher lens.
The contact lens industry has developed the lens design, manufacturing technology, and supply chain innovations required to produce high-quality contact lenses at a price that makes daily lens replacement affordable. But the drive to do so was sparked by practitioners such as Hikaru Hamano, MD, the founder of Japan's largest contact lens practice and an early researcher on the effects of contact lens wear on the cornea and tear film.
“Dr. Hamano was a great believer in the concept of daily disposable lenses,” says Yoshihiro Igarashi, OD, director of Professional Medical Affairs for Johnson & Johnson Vision Care in Japan. Because he preferred for patients to use sterilized lenses every day without relying on their compliance or proper contact lens care, Dr. Hamano tested Acuvue lenses on a daily disposable basis in his clinic.
“He was always seeking better answers for his contact lens patients and he was passionate about gathering hard data,” says Dr. Igarashi. Dr. Hamano's landmark 1994 study of complication rates in more than 23,000 contact lens wearers demonstrated that one-day contact lenses offered the lowest rate of complications (Hamano et al, 1994). “Largely as a consequence of that research, one-day lenses have been widely accepted by Japanese ophthalmologists and a safety-conscious Japanese public ever since,” says Dr. Igarashi.
And the Japanese are not alone in their preference for this contact lens modality. According to the most recent international survey results, one-day contact lenses account for 30 percent to 70 percent of contact lens fits in many countries in Europe, Asia, and the Near East, compared to less than 10 percent in the United States and Canada (Morgan et al, 2010) (Figure 1).
Figure 1. A survey on prescribing trends in 2009 shows dramatic differences in one-day lens fits by country and region, with the United States among the lowest in the world.
United States Views
“In this country, one-day lenses have typically been viewed only as problem-solvers,” says Brad Ripps, OD, of Lake Hopatcong, N.J. “And while they are a great option for allergy sufferers or GPC patients, I have found over the years that many of my frequent-replacement patients experience discomfort at the end of a wearing cycle and could benefit from daily replacement.” Today, two-thirds of his contact lens patients are in a one-day modality.
There is no denying that the cost of one-day lenses compared to traditional frequent-replacement has been a major barrier to others following his lead. Many doctors feel uncomfortable recommending a more expensive lens.
“Patients aren't as focused on cost as we think they are,” says Dr. Ripps. “What they really want is for their practitioner to tell them what is best for them.”
The Four Cs: Convenience, Compliance, Comfort, Clarity
And are one-day lenses the best? They certainly offer tremendous advantages in terms of convenience. There are no wearing schedules to remember, no solutions to buy, no case to clean. A number of studies have shown that compliance with the recommended replacement schedule is higher with one-day lens wear than with any other modality (Dumbleton et al, 2009; Dumbleton et al, 2010; Yeung et al, 2010).
Even with first-generation one-day lenses, patients often reported better comfort, vision, and satisfaction compared to traditional daily wear (Solomon et al, 1996; Nason et al, 1994). In 2007, Vistakon incorporated advanced wetting technology into a one-day lens with the introduction of 1-Day Acuvue Moist with Lacreon technology. This technology employs a process that is designed to lock in moisture that lasts throughout the day. During the next few years, other manufacturers introduced one-day lenses with their own technology, including Ciba Vision's Dailies AquaComfort Plus, Bausch + Lomb's SofLens Daily Disposable lenses and CooperVision's Proclear 1-Day daily disposable lenses.
Going beyond comfortable materials, newer one-day lenses also offer ocular protection and design advantages. Among contact lens brands, for example, 1-Day Acuvue Moist offers up to 82 percent UV-A and 97 percent UV-B protection. Bausch + Lomb introduced aspheric optics with its SofLens Daily Disposable. Toric and multifocal one-day lenses are now available from several manufacturers (Table 1).
“Each generation of one-day lenses seems to be an improvement over the previous one,” notes Bellevue, Wash., optometrist Stephanie Kitamura. “In general, the clarity of vision with one-day lenses is superior, because there is no filminess, no coating, and no particulates from the environment,” says Dr. Kitamura, who had previously struggled with contact lens wear herself. “I love wearing one-day lenses, so it's very easy for me to talk about the benefits to my patients,” she says. “Once they try them out, most patients decide that one-day lenses are well worth the additional cost.”
Ocular Health and Safety
A number of studies have shown that daily replacement is a safe and healthy modality (Yeung et al, 2010; Nason et al, 1994; Suchecki et al, 2000). In a year-long prospective trial, Sankaridurg and colleagues (2003) demonstrated that one-day hydrogel lens wear was nearly as safe as spectacle wear, something Morgan and colleagues (2009) also found true of silicone hydrogel one-day wear after one month. In the silicone hydrogel study, with the exception of conjunctival staining, there were no clinically or statistically significant physiological differences between the spectacle wearers and the lens wearers after one month of wear.
But large epidemiological studies looking at corneal disease have produced some surprising results (Stapleton et al, 2008; Dart et al, 2008). “The one-day modality does not seem to have affected the absolute risk of infection compared to daily wear,” says Fiona Stapleton, PhD, MCOptom, FAAO, professor and head of the School of Optometry and Vision Science of the University of New South Wales in Sydney, Australia. “What we do know is that one-day wear is associated with less severe disease.”
She notes that brand differences in studies of both bacterial keratitis and sterile corneal infiltrates indicate that material and design, independent of modality, continue to play a role in the rate of complications (Dart et al, 2008; Radford et al, 2009).
In recent years, there has been a trend worldwide toward prescribing silicone hydrogel lenses for their superior oxygen transmission. Until recently, health-conscious wearers had to choose between one-day wear and silicone hydrogels, but 1-Day Acuvue Tru-Eye (Vistakon), the world's first one-day silicone hydrogel lens (currently marketed in Canada, the United Kingdom, Germany, Italy, Spain, France, Russia, and Poland and recently launched in the United States), offers both. Studies have shown that patients find this lens to be consistently comfortable throughout the day (Morgan et al, 2009) (Figure 2).
Figure 2. Wearer comfort in 1-Day Acuvue TruEye was comparable to that of spectacle wearers. Comfort did not diminish throughout the day (Morgan et al, 2009).
“1-Day Acuvue TruEye was really the answer we were looking for,” says Hayley Wainer, Bsc(Hons), MCOptom. She has been fitting her London patients in one-day lenses since they were first introduced and now estimates that 60 percent to 70 percent of her patients use the one-day modality.
“We've always viewed one-day lenses as more convenient and healthier than extended wear,” Dr. Wainer says. “That is especially true with a silicone hydrogel. We have patients with incredibly long wearing times,” she says. “A silicone hydrogel that provides as much oxygen as possible to the cornea, with all the convenience and hygiene benefits of a one-day lens, is ideal.”
Kids and Allergy Sufferers: A Natural Constituency
“Pediatric fitting has been the biggest market for one-day lenses in our practice,” says Lance I. Alpert, OD, who practices in Manchester and Glastonbury, Conn. “Parents immediately appreciate that with this modality they have a lot less to worry about,” he says. “The common concerns about whether a child can properly clean and care for his contact lenses just disappear.”
Moreover, the potential health and safety benefits also resonate strongly with parents. “I can say unequivocally that patients in my practice who wear one-day lenses have a much lower incidence of ocular irritation and unscheduled visits. That's a benefit I impart to parents,” Dr. Alpert says. Parents of children enrolled in the Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study overwhelmingly (93 percent) chose one-day contact lenses when given the option between two-week and one-day contact lenses for their children (Walline et al, 2009).
Ocular allergy sufferers are another natural constituency. Very soon after the introduction of one-day contact lenses, we learned that these patients can benefit from minimizing their exposure to allergens and irritants that can accumulate with repeated use of a single pair of lenses. In fact, 67 percent of ocular allergy sufferers who switch to one-day contact lenses report improved comfort over their habitual contact lenses, and they exhibit improved slit lamp findings after one month of lens wear (Hayes et al, 2003).
In Britain, part-time wear of contact lenses for sports and social activities is very common. About 40 percent of one-day lens wearers there use contact lenses on a part-time basis (Efron and Morgan, 2008).
“We have many patients for whom there simply is no contact lens available that can provide them with sufficiently good vision and comfort to wear it all day, seven days a week,” says Glasgow, Scotland, optometrist Peter Ivins, BSc, MCOptom. “One-day lenses give them an opportunity to wear contact lenses occasionally, perhaps for activities in which vision demands are different.”
For part-time wearers, the one-day contact lens modality can actually be more affordable and safer than trying to remember how often they have worn and/or disinfected a standard replacement contact lens.
Will Britain's degree of part-time wear ever catch on in the United States? Our research shows that American patients are very accepting of using both contact lenses and glasses to meet different visual needs (Neadle et al, 2009). Especially for presbyopes, the combination of PAL spectacles with either multi-focal or one-day contact lenses may be ideal. But Robert A. Davis, OD, in Pembroke Pines, Fla., says too many patients don't even know that part-time wear is an option.
“I give my spectacle wearers a trial pair of one-day lenses to wear while they are choosing new frames,” Dr. Davis says. “Most of them have never even thought of wearing contact lenses, but when they come back into the exam room, I now have an opening to ask how the lenses felt and whether they would like to have some on hand for golf or evenings out. They are almost always pleasantly surprised and eager to add a few boxes of one-day lenses to their glasses order.”
Creative approaches like this are a great way to introduce patients to contact lenses without a full-time commitment. “Lens technology has come a long way in the 35 years I've been fitting contact lenses,” says Dr. Davis, “But I fully expect that someday we will only fit one-day lenses.”
A Peek in the Crystal Ball
Whether through a healthy start in childhood, comfort and convenience during the working years, or part-time lens wear at any stage of life, one-day lenses offer many opportunities for patient success and enhanced satisfaction.
Across the board, contact lens manufacturers have been expanding the parameters and range of patients who can wear this modality, spurred on by practitioners who want to give all of their patients the very best options. Thanks to a combination of new technology development and the initiative of clinicians who are exploring new ways to help their patients who have allergy, glaucoma, and other conditions, contact lenses may soon be able to treat medical conditions. The next 15 years of innovation in lens development and practice promise to be very exciting. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #177.