The Buiness of Contact Lenses
Old Technology Versus New: Both Sides of the Argument
By Clarke D. Newman, OD, FAAO
At dinner recently, the issue of when to prescribe a different lens or care system came up. There were two distinct positions on that issue. The first position is the fairly predictable one of not fixing things that are not broken. When patients are very happy, so the argument goes, with the lenses that they are wearing, what justification does the prescriber have for changing the situation?
I think the patient has to be perfectly happy, but so does the prescriber. If prescribers observe objective signs of trouble, then they are correct to advocate prescribing a different lens or care regimen—even when patients think all is well. The patients would then do well to accept that wise counsel.
The other argument is that we have a duty to our patients to prescribe the very best technology to each and every patient that walks through our door.
We take an oath that begins, “First, do no harm.” That is all well and good. However, do we do harm by not moving patients to “the better stuff?” It is a difficult question to answer, and it caused quite a bit of back-and-forth at dinner.
Is Newer Better?
When the lens companies spend fortunes to develop lens material and solution technology, the expectation is that what they bring to market is better than what is currently available and currently in use by the patient in the chair.
Fortunately, the overwhelming majority of what comes to market is an incremental, if not a quantum, step forward.
The first question that has to be answered is, essentially, “Is newer better?” Amid the hype and huff of new product rollouts, we often do not really get a firm grasp on the true benefits and the true liabilities until the new products have been in service for an extended period and across a wide cross section of patients.
The eyecare industry has not been immune from the same sorts of product failures that have plagued other areas of health care. Further, even when products measure up to expectations, they sometimes do not demonstrate the benefits that were anticipated when held to the rigor of scientific review. The evidence base can sometimes stack up against our conventional wisdom in an uncomfortable fashion.
Take the incidence of microbial keratitis and bacterial protein binding. When silicone hydrogel lenses were first introduced, it was widely speculated that these two problems would be greatly reduced. The evidence base now shows that this has not happened.
Yet, we have all, myself included, embraced this technology. The same is true of the multipurpose solutions when compared to peroxide.
I worry that we trivialize the argument because we are dealing with devices and solutions. If one of your glaucoma patients were being successfully treated with an older, cheaper medication, would you change the patient to a newer drug, just because?
Putting Patients First
Someone at dinner quoted the business guru, Robert Kriegel, who said, “If it ain't broke, break it!” A catchy business axiom to be sure, but does that sort of thinking have any business being insinuated into the doctor-patient covenant? No.
We must advocate for our patients with their interests above our own. We must do so with the full weight of the evidence base behind total informed consent because the patient gets a say.
No one supports industry more than I, but our first duty is to our patients, and not to fix things that ain't broke. CLS
Dr. Newman has been in private practice in Dallas, Texas since 1986 specializing in vision rehabilitation through contact lenses as well as corneal disease management, optometric medicine and refractive surgery. He is also a consultant or advisor to B+L. You can reach him at firstname.lastname@example.org.