I have seen the soft contact lens market accelerate in exciting ways over the past 20 years. Companies are trying to stay ahead of what patients want and for the most part, they have been doing an excellent job. Soft contact lenses that have out-performed their usefulness have been discontinued. Companies are changing their names such as Ciba Vision, now Alcon, and Vistakon, now Johnson and Johnson Vision Care. 1-day contact lenses are becoming more numerous and more available in spheres, torics and multifocals.
One Day at a Time
There are now 1-day colored contact lenses available. Because these lenses can only be worn one time, there is less of a chance that a patient will over-wear their contact lenses causing irritation and the potential for infections. Patients should never sleep in 1-day contact lenses, so the risk of over-wear is also eliminated. Since a contact lens case is no longer needed, there is no chance that a contaminated case can be a source of infection. No solutions are necessary for 1-day use, so “topping-off” a case is eliminated. And those patients that have solution sensitivities or allergies to these products no longer have this problem.
There are many patients who still like to wear their glasses most of the time. But they may have social events, occupational requirements, or sports activities where a daily soft lens may be necessary or appropriate. There are some patients who are wearing soft contact lenses who believe that soft contact lens solutions and saline are the same. Some patients mistakenly use saline to clean or to store their lenses which is never appropriate. Saline can be used as a rinse, if needed, but should never be used in conjunction with cleaning, disinfecting, or storing any contact lens. This problem will also be eliminated with 1-day soft contact lenses. The costs of solutions are also eliminated.
Examination & Education
Any patient who is considering contact lenses must have a complete eye examination and contact lens evaluation. All aspects of eye health must be evaluated. Any dry eye conditions, corneal irregularities, irregular astigmatism, amblyopia, retinal problems, or any eye diseases must be considered before any patient can become a successful contact lens wearer. Patients must be educated concerning insertion, removal, wearing schedule, emergency procedures, and realistic expectations. Contact lens training and education will involve direct explanations when educating a first-time contact lens patient as to how to insert and remove a contact lens.
Numerous websites and on-line videos can enhance this educational process and handouts to be read at home may be something to be considered. Patients should be provided trial lenses during this learning process. Patients should be advised to put their lenses on at home initially until they become comfortable with the process. Schedules must be adjusted for the working person, the young adult who is in school, or the person who has an at-risk job. Case histories will disclose if a patient should be wearing contact lenses in a risky work environment. Dusty environments may not be the ideal place for someone to be wearing any contact lens. And those patients who are operating machinery, using chemicals, operating heavy equipment, or using power tools or mechanical equipment must always be advised to protect their eyes with safety glasses, safety lenses, and a safety frame.
A thorough case history should always include the question, “are you doing anything risky at work or at home and do you have any hobbies or participate in any sports that may place the safety of your eyes at risk?” Many people may have day jobs where there are no risks during the day. These same people then come home to work on their sports car, go to a boxing class, soccer match, or play basketball that may place their eyes at risk. And during the warmer months of the year, many patients forget to protect their eyes from weed trimmers or lawn mowers.
Written instructions and phone numbers in case of an emergency should always be provided to a new contact lens patient. Parents must be informed at all times of the costs, risks, and benefits of contact lenses. And a final follow-up should be scheduled whenever the ECP feels it is appropriate. Contact lens prescriptions must be provided to a patient by law. If the patient is experiencing presbyopic symptoms, then a daily multifocal may be a good option. All costs, risks, and benefits should be discussed with the patient so that there is a realistic understanding of the facts. If patients have a vision insurance plan, they should know what is paid for and what is not paid for. As an example, some plans will pay for a “fitting” fee, some plans will not. Some plans cover certain types of contact lenses, but not daily contact lenses. Some plans do not cover contact lenses at all and only provide glasses to a patient.
Staying Up to Speed
In order for ECP’s to keep up-to-date concerning contact lenses and contact lens products, Tyler’s Quarterly is an excellent source of information. Their website is located at http://tylersq.com/orderform.htm where you can find out about subscription information. Or check each contact lens company’s website to see if the product you need is available. Many of these companies including Cooper Vision have on-line ordering available. Every company that manufactures contact lenses is listed in Tyler’s Quarterly.
All fitting parameters and contact lens characteristics are provided for every contact lens including base curves, diameters, material, water content, FDA#, Dk values, unit costs, sphere and cylinder powers, available axis, optical zones, center thickness, toric markings, and disinfection methods. There are a number of companies that manufacture one-day contact lenses, some of the major ones include: Alcon, Bausch and Lomb, Clearlab, Cooper Vision, Johnson and Johnson Vision Care, Optical Connection, The Preferred Vision Group, and Unilens Corporation. Each of these manufacturers has at least one, and most of them have multiple different lens options to choose from.
Some of those options include high astigmatism lenses, U.V. lenses, and more. In general, the products are similar from company to company. However, they tend to vary in their base curves and diameters, which helps when trying to get a perfect fit on a patient. If one vendor is a little too ‘tight’ on the eye, another vendor may be perfect. Of course, once I find the best lens for the patient, I give them at least a week to try the lenses to make sure they are happy and understand the wearing schedule, as well as the do’s and don’ts of the lenses.
As the demand for daily lenses continues to increase, the supply from these companies and from others will also increase. For those patients who need toric lenses, the cylinder powers are readily available. Unfortunately, not all axis are available yet, including many of the oblique axis. But I would expect this to improve in the future. New products will be introduced in the future and it will be important for all ECPs to review their journals for updates. ECP journals such as Contact Lens Spectrum have always been a good source of current and updated information that is available on-line as well as in a printed edition that can be mailed to your office.
Keep in mind that the idea here is not to improve your bottom line with lens sales. There’s little to no direct financial incentive to this – you’re not going to make much more money by offering these. The point here is to provide increased patient satisfaction, which can in turn have a number of intangible benefits. Since daily contacts can help to reduce a number of common risks, you’re going to have to deal with fewer problems resulting from lens overuse. This includes a lower possibility of contamination and infection from using old cases, as well as completely eliminating problems from lens solutions, since there aren’t any. It’s a win-win for both you and your patient. They don’t need to buy solutions or lens cases, and you have fewer problems. When there are fewer problems, you’re more likely to get positive referrals, and spend far less time troubleshooting and dealing with an unhappy patient.
— Jason Smith,O.D.,M.S.