A WORLD OF OPTIONS

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Alcon’s DAILIES AquaComfort Plus provides Blink-Activated Moisture Technology with every blink.
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1-DAY ACUVUE TruEye by Johnson & Johnson Vision Care features HYDRACLEAR 1 Technology to create a highly wettable and ultra-smooth lens.
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Paragon Vision Sciences was the first company to receive FDA approval for overnight corneal reshaping with Paragon CRT, shown here.

Grow your practice by putting—and keeping—kids in contact lenses.

One thing that contributed to my interest in becoming an optometrist was my early experience with contact lenses. After months of avoiding wearing my glasses to school when I was in fifth grade, my parents were sensitive enough to bring me back to my ECP to be fit with contact lenses.

Although glasses are now more fashionable and a lot of kids are actually interested in wearing them, they are still shunned by some kids and teens much like I was when I first found out I needed them. Today, it is more common for children to be wearing contact lenses at a young age. This is partly due to the many benefits that both ECPs and parents recognize for today’s active children and teens.

Increasing the number of kids in your practice that wear contact lenses begins with your conversation during the exam and your professional recommendations. By discussing with parents which activities their kids participate in, the way contact lenses can help them naturally follows.

TALK THE TALK
Many parents still think of contact lenses as being more work than they truly are, or they remember having to wait until they were teens themselves for their parents to consider it. Let parents know that contact lenses are not only a practical choice, but the vision benefits and increase in self-confidence can change their children’s lives. For example, many kids choose to not to wear glasses for sports. Those with relatively low prescriptions may not feel it’s a significant difference, yet clearer vision can make a big impact on their performance. When asked, kids are more likely to want to wear contact lenses on the field or court than glasses.

SHOW AND TELL
In many cases, actions speak louder than words. Showing a parent what their child’s vision is like uncorrected can be very powerful. A simple demonstration with a set of loose lenses or a trial frame will let a parent understand what their child is seeing  and what they are missing. They then realize how hard it can be to hit or catch a ball, perform well, and even see clearly in the classroom.

There are a couple of choices for children when it comes to contact lenses: Daily disposables and Ortho-K. What follows are examples of some of what I consider the “better” options.

DAILY DISPOSABLES
With a minimum of lens care and a higher compliance of replacement, daily disposable lenses are an ideal choice for children and teens. Here are some of the more popular ones worth discussing with your patients. (For a complete listing of current options, see “Daily Disposables At-A- Glance.”)

  • Alcon’s DAILIES AquaComfort Plus (nelfilcon A): These lenses feature Blink-Activated Moisture Technology whereby moisture is released on both sides of the contact lens with every blink.
  • Alcon’s DAILIES Total1 (delefilcon A): The first and only water-gradient contact lens, DAILIES Total1’s  water content increases from 33% at its silicone hydrogel core to an average of 80% at the surface of the lens, approaching nearly 100% at the very outer surface. According to the company, the outer 6µm of the lens is composed of an ultra-soft, hydrophilic surface gel with exceptional lubricity.
  • Bausch + Lomb’s SofLens daily disposable (hilafilcon B): Its ComfortMoist Technology provides all-day comfort and the high-definition optics reduce appearance of blurriness, halos, and glare in various conditions.
  • Bausch + Lomb’s Biotrue OneDay (nesofilcon A): B + L refers to the lens material as HyperGel, which it states was designed to mimic the eye’s ability to prevent dehydration for better comfort and vision.
  • CooperVision’s ClearSight 1 Day (ocufilcon B): An advanced lens design minimizes lid interaction ensuring a comfortable lens wearing experience and also features UV blocker protection.
  • CooperVision’s Proclear 1 Day (omafilcon A): Aspheric optical design in Proclear 1 Day corrects lens and theoretical corneal aberrations. The Proclear material is the only lens that has FDA-cleared indication for improved comfort from dryness or mild discomfort during lens wear, according to CooperVision.
  • Safigel’s Safigelâ„¢ 1 Day (methafilcon A): Contains Hyaluronate Gel, a natural lubricant found in the tear film. With every blink, Safigel releases hyaluronate into the area between the lens and the cornea, which Safigel says provides welcome relief from the feelings of grittiness and friction that are often caused by conventional lenses.
  • Johnson & Johnson Vision Care Inc.’s 1-DAY ACUVUE MOIST (etafilcon A): LACREON Technology permanently embeds a hydrophilic wetting agent into the lens to create a cushion of moisture.
  • Johnson & Johnson Vision Care Inc.1-DAY ACUVUE TruEye (narafilcon A): The first silicone hydrogel daily disposable lens in the U.S. features HYDRACLEAR 1 Technology to create a highly wettable and ultra-smooth lens.

THE ORTHO-K OPTION
The prevalence of daily disposable contact lenses has likely helped shift how ECPs prescribe contacts lenses for kids. Another area that has grown, albeit far slower, is the use of orthokeratology lenses to reduce myopia progression in children.

Ortho-k treatment occurs from the fluid forces that arise from tear interactions with the lens periphery when it exerts a “pulling” force on the contact lens. The epithelial layer conforms to the shape of the lens base curve.

Unlike soft contact lenses, most patients are not familiar with this type of option which is why a number of techniques should be employed to help grow this segment of the business. Parents who are very nearsighted and have gone through years of glasses or contact lens dependency will appreciate ortho-k’s benefits of myopia control for their kids. Those who have had LASIK will also quickly understand the advantages of having lenses that can slow the progression of changes.

Don’t judge a parent and think they will not spend the money for ortho-k. Some will do anything for their kids and they place a high return on their investment by not allowing their child’s myopia to worsen over the years. I recommend discussing ortho-k’s benefits early on when myopia begins to present. An explanation of how it will likely progress presents both the patient and parent with information they can use to make a decision about proceeding with ortho-k lenses.

Numerous contact lens manufacturers have orthokeratology lenses available. Some examples include:

  • Paragon Vision Sciences Paragon CRT (Corneal Refractive Therapy): Paragon was the first lens to receive FDA approval for overnight corneal reshaping. Since FDA approval in 2002, Paragon CRT continues to have the highest overnight corneal reshaping approval for myopic correction (up to -6.00D sphere with or without 1.75D cylinder), and oxygen permeability with Paragon HDS 100 (100 Dk*) or Menicon Z material (163 Dk* ““ *ISO/ANSI Method), according to the company. Note that Safigel uses the term “corneal reshaping” when talking about CRT.
  • Bausch + Lomb Vision Shaping Treatment (VST): This VST uses Euclid Systems orthokeratology designs. Euclid manufactures its Emerald lens under the B + L brand.
  • In addition, many other VST designs, including Dreamlens, OK E System, Ortho-Focus, CKR, Super Bridge and E-Lens, Vipok, Wave Ortho-K, Miraclens, and BE Retainer, are available from various authorized Boston laboratories.

With thoughtful discussions about contact lenses with both your pediatric patients and their parents, you can grow your contact lens practice and offer youngsters the best in vision, health, and convenience for their eyes.

Eric L. Bran, Professional Editor of Optometric Office, is in a private group practice in Ridgefield, CT.

WHERE TO FIND IT:
Alcon Laboratories, Inc.
800-451-3937
alcon.com
Bausch + Lomb
800-828-9030
bausch.com
Boston Laboratories
508-869-7858
bostonlabs.com
CooperVision, Inc.
800-341-2020
coopervision.com
Paragon Vision Sciences
800-528-8279
paragoncrt.com/getcertified
Safigel
877-723-4435
safigel.com
Johnson & Johnson Vision Care, Inc.
800-843-2020
ACUVUEProfessional.com
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