Whether patients are interested in full-time or part-time wear, the options have expanded.
During the last 30 years, advances in contact lens modalities have vastly increased the number of candidates eligible to wear them. Now, many former contact lens wearers and most new wearers in our practice choose daily disposable lenses for the obvious simplicity in wear and care and the less obvious decrease in complications.
We tell patients that what they used to spend on solutions, they can now spend on having fresh lenses every day. Giant papillary conjunctivitis and corneal abrasions as a result of contact lens wear are rare now, but at one time, I had this discussion with patients daily.
We choose the initial daily lens based on patient experience factors. We usually fit patients who need spherical or toric lenses or who have never worn contact lenses before with a standard daily disposable lens such as Alcon’s DAILIES AquaComfort Plus or 1-Day Acuvue Moist from Johnson & Johnson Vision Care. We find these lenses perform well for most patients who wear contact lenses part time or for most first-time wearers.
For patients who have had past contact lens discomfort or report symptoms of dryness, we usually move to Alcon’s DAILIES TOTAL1 or Johnson & Johnson’s ACUVUE OASYS1-DAY. We’ve had success with all of these lenses.
The latest benefit of the newest crop of daily lenses is our ability to offer part-time wear to those who never thought that they were contact lens wearers. Patients are delighted when we give them a free trial of daily lenses in the office while they are looking at glasses. Getting a supply of contact lenses to wear on weekends or vacation is a smaller expense than many other discretionary items commonly used today.
Even so, we cannot ignore the large difference between the least and most expensive daily disposable lenses. We believe that patients need to be convinced of the necessity for a specific lens even if it costs several times more than the cheapest lenses.
It’s not that we cannot complete the initial fit. Without explanation, however, we will lose the reorders and potential referrals of the patients’ family and friends if the patient thinks we were too expensive. This means that we try to thoroughly explain not only the features and benefits of the lens modality fit but why we chose a specific lens.
In our practice, presbyopes represent the biggest untapped pool of patients to fit with contact lenses. Statistically, this is the group with the lowest penetration of contact lens use, yet we’ve found a huge potential pool of these patients who are
interested in trying contact lenses. To them, the opportunity to take a break from wearing glasses every day is very appealing.
Managing expectations is the key to success. I normally tell patients that I can replace glasses for 90% to 95% of their day. Trying to get 100% patient happiness will drop your success rate dramatically and increase your frustration. By aiming for good enough, patients are much more likely to be happy. If patients push you for just a little better (distance, near) you are likely to fail.
I tell patients to think of their distance and near vision like a balloon. If we change (squeeze) one end, it changes the other. So, if they want better vision, something else will change. This understanding will usually yield more thoughtful requests at the first check-up.
I almost always use unequal adds when fitting daily bifocal contact lenses. I find this gives a good combination of distance, intermediate and near vision. Many guides recommend this, but this approach, when compared to monovision, improves both distance and near vision. It also improves the likelihood of acceptable night driving.
This method is especially good for either general purpose vision or social events. I have found that there is rarely success if the distance vision is not acceptable. A big improvement in our success rate with daily disposable lenses for presbyopia is a direct result of lenses having better optics and comfort. Lenses such as the J&J’s 1-DAY ACUVUE MOIST Brand MULTIFOCAL Contact Lenses and Bausch + Lomb’s Biotrue ONEday for Presbyopia have good comfort and, with careful fitting, can result in happy patients.
DAILY DISPOSABLE CONTACT LENSES
Alcon | 800.451.3937 | Alcon.com
DAILIES AquaComfort Plus, DAILIES AquaComfort Plus Multifocal, and DAILIES AquaComfort Plus Toric
DAILIES TOTAL1 and DAILIES TOTAL1 Multifocal
FOCUS DAILIES, FOCUS DAILIES Progressives and FOCUS DAILIES Toric
Bausch & Lomb | 800.828.9030 | Bausch.com/ecp
Biotrue ONEday, Biotrue ONEday for Presbyopia, and Biotrue ONEday for Astigmatism
SofLens Daily Disposable and SofLens Daily Disposable Toric for Astigmatism
ClearLab | 888.777.7147 | ClearLabUSA.com
eyedia fresh daily disposable
CooperVision | 800.341.2020 | CooperVision.com/practitioner
clariti 1 day, clariti 1 day multifocal and clariti 1 day toric
Proclear 1 day and Proclear 1 day multifocal
Menicon | Menicon.com/pro
Miru 1 day Menicon Flat Pack
Vistakon | 800.843.2020 | ACUVUEProfessional.com | firstname.lastname@example.org
1-Day ACUVUE Define
1-DAY ACUVUE MOIST, 1-DAY ACUVUE MOIST for ASTIGMATISM and 1-DAY ACUVUE MOIST
1-DAY ACUVUE TruEye
ACUVUE OASYS 1-DAY with HydraLuxe Technology and ACUVUE OASYS 1-DAY with HydraLuxe Technology for Astigmatism
X-Cel Specialty Contact Lenses | 800.241.9312 | XCelSpecialtyContacts.com
Extreme H2O Daily
One of the biggest obstacles to success is still overcoming patient perceptions. Proper staff training to at least suggest that contact lenses are an option is the only way to succeed.
Once there is interest, a hassle-free trial may lead to a full evaluation. If not, then perhaps it will just lead to a water cooler conversation and referral to someone even more motivated.
David H. Hettler, OD, is principal partner in a seven-location practice in Virginia.