DEALING WITH THE DROPOUT ISSUE

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Alcon’s SYSTANE Lid Wipes are effective in removing oil, debris, and desquamated skin associated with problem eyelids.
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LASTACAFT, an Allergan product, is a prescription medicine approved for the prevention of itching associated with eye allergies.
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RevitaLens OcuTec Multi-Purpose Disinfecting Solution from AMO offers broad-spectrum disinfection comparable to peroxide. 

By treating the ocular surface, ECPs have a greater chance to make their CL patients comfortable.

It’s no secret there’s been a slowdown in contact lens usage. It’s also no secret that the key reason patients leave the contact lens arena is because of discomfort. With all the advances in materials, designs, and cleaning solutions over the last two decades, we would have anticipated lower dropout rates, but sadly, this doesn’t hold true.

While we know not all patients’ eyes are amenable to lens wear, we also know that from a prescription standpoint, there are a much larger number of patients that can now be fit into lenses. Asking questions is key to closing the gap. For example, when a current contact lens wearer tells you of her lens issues, do you just leave the issue on the table, or do you dig deeper? What discussions, if any, are you having about maintaining a healthy ocular surface?

We all know a healthy ocular surface is critical for comfortable contact lens wear, yet how often, despite seeing mild corneal, conjunctival, and lid margin issues, do we continue to move forward and fit patients with contacts? Shouldn’t we stop for a second and wonder if this is jeopardizing their long-term success?

LIDS AND LASHES
When patients express issues with lens discomfort, instead of thinking of what other brand or material to change the patient into, your first thought should be: I wonder what the lids and lashes look like. Meibomian gland dysfunction (MGD) is extremely common and contact lens dryness is often cited as the main reason for discontinuing lens wear.

If MGD is present, you need to educate your patient about improving lid hygiene. Warm compresses daily for two weeks and cleaning of the lids and lashes should be stressed. TheraTears Sterilid Eyelid Cleanser (Advanced Vision Research), OCuSOFT lid scrub pre-moistened pads  and foam (OCuSOFT), and SYSTANE Lid Wipes (Alcon) are all effective in removing oil, debris, and desquamated skin associated with problem eyelids. Frequent use of these cleansers can improve contact lens comfort and can effectively remove eye makeup.

In addition to cleaning of the lids and lashes, using omega-3 supplements and Restasis (cyclosporine ophthalmic emulsion) 0.05% (Allergan) helps the eyes’ natural ability to produce tears which may be reduced by inflammation due to chronic dry eye.

THE AGE ISSUE
With a large population of contact lens patients now in their 40s, wearing contact lenses comfortably can become more challenging. With dryness and lens intolerance issues, educating patients about using the right solutions, along with proper cleaning becomes increasingly important.

This often leads to the generic brands discussion. What most patients don’t realize is that in saving a few dollars, they may be compromising the comfort of their lenses by using solutions that are less than ideal for their lens material. If you’re not questioning patients about the solution they use and specifically how they clean their lenses, you may be ignoring a contributing factor to their lens discomfort.

SOLUTION SOLVERS
These are the most commonly recommended solutions for soft hydrophilic and silicone hydrogel lenses:

  • OPTI-FREE PureMoist Contact Lens Solution (Alcon) features HydraGlyde Moisture Matrix which provides moisture that lasts from morning until night. The solution forms a cushion of moisture across the surface of the lens, creating a barrier that reduces deposits and removes dirt. It also decreases oily deposition for clear vision while being gentle enough for sensitive eyes.
  • OPTI-FREE RepleniSH multi-purpose solution (Alcon) is formulated to provide a high level of moisture. RepleniSH is a sterile, buffered, isotonic solution that contains sodium borate, sodium chloride, propylene glycol, and sodium citrate. The TearGlyde formulation provides the lenses with a layer of moisture all day, leading to comfortable, moist lenses and clearer vision.
  • LASTACAFT (alcaftadine ophthalmic solution) 0.25%, (Allergan) is a prescription medicine approved for the prevention of itching associated with eye allergies.
  • Bausch + Lomb’s Biotrue Multipurpose Solution matches the pH of healthy tears and contains the same lubricant, hyaluronan, that is found naturally in the eye. Biotrue helps keep lenses moist for up to 20 hours. It can be used with all soft and silicone hydrogel lenses.
  • RevitaLens OcuTec Multi-Purpose Disinfecting Solution (Abbott Medical Optics) is a solution for use with silicone hydrogel and soft lenses that offers broad-spectrum disinfection comparable to peroxide. This multi-purpose solution can be used to disinfect, clean, rinse, store, remove protein, and condition patients’ lenses, even for patients who wear their lenses 16 hours or more.
  • Clear Care (Alcon) is a hydrogen peroxide system patients can actually see working. Triple Action Cleaning deep cleans, loosens, and carries away dirt and provides enhanced protein removal for pristine clean lenses. Patients simply rinse their lenses, fill the special lens case provided with solution, and soak lenses for six hours. CLEAR CARE then neutralizes into a gentle, saline solution with no added preservatives for irritant-free comfort.
  • PeroxiClearâ„¢ 3% hydrogen peroxide cleaning and disinfecting solution (Bausch + Lomb), was just released in the U.S. (see “Bausch + Lomb Triples Its Moisture Technology“). This unique formula contains Triple-Moist Technologyâ„¢ which helps to provide up to 20 hours of moisture.

For those who tend to get heavier lipid and mucous deposits on their lenses, hydrogel lenses may be more appropriate than silicone hydrogel. While contact lens manufacturers tend to focus on newer materials, traditional hydrogel lenses may be more successful for a percentage of your patients. And don’t forget about gas permeable lenses; though they take more time to adapt to, most patients are extremely happy and seem to encounter fewer dry eye issues.

ALLERGY ISSUES
With allergies affecting a large number of contact lens wearers, treating the ocular surface becomes an important step in continuing contact lens wear. These prescription ophthalmic eyedrops are commonly used to alleviate symptoms and improve lens wearability:

  • Bepreve (bepotastine besilate ophthalmic solution 1.5%), (Bausch + Lomb)
  • Patanol (olopatadine hydrochloride ophthalmic solution) 0.1%, (Alcon) and Pataday (olopatadine hydrochloride ophthalmic Solution) 0.2% (Alcon)
  • LASTACAFT (alcaftadine ophthalmic solution) 0.25%, (Allergan)

SUCCESSFUL LENS WEAR
Lens replacement modality is another important consideration when attempting to prevent patients from dropping out of lens wear. A greater number of daily disposable lens choices continue to become available, so frequent replacement may certainly lead to better patient comfort.

Some patients may not be able to wear lenses full time, but with proper treatment they may be able to build up over time. By taking the necessary steps to improve their condition in the short term, they may reach a path to successful lens wear.

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

WHERE TO FIND IT:

Abbott Medical Optics (AMO) •800-347-5005 •amo-inc.com/products/corneal

Advanced Vision Research •800-579-8327 •theratears.com

Alcon Laboratories, Inc. •800-451-3937 •alcon.com

Allergan •800-347-4500 •allergan.com

Bausch + Lomb •800-828-9030 •bausch.com

CYNACON/OCuSOFT, Inc •800-233-5469 •ocusoft.com

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