Recommending toric lenses based on patients’ lifestyles can successfully grow a contact lens practice.
Toric contact lens patients frequently state they’re “doing well” and are happy with their lenses. A close evaluation during their eye exam may tell us otherwise. Whether patients with astigmatism have poor compliance with lens replacement, are wearing a spherical lens, or wearing a lens that is not optimal for their eye health, we need to use our expanding knowledge of lens benefits to provide a great contact lens-wearing experience. Here are some real cases from my practice where a change in toric lenses achieved just that.
A hair stylist aged 34 presented for her annual exam. She had been using a two-week disposable spherical lens with a multipurpose solution but didn’t rub her lenses to clean. She simply dropped them in a lens case every night. Trying various multipurpose solutions to get the lens more comfortable hasn’t worked. She also admitted to replacing her lenses about every three to four weeks. Considering the hair chemicals and hair products she works with, her lenses are getting dirtier than average patients and she isn’t cleaning them correctly.
Her refraction uncovered -1.00D of astigmatism in each eye that wasn’t corrected in her current spherical contacts. Refraction was OD: -2.25 -1.00×180 OS: -2.50-1.00×005. She was educated about the improved
|Intended for normal corneas, SynergEyes’ Duette combines a GP center and a soft lens skirt.|
vision daily disposable toric lenses provide and was fit with CIBA VISION’s Dailies® Toric. This lens is available in a power range from +4.00D to -8.00D sphere, with a cylinder power of -0.75D and -1.50D at axes of 90 and 180° +/-20° on either side of these axes (20, 70, 110, 160). It’s made of nelfilcon A material and has a water content of 69%.
At her one week follow-up, the patient shared how more comfortable she’s been with the lenses and appreciated not having to care for them. Though the lenses are more expensive, the increased comfort, having a fresh lens each day, and saving on contact lens solutions made her happy to convert to daily disposables.
Another daily disposable toric lens is CooperVision Inc.’s ClearSight™ 1 Day Toric, which is a prism ballast design lens manufactured with ocufilcon D. It’s offered in spherical powers from plano to -7.00D, with a base curve of 8.7 and diameter of 14.5. Cylinder powers of -0.75D and -1.25D are available in four different axes: 180, 160, 90, and 20.
A golf pro aged 38 came to the office after being referred by his client to whom he gives golf lessons. For the past 10 years, the pro has had limited success getting the quality of vision he wants with contact lenses, so he alternates wearing contact lenses with using glasses, depending on his activities. Previous doctors tried various soft lenses to correct his astigmatism and although he’s been told a gas permeable (GP) lens would be ideal, he hasn’t tried it due to his hesitation about comfort.
The patient’s refraction was OD: -6.00-2.75×080, with 2.50D of corneal
|CIBA VISION’s Dailies Toric lenses can be ideal for patients who have poor compliance.|
cylinder and OS: -7.00-3.00×110 with 3.00D of corneal cylinder. After discussing the importance of lens stability and comfort when he’s giving lessons or playing in a tournament, it was recommended he try SynergEyes, Inc.’s Duette™ hydrid lenses.
Intended for normal corneas, Duette combines a GP center and a soft lens skirt into a hybrid lens. The rigid center corrects farsightedness, near- sightedness, and astigmatism and delivers clear, high-definition vision, even at night. The soft skirt surrounding the center provides the all-day comfort of a soft lens. Duette hybrid contact lens products feature a new SynergEyes-developed GP material, MaxVu™, and a proprietary Flex2O™ silicone hydrogel skirt. Lenses are indicated for daily wear for correction of up to ±20.00D with astigmatism as high as 6.00D. The high modulus MaxVu GP has a Dk of 130 and Class II UV blocker. Low modulus silicone hydrogel skirt offers durability, resists protein deposits, and improves wearability.
After being fit with the Duette diagnostic lens set, the patient was immediately impressed by the comfort level. Pleased with clear 20/20 in each eye, he headed directly to the golf range.
A law student aged 23 presented for an examination for contact lenses. One month earlier, she had her first exam visit and was interested in LASIK surgery. Though her prescription was within the parameters for surgery, her refraction revealed an increase in myopia and astigmatism in each eye from her previous prescription. Her refraction was OD: -4.50-1.75×180, OS: -3.50-1.25×170. After discussing the necessity of a stable prescription to be a qualified surgery candidate and how her eyes sometimes feel dry, it was suggested she be refit with silicone hydrogel lenses.
Following corneal topography measurements, the patient was fit with CooperVision’s Biofinity® Toric lenses, which boast the company’s proprietary Aquaform® Comfort Science™ technology. Made of comfilcon A material, the lenses have a high oxygen permeability with a Dk of 128. It offers a Dk/t of 116, allowing it to be worn on either a daily wear or extended wear basis. Recommended for monthly replacement, the Biofinity Toric has an Optimized Ballast Design with cylinder powers -0.75D, -1.25D, -1.75D, and -2.25D.
Other options include ACUVUE® OASYS™ for ASTIGMATISM from VISTAKON, Division of Johnson & Johnson Vision Care, Inc., Bausch + Lomb’s PureVision® Toric, and CIBA’s AIR OPTIX® for ASTIGMATISM.
VISTAKON’s ACUVUE OASYS for ASTIGMATISM merges HYDRACLEAR® Plus technology with an Accelerated Stabilization Design, which delivers clear, stable vision beyond the chair. The lens design has four zones of stability, compared to the single zone of ballast design lenses. It features 8.6mm base curve, 14.5mm diameter, and 38% water content. Parameters include plano to -6.00D in 0.25D steps, 6.50D to -9.00D in 0.50D steps, and +0.25D to +6.00D in 0.25D steps.
With its anterior aspheric optics, Bausch + Lomb’s PureVision® Toric is another stable option. AerGel™ silicone hydrogel material allows for long wearing times and healthy eyes. It’s available in plus powers and up to -2.25D cylinder across entire parameter range. Fits and refits are easy with its one base curve that’s suitable for 95% of patients.
CIBA’s AIR OPTIX for ASTIGMATISM features a Precision Balance 8 | 4™ design that has the thickest points of the lens at 8 and 4 o’clock to minimize interaction with the lower lid for maximized oxygen transmission at 6 o’clock, and exceptional stability, consistent rotation, and fit performance.
Also available is Unilens Vision Inc.’s new C-VUE Advanced® HydraVUE™ Custom Toric. See “New Product Gallery” for more information on this lens.
All these patients who presented with astigmatism had their contact lens experience improved and are currently seeing clearly and comfortably. You can achieve the same success and grow your practice by taking the initiative to educate patients about new toric lenses and their specific benefits.
Eric L. Bran, Professional Editor for Ophthalmic Office, is in a private group practice in Ridgefield, CT.
WHERE TO FIND IT:
Bausch + Lomb • 800-828-9030 • bausch.com
CIBA VISION • 800-241-5999 • cibavision.com
CooperVision, Inc. • 800-341-2020 • coopervision.com
SynergEyes, Inc. • 877-SEE-2012 • synergeyes.com
Unilens Vision Inc. • 800-446-2020 • unilens.com
VISTAKON, Division of Johnson & Johnson Vision Care, Inc. • 800-843-2020 • jnjvisioncare.com