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  • Review of Optometry

Which Modality is Best?

Individualize your contact lens prescribing habits to best meet each patient’s lifestyle and maximize compliance.
Mile Brujic, O.D., and Jason Miller, O.D., M.B.A.

10/19/2010

From single-use daily disposable contact lenses to two-week, one-month and the less common, quarterly/yearly replacement schedules—today’s contact lens wearers have many options to consider when choosing a lens modality. But ultimately, the eye care practitioners are responsible for selecting a proper contact lens modality, material and solution combination to ensure lens wear success.

When not addressed properly and discussed at every visit, non-compliance may become a bigger problem than you think. There are many variables that contribute to noncompliant behavior in contact lens wearers including: age, education, how long they have been wearing contact lenses, wearing schedule and their purpose for wearing contact lenses. Non-compliance with medical care can be as high as 44%, and the rates for contact lens care non-compliance range from 50% to 99%.1 The issue is that many contact lens wearers think they were compliant, but actually reported multiple non-compliant behaviors.1 For instance, many patients don’t realize that they should not handle their lenses when their hands are still wet with tap water.2 This is why we must be consistent in the way that we educate and prescribe a specific lens. This month, we are going to focus on wearing schedules and fitting philosophies.

The Debate
Eye care professionals receive multiple mixed messages on ocular health, comfort, fitting techniques and replacement schedules—there are the manufacturer claims, the varying opinions from colleagues and the feedback received from patients. The manufacturers focus on their products’ best properties (for good reason) and our colleagues may have their own bias or experience, but the most important message has to be the feedback from our patients. Whether it is the amount of redness, the compliance, the wearing schedule or complaints of comfort, patients will tell us what they like and what they don’t, as long as we ask.

Lens manufacturers also keep track of these reports in efforts to develop better contact lenses. And, competition between manufacturers is not just a good thing for our industry—it is a great thing, especially if you are focused on growing your contact lens population.

The ongoing debate on choosing an appropriate contact lens boils down to two major topics:

• Which contact lens is the safest for patients to wear?
• What contact lens is in the patient’s best interest?

All things considered, the lens and lens care system that minimize patients’ chances for an infectious or infiltrative event is the one you should choose. Always prescribe patients’ preferred wearing schedule, while considering their budget concerns. Finally, the best lens/care system combination to use is the one that maximizes comfort.

Daily Disposable Contact Lenses
Daily disposable contact lenses offer many advantages—of which convenience is by far the biggest. If a patient is looking for part-time wear, travels frequently or is looking for something very convenient, the daily disposable lenses are probably the best choice. These contact lenses are a great choice for patients with a history of solution or material sensitivity or toxicity. This lens modality may be the best choice for our younger, not-so-responsible patients.3

But, this option is not perfect for everyone. Some patients are resistant to switch to daily disposable lenses, so make sure to choose your words wisely when discussing this option. While demonstrating the advantages of this modality, talk about the net cost of these lenses and they may become a large portion of your contact lens practice.

Two-Week vs. One-Month
This category sparks the largest compliance debates. The two-week and one-month replacement lens category includes many options for maximizing vision and comfort, along with excellent choices in materials and design. But, the debate seems to center around predicting how patients are actually going to wear their contact lenses. We can look at studies and try to determine which modality promotes compliance, but it may be better to analyze which types of practices have more compliant patients.

As mentioned previously, patients often don’t even realize they are wearing their lenses incorrectly. Just as is the case with practitioners, patients also get mixed messages about their lenses. If doctor X prescribed a certain lens as a two-week disposable and doctor Y prescribed the same lens as a one-month disposable, this confuses the patient and reflects negatively on our eye care community. The perception is that doctor X “is just trying to sell more contact lenses,” which is not really the case.

It has been shown that 18% of eye care practitioners prescribe a two-week disposable contact lens replacement schedule for longer than the manufacturer’s recommendation (4% for daily disposable lenses and 1% for one-month disposable lenses).4 This study also reveals that patients are less compliant with two-week disposable lenses.

Regardless of the replacement schedule you are prescribing, you need to deliver a consistent message. Members of the eye care community must be on the same page regarding wearing schedules before we can ever truly analyze patient compliance.

When patients present reporting comfortable contact lens wear with their two-week or one-month disposable lenses even up to six weeks or longer, I try not to focus on how negligent this patient has been. Instead, I simply describe the infection risk the patient has created. I let such patients know that quite a few of my red eye emergent patients are contact lens wearers who have been abusing their eyes with non-compliant contact lens wear. I explain that their contact lenses have not been designed to last that long, and I would recommend changing the lens as prescribed. Compliance has received publicity in a recent Pediatrics article that revealed that the eye is the most frequently injured body part due to medical device complications, and that contact lenses accounted for a high percentage of these injuries.5 Whether you agree with the numbers in this report, it is important to realize that we need to do a better job of patient education. Non-compliance with the prescribed wearing regimens not only impacts the ocular health of our patients, but also the health of our contact lens business.

The Winning Modality
Effects of non-compliance range from mild comfort issues that hinder lens wear to vision-threatening adverse events. The key to choosing the best modality is listening to your patients, educating them on the importance of compliance and understanding what they are looking for in a contact lens. It’s best to make specific recommendations based on patients’ preferences and their ocular health, which will ultimately lead to improved compliance and maximize success with contact lenses.

A Case in Point
“Jennifer,” a 35-year-old new patient, presented wearing one-month disposable, HEMA material contact lenses. She worked long hours on the computer and complained about decreased comfort with her lenses later in the evening, which became worse as the lenses aged during the month. After her comprehensive eye examination revealed no signs of anterior segment diseases—specifically MGD and dry eye—the advantages of two-week and one-day modalities with various materials were discussed.6 Jennifer was intrigued with the one-day disposable, but thought she’d prefer the two-week lens. I dispensed her a pair of silicone hydrogel two-week lenses along with five pairs of one-day disposable lenses and told her to “wear the winner” to her follow-up appointment.

Allowing Jennifer to choose the lens she found most comfortable gave her a role in the decision-making process. She returned loving the comfort of her two-week silicone hydrogel lenses, but liked the one-day lenses for travel and sporting events. Both fit well and she ended up buying a one-year supply of two-week contact lenses and a 90-day supply of one-day disposables to wear when she desired. 

1. Donshik P, Ehlers W, Anderson L, Suchecki J. Strategies to better engage, educate, and empower patient compliance and safe lens wear: compliance: what we know, what we do not know, and what we need to know. Eye Contact Lens. 2007 Nov;33(6 Pt 2):430-3
2. Stone R. The importance of compliance: Focusing on the key steps. Poster. BCLA. May 2007. Manchester, UK.
3. Nixon GJ. A Review of Contact Lens Modalities. Available at: www.clspectrum.com/article.aspx?article=&loc=archive\2006\march\0306032.htm. (Accessed August 2010).
4. Dumbleton K, Richter D, Woods C, et al. Compliance with contact lens replacement in Canada and the United States. Optom Vis Sci. 2010 Feb;87(2):131-9.
5. Wang C, Hefflin B, Cope JU, et al. Emergency department visits for medical device-associated adverse events among children. Pediatrics. 2010 Aug;126(2):247-59.
6. Nichols KK. A Therapeutic Approach to Contact Lenses. Available at: http://cms.revoptom.com/index.asp?ArticleType=SiteSpec&Page=osc/105470/lesson.htm. (Accessed August 2010).



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