The guiding principle of long-term contact lens success is that patients who experience the most comfort in their lenses are much less likely to drop out of contact lens wear. Unfortunately, that isn’t always the case. Despite having access to highly advanced technologies to help our patients achieve ever-increasing levels of comfort, current contact lens wearers exhibit a dropout rate of 16% to 23%.1,2
This prompts the question, “What are the barriers to providing our patients with the best possible wearing experience?” The answer to this question, while important to the success of all of our contact lens wearers, is absolutely critical for our presbyopic patients. This cohort faces the challenge of a deteriorating tear film, which can significantly impede comfortable lens wear. Our presbyopes also tend to live very busy lifestyles that require convenience as a critical component to success. Additionally, these patients tend to have the most challenging prescriptions to fit—requiring both distance and near correction. Adding to the complexity, their visual needs and ideal correction will change often as presbyopia advances.
Fortunately, several new daily disposable lens options for our presbyopic patents have recently hit the market. The advanced designs of these new lens options offer a comfortable wearing experience and the opportunity to improve both distance and near vision. As with other daily disposables, they also provide our patients the convenience of a new lens every day.
This month’s column will review some of the new daily disposable options for presbyopes and how they might help dissuade them from discontinuing lens wear. In addition to keeping current wearers in their contact lenses, they can provide presbyopes who are new to refractive correction the option of comfortable, convenient lens wear.
Focusing on New Lens Options
The Proclear 1 Day Multifocal (CooperVision) is made of omailcon A and contains phosphorylcholine, a coating designed to optimize the surface characteristics of the lens, leading to comfortable wear throughout the day. The lens is available in powers ranging from +6.00D to -10.00D in 0.25D steps up to -6.00D and then in 0.50D steps above -6.00D.3
What makes this lens unique is the availability of just one add power, which simplifies the fitting process. For patients with an add power up to +1.00D, the lens is fit by simply selecting their best-corrected distance vision power after being vertexed. For add powers between +1.25D to +1.75D, a “near boost” is recommended by adding +0.75D to the distance power of the non-dominant eye.
For those who require add powers between +2.00D to +2.50D, a near boost is also recommended, but it should be slightly stronger than the aforementioned approach; in these patients, it is recommended to add between +0.75D to +1.00D to the distance power of the lens. It is important to note that the dominant eye power is not modified as the patient progresses through presbyopia.3
The Dailies AquaComfort Plus Multifocal (Alcon) daily disposable lens, made of nelfilcon A, has a 69% water content; this is the same material found in Alcon’s Dailies AquaComfort Plus spherical lens. The blister pack contains both polyethylene glycol and hydroxypropyl methylcellulose, which helps to provide comfort upon initial insertion of the lens.4 Additionally, the lens contains polyvinyl alcohol, which is designed to slowly release upon blinking, providing the lens with what the company refers to as “blink-activated moisture.”
The multifocal possesses a center-near design that progresses to the distance power in the periphery—the very same design found in its monthly replacement predecessor, the Air Optix Aqua Multifocal. It is available in three add powers: Lo (for patients with an add up to +1.25D), Med (for patients with an add between +1.50D and +2.00D) and Hi (for patients with an add between +2.25D and +2.50D).5 Because the fitting guideline is the same as the Air Optix Aqua Multifocal, success found with the monthly replacement option should translate well to the new daily disposable lens.
The Clariti 1day Multifocal (Sauflon), the first daily disposable silicone hydrogel multifocal lens, is composed of somofilcon A and has a 56% water content. Its base curve is 8.6mm and diameter is 14.1mm.6 The lens uses a simultaneous vision design—its near optics are located in the center of the lens and progress to the distance power in the periphery of the lens. It is available in two add powers: Low (for patients with an add up to +2.25D) and High (for patients with an add between +2.25 and +3.00D).7
Because it is a silicone hydrogel lens, it offers a high level of oxygen permeability; at -3.00D, the Dk/t is 86. Currently, the lens is available in distance powers ranging from +5.00D to -6.00D in increments of 0.25D.7
It is important that we keep abreast of the newest multifocal options and understand how they might prevent our presbyopes from dropping out of lens wear. It is equally important to provide the opportunity for comfortable contact lens wear to new patients in this demographic who require refractive correction. With so many new options emerging in the presbyopic market, patients and practitioners alike are sure to find an appropriate solution for this often frustrating condition.
A Multifocal Solution
A 44-year-old female
came to our office for an eye exam as a new patient. At that time, her
medical history was unremarkable and she denied any allergies. Her chief
complaint was an increasingly difficult time focusing at her computer,
tablet and smart phone. Additionally, her ocular health was
unremarkable. Her refraction was as follows:
OD +0.75 20/20
OS +0.75 20/20
+1.00 add 20/20 OU
We discussed the advantages and disadvantages of the various options available to correct her vision. We fit her with a simultaneous vision daily disposable contact lens with the following parameters:
OD +0.75 / Lo / 8.7 / 14.0
OS +0.75 / Lo / 8.7 / 14.0
The patient’s visual acuity was 20/20 OU at distance with the lenses and 20/25 OU at near. She was pleasantly surprised by the quality of both her distance and near vision with the lenses. No over-refraction was needed to improve her vision. She purchased a 30-day supply of the lenses and was seen again for follow-up 20 days after the initial fitting. At that time she reported comfortable lens wear and functional vision without the need for reading glasses. She then proceeded with a year supply of contact lenses.
1. Rumpakis J. New Data on Contact Lens Dropouts: An International Perspective. Review Optom. 2010;147(11):37-42.
2. Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. Jan 2013;39(1):92-98.
4. Dailies AquaComfort Plus Multifocal package insert.