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Let’s reconsider extended wear
I remember it all too well. The anticipation, patient demand, clinician excitement — and then the inevitable. It was 1983 and the Food and Drug Administration (FDA) had just approved the first extended-wear contact lens for cosmetic use. Many clinicians, myself included, viewed it as nothing short of phenomenal, given that a mere 10 years prior only PMMA existed. For our patients, it seemed too good to be true. A contact lens so comfortable and convenient that it needed to be removed but just once a month. And so we embarked upon the journey of prescribing extended wear, cautious but confident.
The rest, of course, is history. Whether it was due to contact lens deficiencies, inexperienced clinicians, noncompliant patients or a combination thereof is a moot point. The fact is extended wear just did not live up to anyone’s expectations; clinicians grew cautious, patients became weary and the FDA rescinded its 30-day approval.
Patient interest high
Given these events, it is understandable why extended wear has remained rather quiet over the past decade. However, this is all about to change. Indeed, patients may be more interested in extended wear than we think. Numerous market surveys indicate that patient interest is high, and that the majority of contact lens wearers would consider extended wear if condoned by their eye care provider. And, if you have any doubt whether patients are willing to assume a little risk in the name of convenience, just consider the popularity of refractive surgery!
Additionally, contact lens manufacturers are aware of its importance. This isn’t about an industry trying to force-feed us an agenda. It’s about knowing your business: patient wants, practitioner needs and the relentless pursuit of better products.
To this end, contact lens manufacturers have spent 15 years scrutinizing extended wear – the good, the bad and the ugly. Assisted by academic and clinical practice researchers, they have developed a keen understanding of the epidemiology and pathophysiology of extended wear-related complications.
As a result, manufacturers have worked tirelessly towards developing contact lenses that minimize these complications. Not an easy task, considering that success hinges upon much more than higher oxygen transmission profiles. Clearly, material wettability, deposit resistance, antimicrobial profile and on-eye mobility are essential characteristics of a successful extended wear lens.
“Next generation” extended wear
The culmination of these efforts is evident in the development of “next generation” extended-wear lenses, such as Bausch & Lomb’s PureVision and Ciba Vision’s Focus Night & Day. As these lenses are introduced around the world, and as other manufacturers matriculate development, one question remains. Are clinicians – somewhat jaded by prior experiences and complacent with current options – ready to embrace this concept?
In my mind, there is only one answer. A simple, unequivocal “yes.” Let me explain. First, even with the tremendous technical advances in lens materials and designs, extended wear is not and never will be for everyone. There will always be metabolically – and intellectually – challenged patients for whom extended wear is inappropriate. If we don’t provide the necessary professional guidance – proper patient screening, education, prescribing and monitoring – who will? Without our efforts, history is destined to repeat itself and patients will suffer.
Keep practice up-to-date
Second, consistent with our commitment to providing the best patient care, it is imperative we adapt new technologies and treatment strategies. Sure, it’s easy to believe that our patients have no interest in or desire for extended wear. But is this really true? It’s also easy to dismiss extended wear as excessively risky. But is this really true as well? Of course, we’ve been down this road many times before, and our profession has repeatedly distinguished itself as a discipline willing to embrace new practice trends.
Finally, and perhaps most importantly, extended wear may be the best option for certain patients. As ludicrous as this sounds, just consider the alternatives. Even though I view refractive surgery as a viable option with relatively few complications, the permanence of any surgical endeavor cannot be dismissed. Arguably, our treatment armamentarium would be more complete with something to bridge the gap between daily wear contact lenses and a surgical alternative. Indeed, a contact lens that can be safely worn for 7 or even 30 days fits this bill nicely.
For those who have struck extended wear from their practice lexicon, please reconsider. Not because it’s for everyone. But because the technology is better, and because it may well be the best choice you can offer certain patients.
For Your Information:
- Dr. DePaolis has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned. His office participated in Food and Drug Administration phase 3 clinical trials for both Ciba Vision’s Focus Night & Day and Bausch & Lomb’s PureVision lenses.