New products are geared to increase compliance while some clinicians fear reduced efficacy

Issue: September 1998

In a world that stresses convenience, contact lens care manufacturers are answering the challenge by developing solutions geared toward increasing convenience as well as ensuring compliance by combining several steps into one bottle.

Convenience plays a very important role in deciding which lens care system or solution to recommend, said Glenda Secor, OD, in private practice here. With patients offering so many excuses for not following the recommended care regimen, practitioners are having more difficulty keeping them compliant.

"I think the simple systems that are efficacious, user-friendly and priced competitively will appeal to most patients and practitioners just because we want to keep patients doing what little we can get them to do," Dr. Secor said.

"Every company is trying to work on a system that is simpler, more effective and encourages compliance," said Rick Weisbarth, OD, executive director of professional services for Ciba Vision. "The more those goals can be achieved, the better the systems will be. Ultimately, the systems we have now are very good, but they are not patient-proof."

Liquid enzymatic cleaners

One advance designed to encourage compliance has been the introduction of liquid enzymatic cleaners.

"They appear to be working very well," Dr. Secor said. "I know there have been some reported problems with reactions and irritation, but it hasn't been a problem with my patients. Compliance with traditional enzyme is weak, seldom at best, if you're doing it on an ongoing basis. I think that's where this type of product is best because it will help prevent protein from accumulating."

The goal is to keep bound protein from adhering to the lens and to make an ongoing attempt to keep it from accumulating, Dr. Secor said. Daily cleaning will be more effective than weekly treatments, and because patients are more likely to forget a weekly step than a daily one, compliance will likely improve.

The change to more frequent lens replacement schedules makes protein removal a much less important consideration, said William Lapple, OD, in private practice in Le Roy, N.Y. In his practice, he does not use enzymatic cleaners because very few of his patients wear the same pair of lenses for more than 3 months, while many are in monthly or 2-week disposables.

"Companies that still come out with these super cleaners and protein removers are a little late to the party and are not having much impact with the practitioner," Dr. Lapple said.

Convenience vs. efficacy

While the newer solutions are more convenient, efficacy has probably been compromised, Dr. Secor said. The weaknesses of these products, however, are balanced by the strength of the ocular system.

"We probably are more at risk for developing eye infections, but the industry has been very lucky in that the natural defenses in our ocular system are what save us," Dr. Secor said.

Understanding the failings of some solutions is where the practitioners' professional judgment comes into play, Dr. Secor said. Patients who are less likely to comply with the care regimen also tend to deviate from the recommended replacement schedule. These types of patients will require different lens care products than those who are compliant.

Jan Bergmanson, OD, PhD, professor and director of Texas Eye Research and Technology Center at the University of Houston College of Optometry, believes one-step solutions should be developed with the likelihood of noncompliance in mind.

"The current solutions, if used as instructed, are effective, but when we have noncompliance, you could argue that these current solutions don't have enough of a built-in safety margin to take care of noncompliance. The increased strength that I'll be looking for in future formulations would be particularly helpful for patients who are clearly noncompliant," Dr. Bergmanson said.

No reduction in Acanthamoeba

One area where one-step solutions have been found particularly lacking is in killing Acanthamoeba culbertsoni trophozoites.

In a study presented at the poster session of the 1997 meeting of the American Academy of Optometry by Scott A. Steel, OD; M. Lance Presley, MS; and Charles G. Connor, PhD, OD, from the Southern College of Optometry, four one-step systems were found to be ineffective against Acanthamoeba. Lenses incubated with Acanthamoeba trophozoites were immersed in ReNu Multiaction (Bausch & Lomb), Opti-One (Alcon), Complete (Allergan) and Solo-Care (Ciba Vision), and none of the solutions showed significant reduction in the organism after 4 hours.

"Results of this study makes a strong case for not prescribing one-steps for people who wear their lenses in hot tubs or have other risk factors that make them predisposed to microbial infection," Dr. Steel said.

Dr. Bergmanson said companies should keep organisms such as Acanthamoeba in mind when developing future solutions.

"I'm looking for a solution that will have stronger antimicrobial action; and in doing that, it would also have a shorter disinfection time," Dr. Bergmanson said.

The next significant advancement would be a solution more effective against micro-organisms that are more complex, such as Acanthamoeba and fungi which, when invading the cornea, are the most difficult micro-organisms to eliminate, he added.

No rub, no rinse possible?

In the interest of simplifying lens care, some industry representatives have shown an interest in developing a solution that would allow the wearer to take the lenses out, put them in a case with solution, then insert them the following day without the need to rinse the solution or rub the lenses. The "no rinse, no rub" solutions are an interesting concept, but are most likely not close to becoming a reality.

"It is realistic from the standpoint of efficacy. I don't know how soon we'll be able to be there, but I believe it is a realistic goal," said Gary Orsborn, OD, director of professional marketing for North American Vision Care, Bausch & Lomb.

"I wouldn't speculate on a time frame; we need to learn more about different compounds and things of that nature," Dr. Weisbarth said. "I think it's achievable; it's just a question of the chemistry and the testing."

The area of a no rinse, no rub solution is a logical place to investigate, because it closely resembles the way many noncompliant patients take care of their lenses already, said Joseph Vehige, OD, senior product manager in the global project management group at Allergan.

Clinicians differed on the value of a system that did not encourage wearers to rub deposits from the lenses.

"I don't see that as being ideal," said Evan Thomas, OD, in private practice in Newport Beach, Calif. "I think you need to at least eliminate some of the larger loosely adherent residues from the lens before you put it away."

"I'd question its efficacy," Dr. Secor said. "Rubbing and rinsing are critical in keeping lenses clean, so I would hesitate not to do that."

Other doctors felt that, because many patients are not following the recommended care of their lenses, a solution that would make noncompliance less harmful would be a welcome addition.

"Patients don't seem to comply anyway," Dr. Lapple said. "Patients are going to take the path of least resistance; if we can make that more convenient, I think that's good for everybody."

Private-label solutions

An area that has become increasingly troublesome for optometrists recently has been aggressiveness on the part of private-label solutions. Some drug stores will carry solutions with the store name on them and market them as being equivalent to a brand name, frequently ReNu MultiPurpose (Bausch & Lomb), Dr. Lapple said. Patients assume they are buying a generic version of the product and can save a few dollars per bottle.

According to Dr. Orsborn, Bausch & Lomb does not manufacture private-label solutions.

The patients frequently return to his office complaining of red eyes and discomfort, Dr. Lapple said. To try to head off these problems, he explains to patients ahead of time that these private brands are not equivalents.

"It's not like pharmaceuticals, where things can have generics. We try to warn patients to be proactive rather than reactive to ward off the problems," Dr. Lapple said.

The next generation

Market research suggests patients want an effective product that keeps the lenses clean, safe and comfortable and is convenient, Dr. Orsborn said. Future developments will continue to address these areas, with an even greater emphasis on convenience, such as quicker disinfection time.

In addition to making solutions more effective, manufacturers also will likely add secondary benefits to make the lenses more comfortable to the wearer, Dr. Vehige said.

Another significant advancement is the realization that comfort is not influenced only by the presence of a single compound, but is also a function of the interaction of compounds. Understanding the nature of these relationships will allow companies to reformulate solutions to provide added benefits.

For Your Information:

Jan Bergmanson, OD, PhD, is a professor and director of the Texas Eye Research and Technology Center at the University of Houston College of Optometry and can be reached at 4901 Calhoun Rd., Houston, TX 77204-6052; (713) 743-1950; fax: (713) 743-2053; e-mail: jbergmanson@uh.edu. Dr. Bergmanson has no direct financial interest in any products mentioned in this article, nor is he a paid consultant for any companies mentioned.

William Lapple, OD, can be reached at 8663 East Main Rd., Le Roy, NY 14482; (716) 538-6435; fax: (716) 538-6409; e-mail: blapple@eznet.net. Dr. Lapple has no direct financial interest in any products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Gary Orsborn, OD, is the director of professional marketing for North American Vision Care, Bausch & Lomb and can be contacted at 1400 N. Goodman St., P.O. Box 450, Rochester, NY 14603-0450; (716) 338-6000; fax: (716) 338-6481; e-mail: gorsborn@bausch.com.

Glenda Secor, OD, can be reached at 17742 Beach Blvd., #305, Huntington Beach CA 92647; (714) 842-0651; fax: (714) 848-7826. Dr. Secor has no direct financial interest in any products mentioned in this article, nor is she a paid consultant for any companies mentioned.

Scott A. Steel, OD, can be contacted the Southern College of Optometry, 1245 Madison Ave., Memphis, TN 38104; (901) 722-3257; fax: (901) 722-3275; e-mail: sasteel@sco.edu. Dr. Steel has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Evan Thomas, OD, can be reached at 522 Old Newport Blvd., Newport Beach, CA 92663; (714) 650-9060; fax: (714) 646-1461. Dr. Thomas has no direct financial interest in any products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Joseph Vehige, OD, is the senior product manager in the Global Project Management Group at Allergan and can be contacted at 2525 Dupont Dr., Irvine, CA 92715; (714) 246-6847; fax: (714) 246-6550.

Rick Weisbarth, OD, is executive director of Professional Services for Ciba Vision and can be reached at 11460 Johns Creek Parkway, Duluth, GA 30097; (770) 418-3560; fax: (770) 418-3151.