Speakers share contact lens fitting tips, industry trends

PHILADELPHIA – The leading cause of contact lens dropout is discomfort, cited by – according to some studies – up to half of wearers, according to Thomas Quinn, OD, MS, in a presentation at Optometry's Meeting.

He and co-presenter Shalu Pal, OD, shared their perspectives, educational tips as well as industry trends in regard to contact lenses.

Quinn said studies show little difference in comfort between those using multipurpose solutions vs. those using hydrogen peroxide, “but the daily disposable modality appears to be the most comfortable,” he said. “That’s our winner when it comes to a comfortable lens.”

He noted an underutilization of this wearing modality, although its usage has nearly doubled in 4 years from 11% in 2009 to 20% in 2013.

Quinn also noted, “Studies of reusable lenses show that incidence of corneal inflammatory events are about twice as frequent with silicone hydrogel lenses vs. hydrogel lenses,” perhaps due to a higher binding of bacteria to silicone hydrogel materials.

Pal said that usage of toric lenses is slowly increasing, from 22% in 2012 to 24% in 2013.

She said this trend is predicted to continue in 2014, which she believes is a result of these lenses being easier to fit than ever before.

Pal shared her tips for fitting torics: start with your own updated refraction, let the lens settle before checking visual acuity, order the lens you need instead of using the wrong lens, and stop once the patient is happy and their vision is good.

Pal also suggested utilizing www.eyedock.com or www.therightcontact.com from the Contact Lens Society of America for cross cylinder calculations.

The lecture team also discussed multifocal contact lenses.

"Twenty-five percent of our population in our practices is presbyopic, Pal said. “That number will continue to increase. This is a population that we all know we need to take care of.

"We also know that as presbyopes age, the contact lens dropout rate increases," she continued. "More than half of aging people who drop out of contacts would consider contact lenses again. These patients want to remain in their lenses. Ninety-one percent of patients in the age group of 35 to 55 want to continue to stay in their contacts no matter how old they get. One out of three presbyopes would consider contacts, but only 8% of presbyopes have actually been told about soft multifocal contact options. That's a huge disconnect. Why are we not talking about it?

"Talk to your patients about it – if you won't, someone down the street will," Pal said. "One out of three would switch ODs if not given the option of multifocals."

She urged optometrists to enhance their patient's overall experience by managing expectations.

"The number-one fitting tip is to use the fitting guides – don't try to reinvent something. Use the tools at your disposal," she said.

"If you have to make changes, try not to do it on the first day," Pal continued. "Explain to the patient that they need to adapt and go through that week trying as many different things as they can so they can see where the contacts are working and not working.”

Pal said she clearly explains to the patient what she expects in terms of a time frame, the patient’s progression, expected number of visits and fees.

For gas-permeable multifocal contact lenses, Pal suggested fitting low to moderate presbyopes with simultaneous design and moderate to advanced presbyopes with translating design.

"In fitting the lenses, you really want to look at a patient's eye anatomy and get as many measurements as you can," she said.

Quinn also shared his successful fitting techniques for scleral contact lenses.

"We fill the bowl with preservative-free saline," he said. "Then you add a little fluorescein and then you apply the lens using what I call the 'elevator technique.' The patient's face will be parallel to the floor and they will bring the lens to the face like an elevator."

Finally, the pair addressed contact lens safety, noting that the poorest level of compliance involves contact cases.

"When you really want to address safety, get rid of the case,” Quinn suggested. “With daily disposables, it all goes away. One paper found that patients are 12.5 times less likely to have a corneal inflammatory event with a daily disposable lens."

Quinn and Pal mentioned the website www.contactlenssafety.org as a tool for both practitioners and patients. The site is managed by the American Optometric Association Contact Lens and Cornea Section with content contributed by the American Academy of Optometry. – by Chelsea Frajerman

Disclosures: Pal has lectured for Novartis, Allergan, Truform Optics, Menicon, Johnson & Johnson Vision Care, CooperVision, Alcon and Bausch + Lomb and is on the ICare board for Alcon. Quinn is a consultant or speaker for Alcon, Allergan, AMO, Bausch + Lomb, CooperVision, Johnson & Johnson Vision Care/Vistakon, Paragon Vision Science and Polymer Technology.