continuous wear
8 Must-Know Points About Continuous Wear
All patients have questions, but some are afraid to ask. Address the important issues for them.
BY JOHN YOAKUM, O.D., Greensboro, N.C.

In the nearly four years that I've been fitting hyper-Dk/t silicone hydrogel contact lenses for continuous wear, just over half of my spherical soft lens patients have converted into the new modality, either as continuous wear, daily wear or flexible wear.

During that time, my candidate pool for the lenses has continued to expand. The reason is that I seek to answer what patients want to know about this new technology and share what I know with them.

Taking them on

Whether patients come in asking about these lenses or whether the option is completely new to them, I have eight talking points about silicone hydrogel lenses for continuous wear. The conversation flows easily from one point to the next and I can address all eight points easily during a regular eye exam. In brief, talking to patients about silicone hydrogel lenses for continuous wear isn't going to take more of your time -- but it can enhance your practice's reputation for proactively addressing patient interest in the latest contact lens advances. Following are the eight points that patients want to know about.

1 Sleeping in lenses isn't taboo

For much of the past two decades, eyecare professionals have been telling patients that sleeping in soft contact lenses is bad. That's with good reason, of course. The low-Dk/t HEMA lenses couldn't meet oxygen transmissibility levels needed for overnight wear. As researchers are better able to study the effects of corneal oxygen deficiency, these minimum oxygen requirements have been revised upward. As a result, patients need reassurance from their practitioners that the new technology exceeds even these newer, higher levels and has been approved by the FDA for continuous wear for up to 30 nights.

There's no doubt that patients would like to sleep in their lenses. According to a CIBA Vision consumer study conducted in March 2004, 84% of soft spherical contact lens wearers say they nap in their contact lenses (at least occasionally). Indeed, 88% of the male respondents said they nap in their lenses -- and one-third of them said they do so "all the time."

2 There's flexibility in the wearing schedule.

When I started fitting these lenses, I expected most patients to opt for continuous wear. To my surprise, about half of my contact lens patients said that while they would like to be able to sleep in their lenses, they didn't think they'd want to do so all the time. Whether patients sleep in their lenses frequently or rarely, they appreciate having the flexibility to set their own wearing schedule within the parameters I recommend.

In fact, I've had to temper my own cynicism a bit since these lenses became available. One of the reasons I thought they'd be so popular is that I thought noncompliance with daily wear was rampant. What I found is that most patients, even if they were flagrantly noncompliant about taking their lenses out at night, felt badly about not following my directions. Here's my chance to make them honest. Rather than scold them for flouting my instructions, I'm able to offer them a lens that accommodates their lifestyle. It's much easier for patients -- especially those who haven't experienced noticeable symptoms of corneal hypoxia -- to switch products than to switch habits.

3 "Convenience" isn't a bad word.

Today, many people often equate convenience with laziness. Think paper plates and fast food drive-throughs. Although disinfecting and storing contact lenses at the end of the day takes only minutes, squeezing in these minutes can prove difficult in the real world. Whether it's the college student who falls asleep at her desk, a parent of an infant who naps whenever she can or the EMT who wants to see the instant a call comes in, plenty of people could benefit from the convenience of continuous wear. Patients want to know that their practitioner isn't judging them because they desire convenience.

In my practice, we heavily promote the convenience of newer products. Already about half of my patients have moved into silicone hydrogel lenses for up to 30 nights of continuous wear. About half wear the lenses overnight routinely or occasionally. The other half use this as their daily wear lens, reporting that it remains more comfortable, their eyes are less red and they can achieve a longer wearing time.

Many of the remainder are in daily disposable lenses, which also are popular because of their convenience. Not only are daily disposable and continuous wear lenses more convenient, but they also both avoid solution toxicity symptoms.

4 Continuous wear is safe.

There's little argument that continuous wear may be the most convenient contact lens wear option available, but patients also want to know that it's safe. In our practice, there's a subset of patients who are keenly interested in the science behind new technology. They're typically young, computer-savvy and mindful of their health. For most patients, however, a quick description of how the Dk/t rate of the continuous wear lens compares with other lenses suffices as a way to reassure them that continuous wear is a safe option. I can cite some of the worldwide clinical results and tell patients that my own clinical results show similarly successful outcomes.

This discussion with patients is subtly different than talking about their desire for sleeping in their lenses. That's the "wouldn't it be nice if . . ." portion of the conversation, where the patient tells me how they could benefit from continuous vision. Here, I'm imparting professional experience to assuage their concerns.

According to the CIBA Vision consumer survey, 73% of soft contact lens wearers would prefer a wearing schedule that includes overnight wear, at least occasionally, if the doctor assured them it was a safe option.

5 Patients don't have to settle for "good enough." 

"How are you doing with your contact lenses?"

"Fine."

Does that sound like a familiar exchange? In those cases where patients aren't having distinct complaints about comfort or vision, chances are you'll hear that kind of an answer. Yet when practitioners ask more specific questions such as, "Do you ever have dryness or itchiness at the end of the day?" or "Are your eyes ever red at the end of the day?" the answers change. It's a rare patient who has no such symptoms. Many common symptoms related to contact lens wear (such as dryness, irritated eyes, blurred, fluctuating vision, end-of-day discomfort and increased light sensitivity) may potentially be linked to hypoxia to some degree.

It's not that patients are trying to hold back information, but more likely, they've come to lower their own expectations about how comfortable contact lenses can be. Perhaps they figure this is as good as it gets, so there's no sense in complaining.

For much of recent history, that's been true. While contact lens manufacturers made some changes to HEMA materials and lens designs, these improvements were small. Not until silicone hydrogels were introduced were we able to offer something fundamentally different and better.

It's also important to be sure that patients don't withhold information out of fear. Patients who have symptoms may be reluctant to share that information assuming that the likely outcome will be that the doctor tells them to wear their lenses less frequently -- or not at all.

6 Patients can try the lenses.

After having described the benefits of greater comfort and the possibility of overnight wear, it's time to let patients know that they're candidates for the lens. This point seems obvious, but it's key. When patients tell me their friend has just been fitted with a continuous wear silicone hydrogel lens, the question inherent in that statement is this one: "Can I try it, too?"

I also make a point of suggesting a trial to patients who have no complaints about their current lenses. For instance, if I see any potential signs of corneal oxygen deficiency -- such as injection, microcysts or neovascularization -- I might say, "I'm glad you're feeling fine with these lenses, but I'm concerned about the future." And I'll offer a trial with these lenses. Often, these patients come back saying they've seen or felt a marked difference in comfort or appearance of the eyes.

7 The benefits outweigh the cost.

Certainly, patients want to save money. But they're not necessarily looking for the least expensive contact lens. They're looking for the contact lens with the greatest value. They perceive that value when the benefits of a lens outweigh the additional cost.

By talking about the points above, you'll have to let patients know that silicone hydrogel lenses offer much more than their current lenses: The opportunity for safe overnight wear; reduced redness, dryness and discomfort for many patients; and longer comfortable wearing time. In theory, that's great, but the best way for patients to truly experience that value is through a trial of the lenses.

When patients come back for followup, as they typically do in my office at one week, having enjoyed continuous vision or greater comfort or less redness, it's a home run.

8 What does the doctor recommend?

This point may also seem obvious, but bears repeating. Patients come to us for our professional advice. Patients often tell me that they're surprised and grateful that I've taken the time to discuss the options and make a recommendation. When all of our available lens options were low-Dk/t HEMA lenses, patients came to expect quick recommendations and minor substitutions.

With the advent of silicone hydrogel lenses for continuous wear, however, our role as professional becomes more meaningful to our soft contact lens patients, especially as our clinical judgment is required to determine if a patient is a continuous-wear, one-week continuous wear or daily wear candidate.

Everyone wins

The end result is that we all benefit. My patients are more satisfied with hyper-Dk/t silicone hydrogel lenses for continuous wear and my professional reputation is enhanced for prescribing them.

References available on request.

Dr. Yoakum is in private practice at Groat Eye Care Associates, P.A. He's also an adjunct clinical instructor at Pennsylvania College of Optometry. Contact him at jyoakum@bellsouth.net.