Smoother Sailing for the Contact Lens Practice
The first part of this series on silicone hydrogel lenses discusses the benefits of continuous wear.
BY JEFFREY SHEARER, O.D., Jacksonville, Fla.

Since I started prescribing contact lenses 20 years ago, my first rule in lens selection has been to follow the old adage, "What's best for your patients is best for your practice." The corollary of this rule: "Never fit your patient in a lens you wouldn't fit on a family member or wear yourself." When I follow these rules, the business side of my practice falls into place.

My most important considerations as I select lenses are ocular health, comfortable wear and convenience. If I optimize these benefits for patients, everything else is secondary.

Because contact lens technology keeps evolving, we shouldn't become complacent and assume that if contact lens patients do not complain, there's no need to recommend new designs and materials. Complacency is a recipe for prescribing commodity lenses that patients can buy anywhere. I prefer to fit "high-performance" lenses they will talk to their friends about. This habit also helps me satisfy my guiding rule.

Benefits of the cutting edge

I continuously test new lenses on small groups of patients. Once I'm satisfied with the results, I proactively recommend lenses that pass my test, even to happy patients. Upgrading them to new technology is usually both good practice and good business; new and improved products usually command higher fees and generate more referrals.

Silicone hydrogel material is one of those new technologies that is revolutionizing the contact lens field. These lenses satisfy both my first rule of lens selection and its corollary. Patients are enthusiastic about these new lenses, which they are able to wear comfortably all day.

The breakthrough of silicone hydrogels is their superior oxygen transmissibility. This alleviates many of the traditional problems of lens wear that we simply learned to tolerate because nothing better was available.

When I refit patients into silicone hydrogels, I observe rapid and dramatic reductions in the potential signs and symptoms of corneal oxygen deficiency, including end-of-day discomfort, limbal redness, and corneal neovascularization. They are easy to fit and patients usually find them comfortable. Silicone hydrogel lenses have transformed my contact lens practice, and are now my lens of choice.

Getting the lens right

I make extensive use of the new silicone hydrogel lenses designed for biweekly replacement, and the continuous-wear lenses designed for monthly replacement. Each appeals to a distinct segment of wearers and each has unique properties designed for its particular indication.

I began experimenting with continuous-wear lenses in early 2002, shortly after the FDA approved them for up to 30 continuous nights of wear. They appealed to me because they offer extremely high levels of oxygen transmissibility and promise safe overnight wear. My experience back in the '80s taught me that many patients are convenience-oriented and prefer to eliminate the daily grind of lens care.

My patients wear their continuous-wear lenses for periods ranging from a week to the full 30 days. Once I verify there are no clinical contraindications, I let them decide on the schedule they find most comfortable. I recommend continuous-wear lenses to those patients who want to regularly sleep in their lenses over night, or are already doing so with their low-Dk lenses.

My lens of choice offers a Dk of 175, the highest oxygen transmissibility of any soft lens currently available. This is well above the 125 Dk standard that researchers have established is necessary to avoid stromal anoxia in overnight wear. Because continuous-wear is a more demanding wearing schedule for the cornea, it only makes sense to maximize the amount of oxygen transmissibility we provide these patients to ensure healthy wear.

Benefits run both ways

Many of my patients report that wearing continuous-wear lenses has been a life-changing experience. Continuous-wear lenses offer the closest thing to natural vision. They are the first lens option that can really compete with the appeal of refractive surgery. The high cost of materials for continuous-wear lenses and the need for regular follow-up care make these patients among the most profitable contact lens patients of any practice.

Currently, I estimate that about 10-15% of my soft lens patients choose a continuous- wear regimen. I expect further growth this year as more patients become aware of the option.

The silicone option

A much larger segment of my patient base is primarily interested in a cost-effective daily- or extended-wear lens alternative. They are accustomed to the routine of daily removal, no-rub cleaning, disinfection and two-week lens replacement. While most express satisfaction with their HEMA-based, two-week replacement lenses, they may experience potential symptoms of hypoxia, such as dryness or end-of-day discomfort.

Patients seldom volunteer these complaints to me. They've come to accept such annoyances as a necessary evil of wearing contact lenses. Many daily wear patients occasionally sleep with their lenses on overnight, even though they are reluctant to admit it.

Silicone hydrogels are the ideal choice for these patients. By helping to reduce the signs and symptoms of corneal oxygen deficiency, you can dramatically improve their wearing experience. The contact lenses are available for modestly more money than traditional two-week replacement lenses and fit into the patient's normal routine.

Transmissibility is good

When I present silicone hydrogels, I focus on the benefits of increased oxygen transmissibility. Patients readily understand that their eyes need oxygen to stay healthy. They are impressed that a silicone hydrogel lens can provide up to five or six times the oxygen transmissibility of traditional soft contact lenses. I tell them the result will be less "wear and tear" on their eyes.

My silicone hydrogel lens of choice for daily or extended wear received FDA approval for up to six nights extended wear. I am also reassured by the higher oxygen transmissibility of the contact lens.

A balmy future in sight

I estimate that I am now fitting approximately 90% of spherical lens patients with silicone hydrogels. As more silicone hydrogels become available, I hope to eliminate the HEMA-based, two-week replacement lenses entirely from my practice. I eagerly anticipate the launch of toric silicone hydrogels, which may revitalize that part of my contact lens practice.

This is an exciting time for contact lens wearers. The manufacturers have "cracked the code" on how to make a lens more breathable, which is a huge leap forward in healthy lens wear.

I would estimate that last year silicone hydrogels increased my soft lens materials revenue by at least 20%. And because I know silicone hydrogel lenses are better for patients, I'm doing them a favor by recommending them. I encourage you to restore your tired contact lens practices with silicone hydrogel lenses. OM

More to Come

Our coverage of silicone hydrogel contact lenses continues in our February 2006 issue with an in-depth discussion on two-week replacement lenses.

 

Dr. Shearer has been in his self-started private practice since 1987, and is a proud member of the American Optometric Association. He is also a member and past president of the Northeast Florida Optometric Society.