LENS PERFORMANCE IN THE REAL WORLD

WHAT CAN YOU DO TO IMPROVE YOUR CONTACT LENS PATIENTS’ QUALITY OF LIFE?

Keith Smithson, O.D.

AN IMPORTANT principle in my practice is that I want patients to have advanced contact lens technology that meets their needs. But getting to that point is about more than the lenses themselves; it’s about what I can do, related to my patients’ eyes, to improve their life.

It requires that I know something about my patients — about how and where they spend their time and what their challenges are. It’s one thing to hang out with your family on a lazy Sunday after a good night’s rest; it’s quite another to get up early, spend 8 to 10 hours staring at a computer screen, go for a jog outside after work, and then spend some more time on a laptop or tablet in the evening. Demanding days like these are the norm for most of our patients, and they are tough on contact lens wear.

Think about it: We are asking that small piece of plastic to sustain great performance (both comfort and vision) across lots of different settings and activities, including heavy use of digital devices. It’s probably no surprise that even good contact lens materials sometimes fail to meet that standard.

A recent study suggests that almost 60% of contact lens wearers experience declining performance during the day, with vision, comfort and satisfaction going down as feelings of dryness and tiredness increase (Figure 1).¹ What’s more, the pattern of decline isn’t always steadily downward, but can fluctuate from one hour to the next. This is confusing to patients, who may not associate their inconsistent vision or comfort with particular settings or activities. And it matters a great deal. The more patients struggle in some situations, the more likely they are to shorten the number of hours of contact lens wear or temporarily discontinue lenses, potentially leading to dropout.^2,3

Figure 1.

I recently had a chance to participate, along with several colleagues from across the country, in a consumer preference study of the new lens, ACUVUE OASYS Brand Contact Lenses 1-Day with HydraLuxe Technology.

With these lenses, Johnson & Johnson Vision Care, Inc., has taken the proven senofilcon A material, enhanced it with HydraLuxe Technology, and made it available as a daily disposable lens, with the goal of providing more consistent performance for demanding days.

We sat down as a group to discuss our initial clinical impressions and how to incorporate this lens — or any new contact lens technology — into one’s practice.

Roundtable Participants

Keith Smithson, O.D.
(Moderator)

Monica Brown, O.D.

April Jasper, O.D.

Jeffrey Sonsino, O.D.

UNCOVERING PATIENT NEEDS

Q: HOW DO YOU DECIDE WHICH CONTACT LENS TO PRESCRIBE FOR A PATIENT?

Monica Brown, OD: I like to ask the question, “Do you like, love or hate your current contacts?” If the answer is “like,” then I know I’ve got some room to improve to turn that into a “love.” One of the insights leading into this study was that patients often use different language than we do to describe symptoms. For example, the term “tired eyes” is commonly used to describe what we as clinicians would call dryness (Figure 2). Recognizing and addressing that complaint — and linking its cause to patients’ eye physiology or lifestyle — is one way to turn the wearing experience around.

Figure 2.

April Jasper, OD: I ask similar questions. What I’m really looking for is an opportunity to help move patients into the best technology available to provide them with good vision for a lifetime and the best performance based on their individual needs and eye physiology. But to do that, you have to really get to their needs and what they want from their contact lenses. That information helps me find a trigger for change around which to frame the conversation.

For example, if a patient has just started training for an Ironman triathlon, I can help her maximize comfort, vision and health for long hours outside in the sun and wind. Or, if someone comes in wearing scrubs and I know he works at the hospital down the street, I can talk about how discarding the accumulation of bacteria and chemicals on the lens each day might be the best option for someone in a health care profession. Those are the kind of conversations that make our recommendations real and personal to patients. Ultimately, we are in the business of solving for our patients’ needs.

Jeffrey Sonsino, OD: I agree. My goal is to have the patient come to the conclusion that he or she needs to be in something else, even if it’s just for certain situations. If I let a patient try a new lens technology, like ACUVUE OASYS Brand 1-Day, that patient walks out of the exam thinking, “Wow, he gave me something that I didn’t even think about before.” That’s how you personalize it to the patient. You look at the individual patient’s needs and prescribe not just a modality, but the best combination of modality, wetting properties, deposit resistance and other characteristics that best meet those needs.

Dr. Brown: I think that ACUVUE OASYS Brand 1-Day is going to be a great lens for new wearers. We can expect that new lens wearers will be heavily into digital technology, so this is a lens that will help support their tear film for the kind of lifestyle they lead. Plus, it launches them into contact lens wear with a really healthy modality and great comfort.

FIRST IMPRESSIONS

Q: IN THE CONSUMER PREFERENCE STUDY, EACH OF US RE-FIT ABOUT 15 ESTABLISHED SOFT CONTACT LENS WEARERS FROM THEIR HABITUAL LENSES INTO ACUVUE OASYS BRAND 1-DAY. WHAT KIND OF RESPONSE DID YOU GET FROM PATIENTS?

Dr. Sonsino: Thirteen of the 15 patients from our practice were unequivocal in saying they wanted to purchase these lenses after the study, which I thought was phenomenal, especially given that they weren’t necessarily unhappy to start with.

My anecdotal impression is that their experience in ACUVUE OASYS 1-Day was more than an incremental improvement in satisfaction. Given that some of these patients were already in daily disposable lenses, what this really drives home for me is that there are real, tangible differences even among daily disposable lenses.

Dr. Brown: There was an undeniable ‘wow’ factor. I had one patient say that he thought his previous lenses were fine, but he could wear the ACUVUE OASYS 1-Day Lenses for an extra two hours in the evening. Another patient who traveled a lot on business noted that she was able to get off the plane without changing her lenses. Those might seem like small improvements, but they were moments that mattered to the patients.

Dr. Jasper: I’m impressed by what I know about the science, but for me that’s just a reason to try a new lens. The proof is really in how patients experience their vision and comfort and what I’ve seen so far is that end-of-day comfort is excellent. I think this is going to be a great lens for patients with the demanding days you were talking about.

Q: WHAT DOES IT MEAN TO YOU TO HAVE A CHOICE OF MODALITIES (2-WEEK DAILY WEAR, 1-WEEK EXTENDED WEAR AND DAILY DISPOSABLE) IN THE ACUVUE OASYS BRAND?

Dr. Brown: There’s a trust factor behind ACUVUE OASYS because it’s a brand that so many patients have worn successfully. There have been times when I wanted to move an ACUVUE OASYS patient into a daily disposable lens for health and convenience reasons, but I just wasn’t able to match the performance in a different brand. Having a daily disposable option in the ACUVUE OASYS family is going to help me meet their comfort needs.

Dr. Smithson: You’re right. In the past, we would sometimes get to that fork in the road where we had to choose between a great material and what we feel is the healthiest way to wear lenses.

Patients will tell me, “I like that it’s fresh and new every day, but it didn’t feel like my eyes were quite as refreshed at the end of the day.” So I’m excited that these new lenses can provide the benefits of daily disposability and still offer the utmost in performance.

GETTING TECH-SAVVY

Q: THE MOST UNIQUE ASPECT OF THIS STUDY WAS THAT WE ASKED PATIENTS TO RECORD HOW THEIR LENSES FELT IN “REAL TIME.” A SUBSET WERE EVEN GIVEN AN APPLE IWATCH TO USE FOR THE DURATION OF THE STUDY. THE WATCH PROMPTED THEM TO ENTER COMFORT AND VISION RATINGS AS WELL AS THEIR ENVIRONMENT AND ACTIVITY LEVEL EVERY HOUR. WHAT DID YOU THINK ABOUT THIS METHODOLOGY?

Dr. Jasper: The patients absolutely loved it! The watch prompts helped them to be aware of the lens in more settings and at more times of the day. I think we got more honest answers than we would have otherwise.

Dr. Sonsino: One of the things I learned was that patients aren’t really paying attention to dryness. During a contact lens exam, when I ask, “Do you have dryness at the end of the day?” patients typically say, “no.” But after going through this assessment and answering questions every 2 hours on a self-directed questionnaire many said, “You know what? I actually do have a problem. I wasn’t thinking about it, but once I was forced to answer it every 2 hours, I realized that, yes, it is a problem.”

Dr. Smithson: Hour-by-hour and minute-by-minute data collection is common in the professional sports world. Everything from oxygen levels to speed to calorie burn can be measured in detail to determine how technologies affect athletes’ performance. Do you think there are applications for us to use wearable technology in a contact lens practice beyond this study?

Dr. Sonsino: Personalized care is the future of medicine — and that includes optometry. What would be great is to carry the experience of self-directed questionnaires forward more routinely with our contact lens patients, so that we had more data on comfort and wearing experience prior to an exam. That would give us so much more insight than a three-minute history questionnaire.

At the end of the day, anything that allows us to have a better dialogue with patients will help us better identify and address their specific needs. For so many patients, I think ACUVUE OASYS Brand 1-Day is going to meet those needs, especially for patients with the feeling of tired eyes throughout the day. OM

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