THE EMMETROPIC EXPERIENCE
HOW TO BETTER EDUCATE PATIENTS ABOUT THE OVERNIGHT WEAR EXPERIENCE
Heather Webster, O.D.
“EVERY PATIENT deserves an emmetropic experience…” Words from a colleague from Norway, a country that leads the world in prescribing contact lenses for extended wear,1 that made me stop and think about prescribing extended wear in a different light.
I am always evaluating the risk profile of what I prescribe. We know there are risks associated with both refractive surgery and sleeping in contact lenses* — rare ones like permanent vision loss with surgical procedures and microbial keratitis (MK) with contact lenses, as well as more common ones like corneal inflammatory events (CIE). And I know that I am well trained and equipped to handle these rare occurrences in my practice, the contact lens-related complications in particular.
But this statement made me think about the patient’s real need, and I wondered whether I could engage in a more productive dialogue with my patients who want the option of sleeping in their contact lenses by better understanding their point of view, instead of approaching it solely from a risk perspective. So I looked into just how prevalent this need is and what is behind it.
THE NEED
The Global Strategic Insights (GSI) team at Johnson & Johnson Vision Care, Inc., had some interesting things to share from their research. I was reassured to see that vision and health are still at the top of the list for patients, along with comfort. This reminds me that there is still an opportunity to educate about what’s important to me, knowing it’s also important to them.
The second reassuring thing was that the percentage of people seeking the convenience of extended wear was actually small, around 15% of the 3,500 people surveyed, but their need was quite strong. These are not just the “poke-a-phobes,” those people who don’t like putting anything in their eye, but people with a genuine need for “always on” vision – people like emergency workers, medical residents, young parents – who have a frequent and unexpected need to be immediately ready to deal with life at odd hours. Practicing in a town that is medically driven, I see these patients often, and they deserve to have their needs met just as much as a contact lens patient who is able to utilize daily disposable lenses. What this taught me is to probe a bit deeper about my patients’ lifestyles, and to consider offering this option to my patients with these emergent needs, at least for that period of their life, provided they understood all the risks and alternatives.
One great tool that has recently been made available through a partnership with the American Optometric Association (AOA) Contact Lens Section and Johnson & Johnson Vision Care, Inc. is a guide to Healthy Vision and Contact Lenses, available on the AOA website. This guide helps doctors and staff members walk the patient through the important steps of informed choice, and helpful Do’s and Don’ts of contact lens wear — for all types of wear, not just extended wear. OM
Spotlight on Science
Overnight Wear
As we all know, overnight wear of contact lenses is not without risk. In consulting with Dr. Robin Chalmers, a leader of several important multi-site clinical investigations regarding risks and management of contact lens-related complications, she shows us that while we can’t eliminate the risks, we can do a lot to better manage them. (See “Tips for Optimizing the Overnight Wear Experience,” below.)
A 2010 retrospective review of risk factors for contact lens complications found that being under age 25 put the patient at a 2.6 times higher risk for CIEs compared to patients over that age. In addition, having a high prescription (over plus or minus 5 diopters) put the patient at a 1.5 times higher risk for presenting with any kind of an adverse event, and a 1.9X risk for infectious complications such as conjunctivitis.2
The high refractive error doesn’t cause the event, but “It just makes the patient more dependent on their contact lenses, so they might tough it out and allow it to get worse before they take their lenses out and go seek care,” says Dr. Chalmers.
A second study arising out of the Contact Lenses Assessment in Youth (CLAY) study3 reinforced the risk of younger age (peak risk between 15 and 25 years), and also showed increase risks for CIEs with the use of multipurpose solutions (2.86X), silicone hydrogel materials (1.85X) and extended wear (2.37X). Limiting the use of solutions by selecting a lens replacement frequency that allows the patient to throw every lens away immediately on removal is key.
The third piece of evidence comes from a retrospective, multicenter case-control study at five academic eye care centers involving more than 50 soft contact lens brands and more than 10 lens care products.4
This study again confirmed the risk of younger age, with each year older resulting in a 5% decreased risk of CIE (0.95X risk), and described the CIE risk of reusing lenses (4X).
These important studies don’t tell us NOT to prescribe extended wear, but help us tell our patients WHY we make decisions and recommendations.
Tips for Optimizing the Overnight Wear Experience
Avoid higher-risk patients (non-modifiable factors)
• Lid or ocular surface disease
• Younger patients (15-25)
• High prescriptions (over +/- 5D)
Educate (modifiable factors)
• Put everything in writing
- Healthy Vision and Contact Lenses guide from the AOA
• Reinforce at EVERY follow-up visit
- Ask them to say AND do
• Avoid lens reuse & storage in cases
- Six night and 30 night options available
• Make sure patients know to seek care IMMEDIATELY in the event of a problem
- Red or painful eye
- Changes in vision
REFERENCES
1. Efron N, M. P. (2012). International Survey of Contact Lens Prescribing for Extended Wear. Optom Vis Sci, 122-129.
2. Chalmers R, K. L. (2010). Risk Factors for Contact Lens Complicaitons in US Clinical Practices. Optom Vis Sci, 725-735.
3. Chalmers R, W. H. (2011). Age and other risk factors for corneal infiltrates and inflammatory events in young soft contact lens wearers from the Contact Lens Assessment in Youth (CLAY) study. Cornea, 6690-6695.
4. Chalmers R, K. L. (2012). Multicenter Case-Control Study of the role of Lens Materials and Care Products on the Development of Corneal Infiltrates. Optom Vis Sci, 316-325.
*ACUVUE OASYS® Brand Contact Lenses are indicated for vision correction for daily wear (worn while awake) or extended wear (worn while awake and asleep for up to 6 nights/7 days). Relevant Warnings: Patients should be cautioned that proper use and care of contact lenses are essential for the safe use of these products. Serious eye problems, including corneal ulcers, can develop rapidly and in rare cases lead to loss of vision. The risk of serious problems is greater for extended wear vs. daily wear and smoking increases this risk. Patients should be instructed not to expose contact lenses to water while wearing them, due to the risk of infection, and to discard and replace them if they are submersed in water during wear. Side Effects: Potential side effects include infiltrative keratitis; other less serious side effects include irritation, dryness, itching, or discomfort. Relevant Precautions: Patients should be instructed to immediately remove their lenses and promptly contact their eye care professional if they experience any problems. Contraindications: Lenses should not be prescribed for routine vision correction if patients have any eye infection, eye disease, inflammation, systemic disease that may be affected by or impact lens wear, severe dry eye, certain allergic conditions, use certain medications (ex. some eye medications), experience eye discomfort, excessive tearing, redness, reduced corneal sensitivity or other eye problems. Additional Information: It is recommended that the contact lens wearer first be evaluated on a daily wear schedule. If successful, then a gradual introduction of extended wear can be followed. Consult the package insert for complete information, or contact VISTAKON® Division of Johnson & Johnson Vision Care, Inc., by calling 1-800-843-2020 or by visiting www.acuvueprofessional.com.
See page 4 for more important prescribing information.
| HEATHER WEBSTER, O.D., is in private practice at InVision Eye Care Center in Columbia, Mo. She received compensation from Johnson & Johnson Vision Care, Inc., for her time in writing this article. Visit tinyurl.com/OMcomment to comment on this article. |
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