CLINICAL

  CONTACT LENSES

CONTACT LENS QUESTIONS

ADDRESSING BENEFITS AND CHALLENGES IN THE PRACTICE

JASON R. MILLER, O.D., M.B.A., F.A.A.O.

Q: WHAT ARE THE SIGNS AND SYMPTOMS OF COMPLICATIONS ASSOCIATED WITH SILICONE HYDROGEL (SIHY) CONTACT LENSES?

A: First, all contact lenses have their benefits and challenges. Anytime a contact lens is placed on the eye, the possibility of a complication exists, regardless of the lens’ material or design.

The complications associated with SiHy wear are:

1. Corneal inflammatory events. These events primarily are the result of mechanical irritation from the stiff SiHy material. The primary signs include small corneal sub-epithelial infiltrates. Symptoms are photophobia and contact lens intolerance.

2. Mucin balls. Due to the stiffness of SiHy material, the degree of mucin ball formation on the cornea can increase, according to an April 2003 study in “Optometry and Vision Sciences.” This mechanical complication can affect vision if it occurs centrally, but can also be transient.

Infiltrative keratitis and limbal injection with a SiHy contact lens.

3. Lipid deposits. Due to the nature of the silicone hydrogel material, lipid deposition is more common with SiHy lenses, according to a February 2006 article in Contact Lens Spectrum. The signs are biofilm formation. Symptoms are complaints of discomfort and blur.

Q: HOW DO YOU EFFECTIVELY MAKE THE CASE WITH PATIENTS FOR DAILY DISPOSABLE LENSES?

A: Similar to the case you would make for any lens, once you identify the patient as a candidate, there are three ways to accomplish this:

1. Believe in the product. There is very little selling if you believe in the product. For example, if you and your staff wear daily disposables, that belief exists. Share your experiences with patients: “I regularly wear a daily disposable lens, as does our staff.”

2. Break down barriers. Address the issues. If some patients struggle with the idea of throwing away their contact lenses, reply, “I know this idea sounds foreign, but daily disposable lenses are designed for your convenience and potential benefits to your ocular health.” Address any price concerns upfront: “When you factor in costs for other needs, such as cleaning solutions for reusable lenses, the annual costs of daily disposables are comparable to that of reusable lenses.”

3. Make the recommendation. “You are a great candidate for contact lenses, and I recommend daily disposable lenses because…” This could be ocular allergies, prescription, recurrent complications with another lens modality or another cause. Provide a reason so that the patient understands the necessity.

Q: WILL DAILY DISPOSABLES BECOME THE MODALITY OF CHOICE?

A: Manufacturers are bringing to market new lens designs in this modality, which is a good fit for many patients. Rather than predict, it can be said that with all the designs and materials available, O.D.s now have a greater opportunity than ever before to fit the lens that best meets the patient’s needs for lifestyle, ocular health and vision correction. OM

Questions are based on reader responses to an Optometric Management online survey, which closed on Dec. 20.

DR. MILLER is a partner at Eyecare Professionals of Powell, in Powell, Ohio, on the board of the Ohio Optometric Association and is an adjunct faculty member for The Ohio State University College of Optometry. To comment on this article, visit tinyurl.com/OMcomment.