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HomemieyecareThinking Outside the Box, and Inside the Drops

Thinking Outside the Box, and Inside the Drops

Proactive management of your contact lens customers will help to achieve wearer comfort, keep them satisfied and coming back for more.

Optometry is a competitive marketplace and certainly not an environment in which to be complacent. There is an ever-present threat that our contact lens patients will continue to drift towards online purchases and we could lose them to the internet. If we can’t wow our patients with a service that the internet can’t provide, then it
seems reasonable that they take their business elsewhere.

The question is what, as optometrists, are we prepared to do about it? Surrendering is certainly an option, but is giving up on contact lenses in the best interests of our patients?

My practice, Custom Eye Care Newcastle, has a heavy contact lens focus: We continue to expose new wearers to the world of contact lenses, work hard to ensure a positive experience for our patients and provide that important ‘wow’ factor.

‚Ķtypically we would prescribe lubricants to symptomatic patients but have you ever wondered how many of our patients don’t make it back into our practices

Asking the more detailed and sometimes tough questions relating to lens wear at each aftercare visit helps uncover any issues. Addressing any concerns presents an opportunity to refit existing wearers
to the best and latest lenses, and to support them in a successful contact lens wearing experience.

Despite all of the advances in technology, and the immense time and funding which continues to be invested by our industry, contact lens drop-out rates remain an issue.1 Unfortunately, patients continue to cease wearing lenses at similar rates to those reported in the 1990s.2,3 Recent studies reveal the contact lens dropout rate is estimated to be at least 16 per cent,4 and as high as 31 per cent in other countries.5,3,6 So one out of every six patients fitted with contact lenses will cease wearing their lenses, with dryness and discomfort being the most reported explanations.5

In 2007 The Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) found that up to 50 per cent of contact lenses wearers reported discomfort with their lenses.3,6,7 Considering lifestyle is the main reason that patients decide to wear contact lenses, it’s disappointing to think that dryness and discomfort forces many to revert back to glasses.

Challenge the Status Quo

Do we need to accept that dryness and discomfort with contact lens wear is inevitable? Why not challenge the status quo?

Acknowledging that not all optometrists enjoy fitting contact lenses as much as I do, maybe it’s time to reconsider the way we approach our contact lens prescribing. After all, it’s optometrists that are experts at contact lens fitting. Our patients expect us to inform them about the benefits of contact lenses. They want us to make recommendations based on their individual needs, which set them up for success.

Imagine the potential! We could breed a loyal community of happy contact lens wearers. End of day discomfort could be reduced as we’ve made the conscious decision to support our patients and prevent a bad experience.

There is so much potential when optometrists are proactively discussing contact lenses. Why not proactively address any possible contact lens discomfort issues too? Using eye-drops to reduce dryness and discomfort is a great way to support our patients. This comfort regimen applies to all new and existing contact lens wearers.

Christine Sindt, one of my optometry idols from the University of Iowa, and Reid Longmuir published a paper titled ‘Contact Lens Strategies for the Patient with Dry Eye’.8 Their study demonstrated that increased lubrication was the recommended approach for all patients with task related dryness symptoms (either from the environment or computer use) and end of day discomfort (simply from wearing contact lenses all day).8

You don’t have to be a dry eye sufferer to experience discomfort with contact lenses. The act of simply applying a contact lens may split the tear film and compromise it. So, even a patient with a healthy tear film will experience a faster tear film break up time simply by applying a contact lens.9 This reduced tear breakup time is associated with decreased lens wear comfort in both hydrogel and silicone hydrogel soft contact lenses.5

Studies show the average contact lens wearer has a tear breakup time of four seconds but the average patient inter-blink interval is seven seconds.10 If we blink every seven seconds, that leaves the contact lens surface exposed to the atmosphere for the last three seconds before we next blink.10 Add to the mix environmental factors, which can further exacerbate dry eye symptoms in contact lens wearers. Many of our patients are regular computer users, which can decrease blink rate by up to 60 per cent and can extend the inter-blink interval up to 12 seconds.11

A healthy ocular surface and stable tear film are key factors for successful contact lens wear, especially when you consider that dryness and discomfort are the main reasons for contact lens dropouts. This is where a proactive approach to address dryness and discomfort can be invaluable to a patient’s long-term success.

A ‘comfort regimen’ is a new way of thinking about prescribing eye-drops with the aim to thicken and stabilise the tear film, and moisten and hydrate the contact lens.12 Alcon has designed a regimen to match the needs of patients and has extended the Opti-Free® range which is already in the market to include a lubricant and re-wetting drop specific for contact lens wearers.

Opti-Free® Pro® Moisturising Lens Drops are formulated to moisten and hydrate contact lenses during lens wear. Once instilled the Opti-Free Pro moisturising lens drops form a cushion that minimises friction between the lens and eye, and lens and eyelid, to support more comfortable lens wear.13

Opti-Free Pro lubricating eye drops are a lipid based formulation which has been shown to increase the lipid layer thickness and improve tear break up time.15 By instilling the eye drops prior to contact lens application, patients have a more stable tear film and a reduction in dry eye symptoms.14

Opti-Free Pro lubricating eye drops are designed for use morning and night, before and after contact lens wear and Opti-Free Pro moisturising lens drops are designed for use with contact lenses throughout the day.14

One of my favourite things about these products is that the instructions on the box, and inside the packaging, are specific for contact lenses wearers rather than dry eye sufferers. I would prefer my contact lens patients to not feel like they have dry eye disease. Instead I want them to feel like it’s normal and perfectly acceptable to use moisturising and lubricating drops with their contact lenses. An added advantage is that now our staff only have to know the difference between the two eye drops in the Opti-Free range for contact lens patients, which makes dispensing eye drops much easier.

Don’t Wait Until the Patient Doesn’t Come Back

Traditionally, contact lens discomfort was a topic of discussion at our aftercare visits. I know typically we would prescribe lubricants to symptomatic patients but have you ever wondered how many of our patients don’t make it back into our practices? What if they dropped out of lens wear due to dryness and discomfort and therefore never returned for their first annual aftercare?

A wise colleague once told me he believed that when patients find their lenses uncomfortable they don’t blame the product. Instead they blame the practitioner and think we didn’t prescribe or fit their contact lenses correctly. If they never make it back to our practices, we don’t get the opportunity to address their discomfort.

Should we be waiting until our patients come back complaining anyway? Prescribing a comfort regimen could avoid the dryness and end of day comfort problems from the outset and avoid a negative wearer experience altogether.

Being proactive, offering our patients the right advice, predicting their needs, and arming them with the right tools for success can improve your patient’s contact lens wearing experience. After all, the main reason to continue to improve our patients’ wearing experience is to keep our patients happy and returning to our practices for their ongoing contact lens care and supply.

Heidi Hunter is an optometrist and co-owner at Custom Eye Care Newcastle, an independent behavioural and specialty contact lens practice in Newcastle West. The practice is a placement partner with Flinders University Optometry students and covers a variety of contact lens options. Heidi is a Clinical Supervisor at UNSW, a NSW board member for the Cornea and Contact Lens Society of Australia (CCLSA). Recently, Heidi has written for OAA Contact Lens magazine and mivision, appeared on ABC radio, and been an advisory member for the OAA Competency Standards Committee.

This article was sponsored by Alcon.

References

1. Schlanger JL. A study of contact lens failures. J Am Optom Assoc. 1993 Mar;64(3):220–4.

2. Pritchard N, Nicola P, Desmond F, Daniel B. Discontinuation of contact lens wear: a survey. Int Contact Lens Clin. 1999;26(6):157–62.

3. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. 2002 Nov;22(6):516–27.

4. Rumpakis K. New data on contact lens dropouts: An international perspective. Rev Optom. 2010;147(1):37–42.

5. Dumbleton K, Kathy D, Woods CA, Jones LW, Desmond F. The Impact of Contemporary Contact Lenses on Contact Lens Discontinuation. Eye & Contact Lens: Science & Clinical Practice. 2013;39(1):92–8.

6. Richdale K, Kathryn R, Sinnott LT, Elisa S, Nichols JJ. Frequency of and Factors Associated With Contact Lens Dissatisfaction and Discontinuation. Cornea. 2007;26(2):168–74.

7. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007 Apr;5(2):75–92.

8. Sindt CW, Longmuir RA. Contact lens strategies for the patient with dry eye. Ocul Surf. 2007 Oct;5(4):294–307.

9. Rohit A, Willcox M, Stapleton F. Tear lipid layer and contact lens comfort: a review. Eye Contact Lens. 2013 May;39(3):247–53.

10. Arthur B. Epstein, O.D., F.A.A.O., and Ralph Stone. Review of Cornea and Contact Lenses > Surface and Polymer Chemistry: the Quest for Comfort [Internet].[cited 2016 Jan 1]. Available from: www.reviewofcontactlenses.com/content/c/20136/dnnprintmode/true/?skinsrc=%5Bl%5Dskins/rccl2010/pageprint&containersrc=%5Bl%5Dcontainers/rccl2010/simple.

11. Abelson R, Lane KJ, Angjeli E, Johnston P, Ousler G, Montgomery D. Measurement of ocular surface protection under natural blink conditions. Clin Ophthalmol. 2011 Sep 22;5:1349–57.

12. Scaffidi RC, Korb DR. Comparison of the Efficacy of Two Lipid Emulsion Eyedrops in Increasing Tear Film Lipid Layer Thickness. Eye & Contact Lens: Science & Clinical Practice. 2007;33(1):38–44.

13. Alcon Data on file, Opti-free Pro Moisturising Lens Drops packaging insert.

14. Alcon Data on file, Opti-free Pro Lubricating Eye Drops packaging insert.

15. Korb D et al. Evaluation of extended tear stability by two emulsion based artificial tears. Proceedings of the 6th International Conference on the Tear Film and Ocular Surface: Basic Science and Clinical Relevance Taer Film and Ocular Surface Society Meeting. Florence, Italy. September 22-25, 2010.

NP4 Number # :A21601425304.

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