CONTINUING EDUCATION, 1 CE Credit – $9.99, 1 Hour, General Knowledge, Level 1, Release date: October 2007, Expiration date: October 31, 2012

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CONTACT LENS CORNER

1 Day Soft Contact Lenses,
Spheres and Torics - 2012

The world of soft contact lenses has changed very quickly over the past 10 years. As the world of plastic technology improves and changes, so has the availability of newer contact lens materials. 

Soft contact lens plastics have been available in low water, nonionic polymers, high water, nonionic polymers, low water, ionic polymers, and high water, ionic polymers. These 4 groups were created by the FDA to clarify the categories of similar polymers for investigating solutions. The newest, 5th group of silicone hydrogel soft lenses are providing a new material that is providing higher oxygen permeability and more comfort to a majority of patients who are new fits or who are being refit with contact lenses. These lenses also provide improved UV protection.

Soft lenses were first available for a patient to use 1 pair that would be used for 1 year. Sleeping with these lenses was never a consideration. Other lenses that followed included the new VUE and Focus lenses that were manufactured by CIBA VISION (now Alcon). These and other lenses changed the contact lens market because soft lenses were now being mass-produced, they were available in plastic packets, and companies were promoting the safety and benefits of sleeping in contact lenses. More companies followed with other soft lenses and the times that were recommended for sleeping in soft contact lenses varied from 1 week, 2 weeks, monthly, and quarterly.

Sleeping in contact lenses became a great marketing tool for the various companies. There were some benefits in sleeping in contact lenses. Solutions were not required as often reducing the cost to consumers. The handling of contact lenses became less, reducing the possibility of infections. But there were other problems. There was considerable confusion among the public and among ECPs concerning how long patients should be sleeping in their contact lenses. Patients, who had been told to use their soft contact lenses for 2 weeks, were now using them for 1 month or longer. Patients wanted to reduce the costs of buying more contact lenses by using them for longer and longer times. Many patients still believe that there are no risks to this "overwear" problem.

The problem of patient compliance to a wearing schedule that was dictated by the FDA, the manufacturer, and by the ECP was becoming significant. In a paper published in 1996 by Dr. E. Goodlaw in the Journal of Optometry and Vision Science, the problem of sleeping in soft contact lenses was described:

"Although the risks associated with extended wear contact lenses are well known, there has not been an adequate explanation of why sleeping with the lenses increases the risk of infection. It is contended that the reduction in the available oxygen caused by contact lenses does not in itself explain the high rate of corneal infection caused by wearing the lenses while sleeping. The results of patient studies show that the risk of ocular infections, particularly corneal ulcers, is substantially increased with overnight wear of lenses. A review of the role of oxygen deprivation, atmospheric pollution, bacterial survival, infection-resistant defenses, and patterns of sleep indicates that oxygen deprivation is not the only factor in increased risk associated with wearing lenses while sleeping. It is suggested that the combination of the introduction of airborne pollutants to the contact lens during the day, the reduced oxygen transmission through the contact lenses and closed eyelids, and the lack of eye and eyelid movement during sleep create the conditions in which bacterial infection is most likely to occur."

The 1 day disposable soft contact lens may offer ECPs a way to reduce the risks of "overwear"  and the hope to eliminate corneal infections. These lenses are to be used for 1 day only while awake, and then discarded. The need to use solutions which creates an added cost is eliminated. Handling lenses is now eliminated with the possibility of contamination with unclean hands and/or surfaces. Using contact lens cases is now unnecessary and they have always been a potential source for contamination and infection. The opportunity to use a 1 day disposable lens on an occasional or social basis can now be offered. The softball player who may have -0.50 Diopter of uncorrected myopia may find that using this type of lens may reduce the errors in the outfield. The seasonal allergy sufferer may also find this type of lens more beneficial for occasional usage or even during their allergy season. In a study by Dr. V.Y. Hayes, Dr. C.M. Schnider, and Dr. J. Veys published in the Journal Contact Lens and the Anterior Eye in 2003, "of 128 allergy-suffering patients, 67% agreed that 1 day disposable contact lenses improved comfort when compared to the lenses that they were wearing prior to the study."

If you have patients that may have solution sensitivities, patients that do not want to put rewetting drops in their eyes, patients that have hygiene issues, patients that have allergies, patients that have been unsuccessful with weekly, 2 week, or monthly lenses, patients that have vision need for occasional use, social occasions, or for hobbies, patients that have excess protein buildup, or you have a specific patient that is not compliant, then the following companies are now selling 1 day soft contact lenses and 1 day toric lenses:

Alcon Vision Care (formerly CIBA) sells the Dailies Aqua Comfort Plus with a base curve of 8.7 and a diameter of 14.0 mm. They also have the Focus Dailies with a base curve of 8.6 and a diameter of 13.8 mm. Bausch and Lomb has the Soflens Daily Disposable with a base curve of 8.6 and a diameter of 14.2 mm. Clearlab provides the Eyedia Fresh Daily Disposable with a base curve of 8.6 or 8.7 and a diameter of 14.0 mm. Cooper Vision sells the Proclear 1 day with a base curve of 8.7 and a diameter of 14.2 mm. Preferred Vision Group sells the Preferred Dailies with a base curve of 8.6 and a diameter of 14.0 mm. Vistakon sells the 1 day Acuvue Trueye with UV blocking. This lens has a base curve of 8.5 and a diameter of 14.2 mm. They also have the 1 Day Acuvue with base curves of 8.5 or 9.0 and a diameter of 14.2 mm and the 1 Day Acuvue Moist with base curves of 8.5 or 9.0 and a diameter of 14.2 mm. Orion Vision Group has the Day Star 1 Day Aspheric with a base curve of 8.6 and a diameter of 14.2 mm. Safigel sells the Safigel 1 Day with a base curve of 8.6 and a diameter of 14.1 mm. Toric 1 Day lenses are available from Cooper Vision-the Clearsight 1 day toric, base curve 8.7, 14.5 mm diameter, Vistakon-the 1 day Acuvue Moist for Astigmatism, base curve 8.5, 14.5 mm diameter, and Bausch and Lomb-the Soflens Daily Disposable for Astigmatism, base curve 8.6, diameter 14.2 mm.

There should be no reason that any patient cannot be fit with a soft contact lens or a soft toric contact lens. Many patients who do have problems with their comfort have a fitting problem. If the fit is not exact then vision will be compromised and a patient will not be happy. There are certainly patients who have comfort problems based on dryness, protein buildup, or allergies and there are lenses available that can satisfy these patients. Some patients may feel more comfortable in the newer silicone hydrogel lenses. The soft lens must be centered symmetrically over the cornea and move freely on the bulbar conjunctiva. There must be adequate movement when blinking in order to allow oxygen and tears to continue to nourish the cornea. The various base curves and diameters that are listed allow the ECP to choose from different base curves and diameters which will affect the fit, the comfort level, and the visual acuity of a patient.

If a lens appears to be too tight, the base curve should be flattened or reduced. Going from a base curve of 8.5 to 8.6 may improve this problem. The ECP can also reduce the diameter of the lens to improve the tight fit or the lack of movement such as changing the diameter of 14.2 mm to 14.0 mm. If a lens is too loose and moves excessively, the ECP can steepen the base curve such as changing the base curve from an 8.6 to an 8.5 or increase the diameter from 14.0 mm to 14.2 mm. Fitting parameters vary widely for every patient and there are always exceptions to every rule. If dailies do not fit correctly, there are many more options available including weekly, 2 week, monthly, and quarterly replacement soft contact lenses. The other factors that need to be evaluated include the material, the water content, the optical zone, the center thickness, the disinfection method, the Dk value, and the cost.

Every contact lens company has trial contact lenses available for patients to try. An instructional lesson should be part of any fitting process which involves insertion, removal, care, and education about soft contact lenses. ECPs should check and recheck their patients after a week or two to be certain that the lenses prescribed are perfect for the patient's needs and uses. And by Federal law, the prescription must be provided to the patient. A disclosure form should be signed by the patient indicating the time and use of their particular lens as well as which solutions were provided. Following these and other guidelines that are appropriate to each ECP will result in a happy patient that returns annually and will result in new patients calling you for your expertise.

Jason Smith
OD, MS

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